膿尿是否可以預測上尿路上皮癌膀胱復發？

黃子恆¹、羅浩倫¹

¹高雄長庚紀念醫院 外科部 泌尿科

Can pyuria predict Upper tract urothelial carcinoma bladder recurrence ?

Tzu-Heng Huang¹, Hao-Lun Luo¹

¹Division of Urology, Department of Surgery, Kaoshiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

Purpose:

The purpose of this study is to assess the prognostic impact of pre-operative pyuria in predicting bladder recurrence in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNUx).

Materials and Methods:

  A retrospective review was conducted on 636 patients who underwent RNUx from between January, 2008 to June 2023. Pre-operative pyuria was defined as >5 white blood cells (WBC) per high power field under a microscope. Clinicopathological variables were collected and analyzed. Kaplan-Meier survival plots were utilized to analyze metastasis free survival and bladder recurrence free survival. Univariate and multivariable analysis were performed to identify risk factors for bladder recurrences.

Results:

Out of the 636 patients, 379 (59.5%) were presented with pre-operative pyuria. The analysis revealed that pre-operative pyuria was associated with older age, higher grade UTUC, and increased rates of bladder recurrence. Kaplan-Meier survival plots indicated preoperative pyuria is significantly associated with 1-year and 5-y bladder recurrence in patients with pyuria. In addition, multivariable Cox regression analysis revealed that preoperative pyuria, concurrent bladder cancer, variant histology, multifocal tumor and male are independent risk factors predicting early bladder recurrence within 1 year.

Conclusion:

Preoperative pyuria can be considered as a predictive factor for early bladder recurrences in patients undergoing RNUx for UTUC. This study also provides prognostic value upon bladder recurrence that might help physicians establish adjuvant therapy and initiate early tumor surveillance strategies after RNUx for UTUC.