Preoperative Pyuria Predicts for Intravesical Recurrence in Patients With Urothelial Carcinoma of the Upper Urinary Tract After Radical Nephroureterectomy Without a History of Bladder Cancer |
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| Affiliation: | 1. Department of Urology and Andrology, Kansai Medical University Hospital, Osaka, Japan;2. Department of Urology and Andrology, Kansai Medical University, Kori Hospital, Osaka, Japan;3. Department of Urology and Andrology, Kansai Medical University, General Medical Center, Osaka, Japan;4. Department of Urology, Saiseikai Noe Hospital, Osaka, Japan;1. U.O. Oncologia, Ospedale Sant''Anna, ASST-LARIANA, Como, Italy;2. Università degli studi dell''Insubria di Varese, Varese, Italy;3. Oncologia Medica, Ospedale di Circolo, Varese, Italy;4. Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria di Varese, Varese, Italy;5. Oncologia Medica, Presidio Ospedaliero di Saronno, Saronno, Italy;6. Oncologia Medica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy;7. Medicina Interna, Azienda USL6 Livorno - Presidio Ospedaliero di Livorno, Livorno, Italy;8. Oncologia Medica, Azienda USL 6 di Livorno, Livorno, Italy;9. Medicina Interna ad indirizzo Oncologico, Ospedale di Vigevano, Azienda Socio-Sanitaria Territoriale di Pavia, Pavia, Italy;10. Oncologia Medica, Ospedale di Busto Arsizio - ASST Valle Olona, Busto Arsizio, Italy;11. Oncologia Medica, Azienda Ospedaliera S. Antonio Abate di Gallarate, Gallarate, Italy;1. Tulane University School of Medicine, New Orleans, LA;2. Tulane Cancer Center, New Orleans, LA;1. Department of Surgery, Catharina Hospital Eindhoven, the Netherlands;2. GROW: School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands;1. Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ;2. Department of Biostatistics and Epidemiology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ;3. Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ;4. Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ;5. Division of Medical Oncology, Department of Medicine, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ;6. Department of Urology, University of Michigan, Ann Arbor, MI;1. Dartmouth-Hitchcock, Lebanon, NH;2. Department of Pathology, Concord Hospital, Concord, NH;3. Center for Urologic Care, Concord Hospital, Concord, NH;1. Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan;2. Department of Urology, Tama-Nambu Chiiki Hospital, Tokyo, Japan;3. Department of Medical Science, Kawasaki Medical School, Okayama, Japan |
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| Abstract: | BackgroundWe assessed preoperative pyuria as a significant predictor of intravesical recurrence (IVR) in patients with upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU).Patients and MethodsWe evaluated the data from 268 patients with UTUC without a history of bladder cancer who had undergone RNU from 2006 to 2016 at 4 academic institutions. The associations between the clinical variables and the presence of pyuria were evaluated by univariate analysis. IVR was assessed using the Kaplan-Meier method and Cox regression analysis.ResultsThe median postoperative follow-up of patients with IVR-free survival was 29.1 months (interquartile range, 15.4-55.3 months). The rate of IVR was significantly greater in the patients with than in those without pyuria (P = .025). Multivariate analysis showed that preoperative pyuria (hazard ratio [HR], 1.70; P = .007), a ureteral tumor site (HR, 1.64; P = .012), and positive surgical margins (HR, 2.70; P = .013) were associated with a significantly increased risk of IVR. A postoperative risk stratification model using these factors showed significant differences among the 3 subgroups of patients with low, intermediate, and high risk. The 5-year IVR-free survival rates for the patients with low, intermediate, and high risk were 69.1%, 51.8%, and 18.8%, respectively (P = .004).ConclusionPreoperative pyuria, a ureteral tumor site, and positive surgical margins were associated with a significantly increased risk of IVR. Although external validation is required, the presence of preoperative pyuria could be a significant predictor of IVR in patients with UTUC after RNU. |
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| Keywords: | Intravesical recurrence Preoperative pyuria Prognostic marker Upper urinary tract Urothelial carcinoma |
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