Tumor multifocality and location are prognostic factors for upper tract urothelial carcinoma (UTUC). However, confounding effects can appear when these two factors are analyzed together. Therefore, we aimed to investigate the impact of tumor distribution on the outcomes of multifocal UTUC after radical nephroureterectomy. From the 2780 UTUC patients in the Taiwan UTUC Collaboration Group, 685 UTUC cases with multifocal tumors (defined as more than one tumor lesion in unilateral upper urinary tract) were retrospectively included and divided into three groups: multiple renal pelvic tumors, multiple ureteral tumors, and synchronous renal pelvic and ureteral tumors included 164, 152, and 369 patients, respectively. We found the prevalence of carcinoma in situ was the highest in the synchronous group. In multivariate survival analyses, tumor distribution showed no difference in cancer-specific and disease-free survival, but there was a significant difference in bladder recurrence-free survival. The synchronous group had the highest bladder recurrence rate. In summary, tumor distribution did not influence the cancer-specific outcomes of multifocal UTUC, but synchronous lesions led to a higher rate of bladder recurrence than multiple renal pelvic tumors. We believe that the distribution of tumors reflects the degree of malignant involvement within the urinary tract, but has little significance for survival or disease progression.
Scientific reports. 2021 Sep 24*** epublish ***
Zai-Lin Sheu, Chi-Ping Huang, Chao-Hsiang Chang, Chung-Hsin Chen, Jian-Hua Hong, Han-Yu Weng, Ta-Yao Tai, Shiu-Dong Chung, Chi-Wen Lo, Thomas Y Hsueh, Yao-Chou Tsai, Yuan-Hong Jiang, Bing-Juin Chiang, Yung-Tai Chen, Jen-Tai Lin, Wei-Yu Lin, Yeong-Chin Jou, Jen-Shu Tseng, Chia-Chang Wu, Wen-Jeng Wu, Hsin-Chih Yeh
School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan., Department of Urology, China Medical University and Hospital, Taichung, Taiwan., Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan., Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan., Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan., Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan., Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan., Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan., Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan., College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan., Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan., Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan., Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan., Department of Urology, Ditmanson Medical Foundation, Chiayi Christian Hospital, Chiayi, Taiwan., Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan., Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan., Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kaohsiung, 80708, Taiwan., Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kaohsiung, 80708, Taiwan. .