Chan Ho Lee1, Ja Yoon Ku2, Chang Wook Jeong3, Ja Hyeon Ku3, Cheol Kwak3, Hyeon Hoe Kim3, Bum Sik Tae3, Seock Hwan Choi4, Hyun Tae Kim5, Tae-Hwan Kim4, Tae Gyun Kwon4, Eu Chang Hwang6, Seung Il Jung6, Taek Won Kang7, Dong Deuk Kwon6, Hong Koo Ha8. 1. Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea. 2. Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea. 3. Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. 4. Department of Urology, Chilgok Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea. 5. Department of Urology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea. 6. Department of Urology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea. 7. Department of Urology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea. 8. Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea. Electronic address: hongkooha@naver.com.
Abstract
INTRODUCTION: The purpose of this study was to identify the prognostic impact of intravesical recurrence (IVR) on oncologic outcomes and the clinicopathologic factors that predict IVR in patients who undergo radical nephroureterectomy (RNU) for upper tract urothelial carcinoma. PATIENTS AND METHODS: Between January 2000 and December 2015, 760 patients with upper tract urothelial carcinoma underwent RNU at 5 institutions in Korea, and patient data were retrospectively collected. Clinicopathologic factors were analyzed for intravesical recurrence-free survival, cancer-specific survival (CSS), and overall survival (OS). Univariate and multivariate Cox proportional hazards regression models were used to test the clinicopathologic factors on IVR. RESULTS: Of the 760 patients, 231 (30.3%) patients experienced IVR within 10 months of the median interval between RNU and the first IVR. The overall estimated probabilities of 5-year CSS, intravesical recurrence-free survival, and OS were 84.2%, 63.8%, and 79.2%, respectively. No difference was noted in terms of CSS and OS between the patients who did or did not experience IVR. The multivariate Cox analysis showed an association between IVR and positive hydronephrosis, tumor size, positive preoperative urinary cytology, and ureterorenoscopy before RNU (all P < .05). However, a significantly decreased risk of IVR was associated with female gender, laparoscopic RNU, and receipt of adjuvant systemic chemotherapy (all P < .05). CONCLUSION: The occurrence of IVR following RNU did not affect CSS and OS. Patients with larger tumor size, preoperative hydronephrosis, positive preoperative urinary cytology, and ureterorenoscopy before RNU had a higher risk of IVR following RNU.
INTRODUCTION: The purpose of this study was to identify the prognostic impact of intravesical recurrence (IVR) on oncologic outcomes and the clinicopathologic factors that predict IVR in patients who undergo radical nephroureterectomy (RNU) for upper tract urothelial carcinoma. PATIENTS AND METHODS: Between January 2000 and December 2015, 760 patients with upper tract urothelial carcinoma underwent RNU at 5 institutions in Korea, and patient data were retrospectively collected. Clinicopathologic factors were analyzed for intravesical recurrence-free survival, cancer-specific survival (CSS), and overall survival (OS). Univariate and multivariate Cox proportional hazards regression models were used to test the clinicopathologic factors on IVR. RESULTS: Of the 760 patients, 231 (30.3%) patients experienced IVR within 10 months of the median interval between RNU and the first IVR. The overall estimated probabilities of 5-year CSS, intravesical recurrence-free survival, and OS were 84.2%, 63.8%, and 79.2%, respectively. No difference was noted in terms of CSS and OS between the patients who did or did not experience IVR. The multivariate Cox analysis showed an association between IVR and positive hydronephrosis, tumor size, positive preoperative urinary cytology, and ureterorenoscopy before RNU (all P < .05). However, a significantly decreased risk of IVR was associated with female gender, laparoscopic RNU, and receipt of adjuvant systemic chemotherapy (all P < .05). CONCLUSION: The occurrence of IVR following RNU did not affect CSS and OS. Patients with larger tumor size, preoperative hydronephrosis, positive preoperative urinary cytology, and ureterorenoscopy before RNU had a higher risk of IVR following RNU.
Authors: Eu Chang Hwang; Niranjan J Sathianathen; Jae Hung Jung; Myung Ha Kim; Philipp Dahm; Michael C Risk Journal: Cochrane Database Syst Rev Date: 2019-05-18