痛風對上泌尿道尿路上皮癌腫瘤學預後之影響：多機構世代研究

陳仲均、蔡秉軒、曾聖修、陳品鍵、蔡曜州

佛教慈濟醫療財團法人台北慈濟醫院 外科部 泌尿科

Association Between Gout and Oncologic Outcomes in Upper Tract Urothelial Carcinoma: A Multi-Institutional Cohort Study

Chung-Chun Chen, Pin-Hsuan Tsai, Shen-Shiou Tseng, , Nicholas Pin-Jian Tan, Yao-Chou Tsai

Divisions of Urology, Department of Surgery, Taipei Tzu Chi Hospital, New Taipei, Taiwan

Purpose: Gout, a chronic metabolic and inflammatory disorder driven by monosodium urate crystal deposition and oxidative stress, may facilitate carcinogenesis through systemic inflammation and oxidative DNA damage. Unlike asymptomatic hyperuricemia, gout represents an active inflammatory state. This study evaluated whether gout influences oncologic outcomes in patients with upper tract urothelial carcinoma (UTUC) after surgery.

Materials and Methods: This multi-institutional retrospective study from the Taiwan UTUC Collaboration Group included patients who underwent radical nephroureterectomy, endoscopic ablation, or segmental resection (2005–2022), stratified by the presence of gout. Gout was defined as physician-diagnosed disease with typical flares or tophi and/or ≥3 months of urate-lowering therapy. Baseline clinicopathologic variables were compared using standardized mean differences (SMDs), and overlap propensity score weighting (OW) was applied for covariate balance. Kaplan–Meier, Cox, and Fine–Gray models assessed associations between gout  and overall (OS), cancer-specific (CSS), disease-free (DFS), and bladder recurrence–free survival (BRFS).

Results: Among 3,549 UTUC patients, 144 (4.1%) had gout. Before weighting, gout patients were more often male (68.1% vs. 41.8%) and hypertensive (68.1% vs. 56.5%). After OW adjustment, balance was achieved (SMD < 0.1). Median follow-up was 58.6 months. A higher risk of bladder UC occurence was observed in patients with gout (HR 1.46, 95% CI 1.11–1.93, p = 0.007), whereas no significant associations were found with OS (HR 1.09, p = 0.488), CSS (HR 0.89, p = 0.592), or DFS (HR 1.05, p = 0.791). Kaplan–Meier curves showed inferior BRFS in gout patients (p = 0.0023; OW-adjusted p = 0.006). Similarly, In the UK Biobank cohort (511 UTUC cases; 51 with gout), subsequent bladder UC occurred in 19.6% vs 13.3% without gout, indicating a consistent but nonsignificant trend. Adverse prognostic factors included advanced stage, high grade, lymphovascular invasion, and positive margin.

Conclusions: Gout was associated with increased bladder UC occurence after UTUC surgery but did not affect OS, CSS, or DFS. Chronic inflammation and metabolic dysregulation may underlie urothelial field cancerization. Prospective studies are warranted to confirm this association and explore whether gout control mitigates occurence risk.