Nobuyuki Tanaka1, Eiji Kikuchi2, Kent Kanao3, Kazuhiro Matsumoto4, Suguru Shirotake5, Hiroaki Kobayashi6, Yasumasa Miyazaki7, Hiroki Ide8, Jun Obata3, Katsura Hoshino9, Nozomi Hayakawa4, Takeo Kosaka10, Masafumi Oyama11, Akira Miyajima3, Tetsuo Momma12, Ken Nakagawa3, Masahiro Jinzaki13, Yosuke Nakajima14, Mototsugu Oya3. 1. Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Musashino Yowakai Hospital, Tokyo, Japan. 2. Department of Urology, Keio University School of Medicine, Tokyo, Japan. Electronic address: eiji-k@kb3.so-net.ne.jp. 3. Department of Urology, Keio University School of Medicine, Tokyo, Japan. 4. Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Saiseikai Central Hospital, Tokyo, Japan. 5. Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, International Medical Center-Comprehensive Cancer Center, Saitama Medical University, Saitama, Japan. 6. Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Kyosai Tachikawa Hospital, Tokyo, Japan. 7. Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Ogikubo Hospital, Tokyo, Japan. 8. Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Saitama City Hospital, Saitama, Japan. 9. Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan. 10. Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Irumagawa Hospital, Saitama, Japan. 11. Department of Urology, International Medical Center-Comprehensive Cancer Center, Saitama Medical University, Saitama, Japan. 12. Department of Urology, National Hospital Organization, Saitama Hospital, Saitama, Japan. 13. Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan. 14. Department of Urology, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan.
Abstract
BACKGROUND AND OBJECTIVE: Few studies have addressed the predictive value of positive urine cytology for prognosis in patients with upper tract urothelial carcinoma (UTUC). We investigated whether the status of preoperative urine cytology could provide additional prognostic information following radical nephroureterectomy (RNU). MATERIALS AND METHODS: The study included 474 patients with primary nonmetastatic UTUC (pTa-4N0M0) from a retrospective multi-institutional cohort. The median follow-up period was 35 months. Associations between the status of urine cytologic evaluation and outcomes were analyzed using multivariate Cox regression models. Urine cytology was evaluated preoperatively using voided samples. Disease recurrence was defined as any relapse in nonbladder lesions and was coded separately from intravesical recurrence. RESULTS: Positive urine cytology was detected in 184 patients (38.8%) preoperatively. Disease recurrence occurred in 127 patients, while intravesical recurrence occurred in 219 patients; 83 patients died of UTUC during follow-up. Kaplan-Meier analysis revealed that only the incidence of intravesical recurrence was significantly associated with the status of urine cytologic evaluation (P = 0.024); the intravesical recurrence-free survival rates at 1 and 3 years following RNU were 61.4% and 46.2% in patients with positive urine cytology and 71.1% and 51.6% in their counterparts, respectively. Multivariate analysis showed that gender (hazard ratio [HR] = 1.74, 95% confidence interval [CI]; 1.28-2.43), tumor multifocality in RNU specimens (HR = 1.64, 95% CI; 1.09-2.47), and positive urine cytology (HR = 1.41, 95% CI; 1.08-1.85) were independent risk factors for subsequent intravesical recurrence. CONCLUSIONS: The results showed the prognostic value of positive urine cytology in patients with primary UTUC, and preoperative positive urine cytology may be associated with a significant increase in the prevalence of intravesical recurrence following RNU.
BACKGROUND AND OBJECTIVE: Few studies have addressed the predictive value of positive urine cytology for prognosis in patients with upper tract urothelial carcinoma (UTUC). We investigated whether the status of preoperative urine cytology could provide additional prognostic information following radical nephroureterectomy (RNU). MATERIALS AND METHODS: The study included 474 patients with primary nonmetastatic UTUC (pTa-4N0M0) from a retrospective multi-institutional cohort. The median follow-up period was 35 months. Associations between the status of urine cytologic evaluation and outcomes were analyzed using multivariate Cox regression models. Urine cytology was evaluated preoperatively using voided samples. Disease recurrence was defined as any relapse in nonbladder lesions and was coded separately from intravesical recurrence. RESULTS: Positive urine cytology was detected in 184 patients (38.8%) preoperatively. Disease recurrence occurred in 127 patients, while intravesical recurrence occurred in 219 patients; 83 patients died of UTUC during follow-up. Kaplan-Meier analysis revealed that only the incidence of intravesical recurrence was significantly associated with the status of urine cytologic evaluation (P = 0.024); the intravesical recurrence-free survival rates at 1 and 3 years following RNU were 61.4% and 46.2% in patients with positive urine cytology and 71.1% and 51.6% in their counterparts, respectively. Multivariate analysis showed that gender (hazard ratio [HR] = 1.74, 95% confidence interval [CI]; 1.28-2.43), tumor multifocality in RNU specimens (HR = 1.64, 95% CI; 1.09-2.47), and positive urine cytology (HR = 1.41, 95% CI; 1.08-1.85) were independent risk factors for subsequent intravesical recurrence. CONCLUSIONS: The results showed the prognostic value of positive urine cytology in patients with primary UTUC, and preoperative positive urine cytology may be associated with a significant increase in the prevalence of intravesical recurrence following RNU.
Authors: Aurélie Mbeutcha; Morgan Rouprêt; Ashish M Kamat; Pierre I Karakiewicz; Nathan Lawrentschuk; Giacomo Novara; Jay D Raman; Christian Seitz; Evanguelos Xylinas; Shahrokh F Shariat Journal: World J Urol Date: 2016-04-21 Impact factor: 4.226
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