Yunzhong Jiang1, Zichuan Yao2, Xianqing Zhu3, Bin Wu4, Song Bai5. 1. Department of Urology, ShengJing Hospital of China Medical University, Shenyang, 110004, China. Electronic address: 18304095870@163.com. 2. Department of Urology, ShengJing Hospital of China Medical University, Shenyang, 110004, China. Electronic address: 17612491522@163.com. 3. Department of Urology, ShengJing Hospital of China Medical University, Shenyang, 110004, China. Electronic address: 18302427176@163.com. 4. Department of Urology, ShengJing Hospital of China Medical University, Shenyang, 110004, China. Electronic address: wub1cmu@163.com. 5. Department of Urology, ShengJing Hospital of China Medical University, Shenyang, 110004, China. Electronic address: baisongcmu81@163.com.
Abstract
PURPOSE: Radical nephroureterectomy (RNU) is the primary treatment strategy for upper urinary tract urothelial carcinoma (UTUC); however, the prognosis is poor and recurrences are common. The risk factors for intravesical recurrence (IVR) remain inconsistent and unclear. Thus, we have identified the risk factors for IVR in patients with organ-confined UTUC. METHODS: We retrospectively studied 229 patients with UTUC who underwent RNU combined with bladder cuff resection at our center between 1 January 2010 and 31 December 2015. After propensity score-matching, 204 patients were included in our study. Patient demographics, co-morbidities, and peri-operative data were recorded. Univariate and multivariate Cox proportional hazard regression were used to estimate the hazard ratio and 95% confidence intervals. Overall (OS) and cancer-specific survival (CSS) were measured using the Kaplan-Meier curve with a log-rank test. A p-value <0.05 was considered statistically significant. RESULTS: Of the 229 patients, 42 (18.3%) had IVR after 40 months (range, 24-56 months) follow-up. In the matched group, the independent risk factors for IVR were tumor diameter (HR = 2.690, p = 0.038) and tumor stage (T3 vs. T1, HR = 3.363, p = 0.019; T2 vs. T1, HR = 2.835, p = 0.022). OS and CSS were poor in patients with IVR than patients without IVR (p < 0.0001). CONCLUSIONS: In this propensity score-matched case-control study, tumor diameter and tumor stage were shown to be independent risk factors for IVR in patients with organ-confined UTUC. Moreover, patients with IVR had poor prognosis than patients without IVR. Thus, more active postoperative surveillance and treatment strategies should be adopted for these patients, which may help improve treatment outcomes.
PURPOSE: Radical nephroureterectomy (RNU) is the primary treatment strategy for upper urinary tract urothelial carcinoma (UTUC); however, the prognosis is poor and recurrences are common. The risk factors for intravesical recurrence (IVR) remain inconsistent and unclear. Thus, we have identified the risk factors for IVR in patients with organ-confined UTUC. METHODS: We retrospectively studied 229 patients with UTUC who underwent RNU combined with bladder cuff resection at our center between 1 January 2010 and 31 December 2015. After propensity score-matching, 204 patients were included in our study. Patient demographics, co-morbidities, and peri-operative data were recorded. Univariate and multivariate Cox proportional hazard regression were used to estimate the hazard ratio and 95% confidence intervals. Overall (OS) and cancer-specific survival (CSS) were measured using the Kaplan-Meier curve with a log-rank test. A p-value <0.05 was considered statistically significant. RESULTS: Of the 229 patients, 42 (18.3%) had IVR after 40 months (range, 24-56 months) follow-up. In the matched group, the independent risk factors for IVR were tumor diameter (HR = 2.690, p = 0.038) and tumor stage (T3 vs. T1, HR = 3.363, p = 0.019; T2 vs. T1, HR = 2.835, p = 0.022). OS and CSS were poor in patients with IVR than patients without IVR (p < 0.0001). CONCLUSIONS: In this propensity score-matched case-control study, tumor diameter and tumor stage were shown to be independent risk factors for IVR in patients with organ-confined UTUC. Moreover, patients with IVR had poor prognosis than patients without IVR. Thus, more active postoperative surveillance and treatment strategies should be adopted for these patients, which may help improve treatment outcomes.
Authors: Tzu Shuang Chen; Yen Ta Chen; Hung Jen Wang; Po Hui Chiang; Wen Chou Yang; Wei Ching Lee; Yao Chi Chuang; Yuan Tso Cheng; Chih Hsiung Kang; Wei Chia Lee; Chien Hsu Chen; Yuan Chi Shen; Yi Yang Liu; Hui Ying Liu; Yin Lun Chang; Yu Li Su; Chun Chieh Huang; Hao Lun Luo Journal: Front Oncol Date: 2022-03-15 Impact factor: 6.244