To evaluate predictive factors of increasing intravesical recurrence (IVR) rate in patients with upper tract urothelial carcinoma (UTUC) after receiving radical nephroureterectomy (RNUx) with bladder cuff excision (BCE).
A total of 2114 patients were included from the updated data of the Taiwan UTUC Collaboration Group. It was divided into two groups: IVR-free and IVR after RNUx, with 1527 and 587 patients, respectively. To determine the factors affecting IVR, TNM stage, the usage of pre-operative ureteroscopy, and pathological outcomes were evaluated. The Kaplan-Meier estimator was used to estimate the rates of prognostic outcomes in overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS), and the survival curves were compared using the stratified log-rank test.
Based on our research, ureter tumor, female, smoking history, age (< 70 years old), multifocal tumor, history of bladder cancer were determined to increase the risk of IVR after univariate analysis. The multivariable analysis revealed that female (BRFS for male: HR 0.566, 95% CI 0.469-0.681, p < 0.001), ureter tumor (BRFS: HR 1.359, 95% CI 1.133-1.631, p = 0.001), multifocal (BRFS: HR 1.200, 95% CI 1.001-1.439, p = 0.049), history of bladder cancer (BRFS: HR 1.480, 95% CI 1.118-1.959, p = 0.006) were the prognostic factors for IVR. Patients who ever received ureterorenoscopy (URS) did not increase the risk of IVR.
Patients with ureter tumor and previous bladder UC history are important factors to increase the risk of IVR after RNUx. Pre-operative URS manipulation is not associated with higher risk of IVR and diagnostic URS is feasible especially for insufficient information of image study. More frequent surveillance regimen may be needed for these patients.
World journal of urology. 2024 Jan 10*** epublish ***
Chen-Ya Chen, Chao-Hsiang Chang, Chi-Rei Yang, Kun-Lin Hsieh, Wen-Hsin Tsing, I-Hsuan Alan Chen, Jen-Tai Lin, Chao-Yuan Huang, Jian-Hua Hong, Jen-Shu Tseng, Wun-Rong Lin, Yao-Chou Tsai, Shu-Yu Wu, Cheng-Huang Shen, Ian-Seng Cheong, Chuan-Shu Chen, Cheng-Kuang Yang, Yuan-Hong Jiang, Chung-You Tsai, Thomas Y Hsueh, Yung-Tai Chen, Chia-Chang Wu, Shih-Hsiu Lo, Bing-Juin Chiang, Wei Yu Lin, Po-Hung Lin, Ta-Yao Tai, Wei-Ming Li, Hsiang-Ying Lee
Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan., Department of Urology, China Medical University and Hospital, Taichung, Taiwan., Department of Urology, China Medical University Hospital, Taichung, Taiwan., Division of Urology, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan., Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan., Department of Urology, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan., Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan., Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan., Department of Urology, Ditmanson Medical Foundation, Chiayi Christian Hospital, Chiayi, Taiwan., Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan., Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan., Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan., Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei City, Taiwan., Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan., Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan., Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan., College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan., Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan., Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan., Department of Urology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan., Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .