The predictive value of positive urine cytology for outcomes following radical nephroureterectomy in patients with primary upper tract urothelial carcinoma: a multi-institutional study

Nobuyuki Tanaka; Eiji Kikuchi; Kent Kanao; Kazuhiro Matsumoto; Suguru Shirotake; Hiroaki Kobayashi; Yasumasa Miyazaki; Hiroki Ide; Jun Obata; Katsura Hoshino; Nozomi Hayakawa; Takeo Kosaka; Masafumi Oyama; Akira Miyajima; Tetsuo Momma; Ken Nakagawa; Masahiro Jinzaki; Yosuke Nakajima; Mototsugu Oya

doi:10.1016/j.urolonc.2013.07.003

The predictive value of positive urine cytology for outcomes following radical nephroureterectomy in patients with primary upper tract urothelial carcinoma: a multi-institutional study

Urol Oncol. 2014 Jan;32(1):48.e19-26. doi: 10.1016/j.urolonc.2013.07.003. Epub 2013 Sep 18.

Authors

Nobuyuki Tanaka¹, Eiji Kikuchi², Kent Kanao³, Kazuhiro Matsumoto⁴, Suguru Shirotake⁵, Hiroaki Kobayashi⁶, Yasumasa Miyazaki⁷, Hiroki Ide⁸, Jun Obata³, Katsura Hoshino⁹, Nozomi Hayakawa⁴, Takeo Kosaka¹⁰, Masafumi Oyama¹¹, Akira Miyajima³, Tetsuo Momma¹², Ken Nakagawa³, Masahiro Jinzaki¹³, Yosuke Nakajima¹⁴, Mototsugu Oya³

Affiliations

¹ Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Musashino Yowakai Hospital, Tokyo, Japan.
² Department of Urology, Keio University School of Medicine, Tokyo, Japan. Electronic address: eiji-k@kb3.so-net.ne.jp.
³ Department of Urology, Keio University School of Medicine, Tokyo, Japan.
⁴ Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Saiseikai Central Hospital, Tokyo, Japan.
⁵ Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, International Medical Center-Comprehensive Cancer Center, Saitama Medical University, Saitama, Japan.
⁶ Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Kyosai Tachikawa Hospital, Tokyo, Japan.
⁷ Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Ogikubo Hospital, Tokyo, Japan.
⁸ Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Saitama City Hospital, Saitama, Japan.
⁹ Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan.
¹⁰ Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Irumagawa Hospital, Saitama, Japan.
¹¹ Department of Urology, International Medical Center-Comprehensive Cancer Center, Saitama Medical University, Saitama, Japan.
¹² Department of Urology, National Hospital Organization, Saitama Hospital, Saitama, Japan.
¹³ Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
¹⁴ Department of Urology, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan.

PMID: 24055429
DOI: 10.1016/j.urolonc.2013.07.003

Abstract

Background and objective: Few studies have addressed the predictive value of positive urine cytology for prognosis in patients with upper tract urothelial carcinoma (UTUC). We investigated whether the status of preoperative urine cytology could provide additional prognostic information following radical nephroureterectomy (RNU).

Materials and methods: The study included 474 patients with primary nonmetastatic UTUC (pTa-4N0M0) from a retrospective multi-institutional cohort. The median follow-up period was 35 months. Associations between the status of urine cytologic evaluation and outcomes were analyzed using multivariate Cox regression models. Urine cytology was evaluated preoperatively using voided samples. Disease recurrence was defined as any relapse in nonbladder lesions and was coded separately from intravesical recurrence.

Results: Positive urine cytology was detected in 184 patients (38.8%) preoperatively. Disease recurrence occurred in 127 patients, while intravesical recurrence occurred in 219 patients; 83 patients died of UTUC during follow-up. Kaplan-Meier analysis revealed that only the incidence of intravesical recurrence was significantly associated with the status of urine cytologic evaluation (P = 0.024); the intravesical recurrence-free survival rates at 1 and 3 years following RNU were 61.4% and 46.2% in patients with positive urine cytology and 71.1% and 51.6% in their counterparts, respectively. Multivariate analysis showed that gender (hazard ratio [HR] = 1.74, 95% confidence interval [CI]; 1.28-2.43), tumor multifocality in RNU specimens (HR = 1.64, 95% CI; 1.09-2.47), and positive urine cytology (HR = 1.41, 95% CI; 1.08-1.85) were independent risk factors for subsequent intravesical recurrence.

Conclusions: The results showed the prognostic value of positive urine cytology in patients with primary UTUC, and preoperative positive urine cytology may be associated with a significant increase in the prevalence of intravesical recurrence following RNU.

Keywords: Intravesical recurrence; Nephroureterectomy; Upper urinary tract; Urine cytology; Urothelial carcinoma.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Neoplasm Recurrence, Local
Nephrectomy / methods*
Outcome Assessment, Health Care / methods
Outcome Assessment, Health Care / statistics & numerical data
Predictive Value of Tests
Proportional Hazards Models
Retrospective Studies
Ureter / surgery*
Urine / cytology*
Urologic Neoplasms / diagnosis
Urologic Neoplasms / surgery*
Urologic Neoplasms / urine