Investig Clin Urol.  2019 Nov;60(6):432-442. 10.4111/icu.2019.60.6.432.

Significant clinicopathologic prognostic factors for bladder recurrence, progression, and cancer-specific survival after surgery among patients with upper urinary tract urothelial carcinoma

Affiliations
  • 1Department of Urology, Center for Urologic Cancer, National Cancer Center, Goyang, Korea. seohk@ncc.re.kr
  • 2Biometrics Research Branch, Division of Cancer Epidemiology and Prevention, Research Institute and Hospital of National Cancer Center, Goyang, Korea.

Abstract

PURPOSE
This study aimed to identify prognostic factors for outcomes after radical nephroureterectomy among patients with upper urinary tract urothelial carcinoma (UTUC).
MATERIALS AND METHODS
We retrospectively reviewed 184 nonmetastatic cases of UTUC after radical nephroureterectomy, bladder cuffing, and/or partial cystectomy (2004-2016). Bladder recurrence-free survival (BRFS), disease progression-free survival (DPFS), and cancer-specific survival (CSS) were estimated. The prognostic values of clinicopathologic parameters were evaluated by using Cox logistic regression analysis.
RESULTS
The median BRFS, DPFS, and CSS values were 19.0 months, 38.5 months, and 67.0 months, respectively. We identified cases of bladder recurrence (64 cases, 34.8%), disease progression (54 cases, 29.3%), and cancer-specific death (23 cases, 12.5%). BRFS was independently associated with lymphovascular invasion (hazard ratio [HR], 0.421); DPFS was associated with intravesical instillation (HR, 0.290), active smoking (HR, 0.367), synchronous bladder lesions (HR, 2.355), and pT2 (HR, 5.199) and pT3 and pT4 (HR, 13.281) stages; and CSS was associated with alkaline phosphatase levels (HR, 0.966). Among 123 cases without previous bladder cancer, DPFS was associated with intravesical instillation (HR, 0.264), multifocal ureteral tumors (HR, 4.823), and pT3 and pT4 stages (HR, 10.899), whereas CSS was associated with pTis (HR, 32.071).
CONCLUSIONS
Patients with the factors we identified should receive adjuvant intravesical/systemic chemotherapy and intensive surveillance.

Keyword

Nephroureterectomy; Prognosis; Risk factors; Survival; Ureteral neoplasms

MeSH Terms

Administration, Intravesical
Alkaline Phosphatase
Cystectomy
Disease Progression
Disease-Free Survival
Drug Therapy
Humans
Logistic Models
Prognosis
Recurrence*
Retrospective Studies
Risk Factors
Smoke
Smoking
Ureter
Ureteral Neoplasms
Urinary Bladder Neoplasms
Urinary Bladder*
Urinary Tract*
Alkaline Phosphatase
Smoke
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