上泌尿道泌尿上皮癌在腎臟輸尿管切除術後對側復發的預後因子：大型跨區域研究

吳冠賢^1,2、錢祖明^1,2、李香瑩^1,2,3,4、Nirmish Singla⁵、Vitaly Margulis⁶、Yair Lotan⁶、Solomon Lukasz Woldu⁶、黃俊農^2,3,4、李經家^2,3、柯宏龍^2,3,4、李威明^2,3,7、李家揚^8,9、黃阿梅^1,9,10、楊曉芳^11,12、杜鴻賓¹³、吳文正^2,3,9、葉信志^2,3,4,9,*

¹高雄醫學大學 醫學院臨床醫學研究所，²附設醫院泌尿部，³醫學院醫學系泌尿科；⁴高雄市立大同醫院泌尿科；⁵約翰斯‧霍普金斯大學醫學院James Buchanan Brady Urological Institute泌尿腫瘤部；⁶德州大學西南醫學中心泌尿部；⁷衛生福利部屏東醫院泌尿科；⁸高雄醫學大學 附設醫院臨床醫學研究部，⁹醫學院醫學研究所，¹⁰醫學院醫學系生物化學科，¹¹附設醫院病理部，¹²醫學院醫學系病理科，¹³醫學院醫學系公共衛生學科

Prognostic Factors for Contralateral Recurrence of Upper Tract Urothelial Carcinoma after Nephroureterectomy: A Large Multiregional Study

Kuan-Hsien Wu^1,2, Tsu-Ming Chien^1,2, Hsiang-Ying Lee^1,2,3,4, Nirmish Singla⁵, Vitaly Margulis⁶, Yair Lotan⁶, Solomon Lukasz Woldu⁶, Chun-Nung Huang ^2,3,4, Ching-Chia Li ^2,3, Hung-Lung Ke ^2,3,4, Wei-Ming Li^2,3,7, Chia-Yang Li^8,9, A-Mei Huang^1,9,10, Sheau-Fang Yang^11,12, Hung-Pin Tu¹³, Wen-Jeng Wu^2,3,9 and Hsin-Chih Yeh^2,3,4,9,*

¹ Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ² Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ³ Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ⁴ Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan, ⁵ Departments of Urology and Oncology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA, ⁶ Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA, ⁷ Department of Urology, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan, ⁸ Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ⁹ Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ¹⁰ Department of Biochemistry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ¹¹ Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ¹² Department of Pathology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ¹³ Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

Abstract

Purpose: This study aimed to examine the prognostic significance of preoperative inflammation-associated blood cell markers in the metachronous contralateral recurrence of upper tract urothelial carcinoma (UTUC).

Materials and Methods: Patients with nonmetastatic UTUC treated in Taiwan and the U.S. between 1990 and 2017 were included. The Kaplan–Meier method was used to calculate the contralateral recurrence rate, and multivariate logistic regression was performed to study the association of blood cell markers and clinicopathological characteristics with contralateral recurrence.

Results: Overall, a total of 1039 patients were included in this study, 52 of whom (5.0%) developed metachronous recurrence of the contralateral side. Kaplan–Meier analysis indicated that a history of bladder cancer (p = 0.006), multiple tumors (p = 0.016), advanced chronic kidney disease (CKD; p < 0.001), elevated serum white blood cell (WBC) count (p < 0.001), and decreased hemoglobin levels (p = 0.001) significantly reduced the contralateral recurrence-free survival. Multivariate analysis showed that multiple tumors (hazard ratio (HR), 1.87; p = 0.030), advanced CKD (HR, 2.63; p = 0.002) and increased WBC count (HR, 2.60; p = 0.001) were independent risk factors for higher contralateral recurrence rate. Notably, advanced CKD was a significant factor regardless of the patient’s region.

Conclusions: In summary, multiple tumors, advanced CKD and elevated serum WBC count are independent predictors of contralateral recurrence in patients with UTUC. It is recommended that patients with these adverse characteristics be closely followed up to monitor the opposite upper urinary tract.