葉信志^1,2、李經家^1,2、黃俊農²、柯宏龍²、李威明²、吳文正²

¹高雄市立大同醫院 泌尿科；²高雄醫學大學附設中和紀念醫院 泌尿科

Hsin-Chih Yeh^1,2, Ching-Chia Li^1,2, Chun-Nung Huang², Hung-Lung Ke², Wei-Ming Li², Wen-Jeng Wu²

¹Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; ²Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

 

Purpose: We aimed to investigate the impact of preoperative hydronephrosis (HN) and flank pain on prognosis of patients with upper tract urothelial carcinoma (UTUC).

Materials and Methods: In total, 472 patients with UTUC managed by radical nephroureterectomy were included from Kaohsiung Medical University Hospital Healthcare System. Clinicopathological data were collected retrospectively for analysis. The significance of HN, especially when combined with flank pain, and other relevant factors on cancer-specific survival (CSS) and overall survival (OS) were evaluated.

Results: Of the 472 patients, 292 (62%) had preoperative HN and 121 (26%) presented with flank pain. Preoperative HN was significantly associated with age, flank pain, tumor location, and pathological tumor stage. Preoperative HN and flank pain were significant predictors of non-organ-confined (NOC) UTUC (p = 0.020 and 0.013, respectively). Kaplan-Meier analysis showed significantly poorer OS and CSS in patients with preoperative HN (p = 0.005 and p = 0.026, respectively) and in patients with flank pain (p < 0.001 and p = 0.001, respectively) than those without. However, only simultaneous HN and flank pain independently predicted adverse outcome (HR = 2.47, p < 0.001 for OS and HR = 2.28, p = 0.002 for CSS, respectively) in multivariate Cox proportional hazards models. Notably, there was no difference in survival between patients with HN but devoid of flank pain and those without HN.

Conclusions: Both preoperative HN and flank pain predicted NOC UTUC. When accompanied with flank pain, HN represented an independent predictor for worse outcome in patients with UTUC.