Predictive Factors of Intravesical Recurrence after Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma
Chen-Ya Chen1, Wen‐Jeng Wu1,3,5,Hsin‐Chih Yeh1,3,4,5, Hung-Lung Ke1,2,3,5,Wei-Ming Li1,2,6, Hsiang-Ying Lee1,2,3
1Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan 2Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 3Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan4Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan5Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 6Pingtung Hospital, Department of Health, Executive Yuan, Pingtung, Taiwan
Purpose: To evaluate predictor factors of increasing intravesical recurrence rate in patients with upper tract urothelial carcinoma (UTUC) after receiving radical nephroureterectomy (RNUx) with bladder cuff excision (BCE).
Materials and Methods: A total of 2,114 patients were divided into two groups: Intravesical recurrence (IVR)-free and IVR after RNUx, with 1,527 and 587 patients, respectively. To determine the factors affecting IVR, TNM stage, the usage of preoperative ureteroscopy, and pathological outcomes were evaluated. The Kaplan-Meier estimator was used to estimate the rates of prognostic outcomes in overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS), and the survival curves were compared using the stratified log-rank test.
Results: Based on our research, ureter tumor, female, smoking history, old age (>70 years old), multifocal tumor, history of bladder cancer were determined to increase the risk of IVR after univariate analysis. The multivariable analysis revealed female (BRFS for male: HR 0.566, 95% CI 0.469-0.681, p<0.001), ureter tumor (BRFS: HR 1.359, 95% CI 1.133-1.631, p=0.001), multifocal (BRFS: HR 1.200, 95% CI 1.001-1.439, p=0.049), history of bladder cancer (BRFS: HR 1.480, 95% CI 1.118-1.959, p=0.006) were the prognostic factor for IVR. Patients who ever received ureterorenoscopic biopsy did not increase the risk of IVR.
Conclusion: Patients with ureter tumor and previous bladder UC history are important factors to increase the risk of IVR after radical nephroureterctomy. More frequent follow-up regimen may be needed for these patients.