We assessed preoperative pyuria as a significant predictor of intravesical recurrence (IVR) in patients with upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU).
We evaluated the data from 268 patients with UTUC without a history of bladder cancer who had undergone RNU from 2006 to 2016 at 4 academic institutions.
The associations between the clinical variables and the presence of pyuria were evaluated by univariate analysis. IVR was assessed using the Kaplan-Meier method and Cox regression analysis.
The median postoperative follow-up of patients with IVR-free survival was 29.1 months (interquartile range, 15.4-55.3 months). The rate of IVR was significantly greater in the patients with than in those without pyuria (P = .025). Multivariate analysis showed that preoperative pyuria (hazard ratio [HR], 1.70; P = .007), a ureteral tumor site (HR, 1.64; P = .012), and positive surgical margins (HR, 2.70; P = .013) were associated with a significantly increased risk of IVR. A postoperative risk stratification model using these factors showed significant differences among the 3 subgroups of patients with low, intermediate, and high risk. The 5-year IVR-free survival rates for the patients with low, intermediate, and high risk were 69.1%, 51.8%, and 18.8%, respectively (P = .004).
Preoperative pyuria, a ureteral tumor site, and positive surgical margins were associated with a significantly increased risk of IVR. Although external validation is required, the presence of preoperative pyuria could be a significant predictor of IVR in patients with UTUC after RNU.
Clinical genitourinary cancer. 2019 Sep 27 [Epub ahead of print]
Goro Sato, Takashi Yoshida, Masaaki Yanishi, Ryoichi Saito, Takashi Murota, Gen Kawa, Hidefumi Kinoshita, Tadashi Matsuda
Department of Urology and Andrology, Kansai Medical University Hospital, Osaka, Japan., Department of Urology and Andrology, Kansai Medical University Hospital, Osaka, Japan; Department of Urology and Andrology, Kansai Medical University, Kori Hospital, Osaka, Japan. Electronic address: ., Department of Urology and Andrology, Kansai Medical University, General Medical Center, Osaka, Japan., Department of Urology, Saiseikai Noe Hospital, Osaka, Japan.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/31635939