Prognostic factors of intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma

Chen-Ya Chen; Chao-Hsiang Chang; Chi-Rei Yang; Kun-Lin Hsieh; Wen-Hsin Tsing; I-Hsuan Alan Chen; Jen-Tai Lin; Chao-Yuan Huang; Jian-Hua Hong; Jen-Shu Tseng; Wun-Rong Lin; Yao-Chou Tsai; Shu-Yu Wu; Cheng-Huang Shen; Ian-Seng Cheong; Chuan-Shu Chen; Cheng-Kuang Yang; Yuan-Hong Jiang; Chung-You Tsai; Thomas Y Hsueh; Yung-Tai Chen; Chia-Chang Wu; Shih-Hsiu Lo; Bing-Juin Chiang; Wei Yu Lin; Po-Hung Lin; Ta-Yao Tai; Wei-Ming Li; Hsiang-Ying Lee

doi:10.1007/s00345-023-04700-9

Prognostic factors of intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma

World J Urol. 2024 Jan 10;42(1):22. doi: 10.1007/s00345-023-04700-9.

Authors

Chen-Ya Chen¹, Chao-Hsiang Chang^{2

3}, Chi-Rei Yang⁴, Kun-Lin Hsieh^{5

6}, Wen-Hsin Tsing^{5

7}, I-Hsuan Alan Chen⁸, Jen-Tai Lin⁸, Chao-Yuan Huang⁹, Jian-Hua Hong^{9

10}, Jen-Shu Tseng^{11

12

13}, Wun-Rong Lin^{11

12}, Yao-Chou Tsai^{14

15

16}, Shu-Yu Wu^{14

17}, Cheng-Huang Shen¹⁸, Ian-Seng Cheong¹⁸, Chuan-Shu Chen^{19

20

21}, Cheng-Kuang Yang¹⁹, Yuan-Hong Jiang²², Chung-You Tsai^{23

24}, Thomas Y Hsueh^{25

26}, Yung-Tai Chen²⁷, Chia-Chang Wu^{28

29

30}, Shih-Hsiu Lo¹⁶, Bing-Juin Chiang^{31

32

33}, Wei Yu Lin^{34

35

36}, Po-Hung Lin^{37

38

39}, Ta-Yao Tai⁴⁰, Wei-Ming Li^{1

41

42}, Hsiang-Ying Lee^{43

44

45

46}

Affiliations

¹ Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
² Department of Urology, China Medical University and Hospital, Taichung, Taiwan.
³ School of Medicine, China Medical University, Taichung, Taiwan.
⁴ Department of Urology, China Medical University Hospital, Taichung, Taiwan.
⁵ Division of Urology, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan.
⁶ Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁷ Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan.
⁸ Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.
⁹ Department of Urology, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
¹⁰ Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.
¹¹ Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan.
¹² Mackay Medical College, Taipei, Taiwan.
¹³ Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹⁴ Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
¹⁵ School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
¹⁶ Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan.
¹⁷ Department of Urology, School of Medicine, Tzu Chi University, Hualien, Taiwan.
¹⁸ Department of Urology, Ditmanson Medical Foundation, Chiayi Christian Hospital, Chiayi, Taiwan.
¹⁹ Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
²⁰ Institute of Medicine, Chung Shan Medical University, Taichung City, Taiwan.
²¹ Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung City, Taiwan.
²² Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
²³ Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
²⁴ Department of Electrical Engineering, Yuan Ze University, Taoyuan City, Taiwan.
²⁵ Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei City, Taiwan.
²⁶ Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
²⁷ Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan.
²⁸ Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
²⁹ Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
³⁰ TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan.
³¹ College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
³² Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan.
³³ Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan.
³⁴ Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan.
³⁵ Chang Gung University of Science and Technology, Chia-Yi, Taiwan.
³⁶ Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
³⁷ Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
³⁸ Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
³⁹ School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁴⁰ Department of Urology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
⁴¹ Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁴² Department of Urology, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan.
⁴³ Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. ashum1009@hotmail.com.
⁴⁴ Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. ashum1009@hotmail.com.
⁴⁵ Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan. ashum1009@hotmail.com.
⁴⁶ Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. ashum1009@hotmail.com.

PMID: 38197890
DOI: 10.1007/s00345-023-04700-9

Abstract

Purpose: To evaluate predictive factors of increasing intravesical recurrence (IVR) rate in patients with upper tract urothelial carcinoma (UTUC) after receiving radical nephroureterectomy (RNUx) with bladder cuff excision (BCE).

Materials and methods: A total of 2114 patients were included from the updated data of the Taiwan UTUC Collaboration Group. It was divided into two groups: IVR-free and IVR after RNUx, with 1527 and 587 patients, respectively. To determine the factors affecting IVR, TNM stage, the usage of pre-operative ureteroscopy, and pathological outcomes were evaluated. The Kaplan-Meier estimator was used to estimate the rates of prognostic outcomes in overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS), and the survival curves were compared using the stratified log-rank test.

Results: Based on our research, ureter tumor, female, smoking history, age (< 70 years old), multifocal tumor, history of bladder cancer were determined to increase the risk of IVR after univariate analysis. The multivariable analysis revealed that female (BRFS for male: HR 0.566, 95% CI 0.469-0.681, p < 0.001), ureter tumor (BRFS: HR 1.359, 95% CI 1.133-1.631, p = 0.001), multifocal (BRFS: HR 1.200, 95% CI 1.001-1.439, p = 0.049), history of bladder cancer (BRFS: HR 1.480, 95% CI 1.118-1.959, p = 0.006) were the prognostic factors for IVR. Patients who ever received ureterorenoscopy (URS) did not increase the risk of IVR.

Conclusion: Patients with ureter tumor and previous bladder UC history are important factors to increase the risk of IVR after RNUx. Pre-operative URS manipulation is not associated with higher risk of IVR and diagnostic URS is feasible especially for insufficient information of image study. More frequent surveillance regimen may be needed for these patients.

Keywords: Intravesical; Nephroureterectomy; Recurrence; Urothelial carcinoma.

MeSH terms

Aged
Carcinoma, Transitional Cell* / surgery
Female
Humans
Male
Nephroureterectomy
Prognosis
Ureteral Neoplasms* / surgery
Urinary Bladder Neoplasms*