The Prognostic Impact of Tumor Location in pT3N0M0 Upper Urinary Tract Urothelial Carcinoma: A Retrospective Cohort Study

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

doi:10.3389/fonc.2022.850874

The Prognostic Impact of Tumor Location in pT3N0M0 Upper Urinary Tract Urothelial Carcinoma: A Retrospective Cohort Study

Front Oncol. 2022 Mar 15:12:850874. doi: 10.3389/fonc.2022.850874. eCollection 2022.

Authors

Tzu Shuang Chen¹, Yen Ta Chen¹, Hung Jen Wang¹, Po Hui Chiang², Wen Chou Yang¹, Wei Ching Lee¹, Yao Chi Chuang¹, Yuan Tso Cheng¹, Chih Hsiung Kang¹, Wei Chia Lee¹, Chien Hsu Chen¹, Yuan Chi Shen¹, Yi Yang Liu¹, Hui Ying Liu¹, Yin Lun Chang¹, Yu Li Su³, Chun Chieh Huang⁴, Hao Lun Luo¹

Affiliations

¹ Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
² Jhong Siao Urological Hospital, Kaohsiung, Taiwan.
³ Department of Hematology and Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
⁴ Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Abstract

Background: We aimed to evaluate the impact of tumor location on cancer outcomes in patients with pT3N0M0 upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU) with bladder cuff excision.

Materials and methods: We retrospectively reviewed 302 patients with pT3N0M0 UTUC who underwent RNU with bladder cuff excision at our institution between 2005 and 2019, including 191 renal pelvis tumors and 111 ureteral tumors. Clinicopathologic characteristics were compared between renal pelvis and ureter urothelial carcinomas. Multivariate Cox proportional hazard regression was used to assess the association between outcomes and clinical factors. Outcomes of interest included intravesical recurrence-free survival (IVRFS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and cancer-specific survival (CSS), which were measured using the Kaplan-Meier curve with a log-rank test.

Results: A total of 302 patients underwent RNU with bladder cuff excision. During the median follow-up of 42.7 months, 70 (23.2%), 95 (31.5%), and 99 (32.8%) patients experienced intravesical recurrence, local recurrence, and distant metastasis, respectively. Seventy (23.2%) patients died from UTUC. Multivariate Cox regression analysis showed that tumor location was an independent predictor of local recurrence (HR = 2.05, p = 0.001), with borderline independent significance in intravesical recurrence (HR = 1.54, p = 0.074) and distant metastasis (HR = 1.45, p = 0.08). Kaplan-Meier analysis showed that ureter tumors had a worse 5-year local recurrence (log-rank p < 0.001) and borderline worse 5-year intravesical recurrence (log-rank p = 0.055) and 5-year distant metastasis (log-rank p = 0.073).

Conclusion: Ureter tumors seem to be associated with worse oncological outcomes, especially with local recurrence in UTUC. Further large and long-term studies are warranted for investigating biological differences based on tumor location.

Keywords: oncological outcomes; pT3N0M0; radical nephroureterectomy; tumor location; upper urinary tract urothelial carcinoma.