術前膿尿與泌尿道上皮癌經腎臟切除術後復發的相關性

黃子恆、羅浩倫¹

¹高雄長庚紀念醫院 外科部 泌尿科

The association between preoperative pyuria and postoperative recurrences in patients with upper tract urothelial carcinoma undergoing radical nephrectomy

Tzu-Heng Huang, 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 intravesical recurrence and non-urothelial tract recurrence in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy.

Materials and Methods: A retrospective review was conducted on 636 patients who underwent radical nephroureterectomy between December 2017 and June 2023. Pre-operative pyuria was defined as >5 white blood cells (WBC) per high power field under a microscope. We collected and analyzed preoperative clinical and post-operative pathological variables. Kaplan-Meier survival plots were utilized to analyze metastasis free survival and bladder recurrence free survival.

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 intravesical recurrence. Kaplan-Meier survival plots indicated preoperative pyuria is significantly associated with 1-year bladder recurrence in patients with pyuria. However, there was no significant difference observed in non-urothelial tract recurrence and 5-year bladder recurrence free survival between patients with and without pre-operative pyuria. In addition, multivariate Cox regression analysis revealed that preoperative pyuria, concurrent bladder cancer, variant histology, multifocal tumor and female are independent factors predicting early bladder recurrence within 1 year.

Conclusion: Preoperative pyuria can be considered as a predictive factor for early intravesical recurrences in patients undergoing radical nephroureterectomy for UTUC, though it does not correlate with non-urothelial tract recurrence and 5-year bladder recurrence free survival. This study also provides prognostic value upon intravesical recurrence that might help physicians establish adjuvant therapy and initiate early tumor surveillance strategies after radical surgery for UTUC.