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.
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Data availability
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
Abbreviations
- UTUC:
-
Upper tract urothelial carcinoma
- UC:
-
Urothelial carcinoma
- URS:
-
Ureterorenoscopy
- RNUx:
-
Radical nephroureterectomy
- BCE:
-
Bladder cuff excision
- IVR:
-
Intravesical recurrence
- OS:
-
Overall survival
- CSS:
-
Cancer-specific survival
- BRFS:
-
Bladder recurrence-free survival
- HR:
-
Hazard ratio
- CI:
-
Confidence index
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Acknowledgements
All members of the Taiwan Upper Tract Urothelial Carcinoma Collaboration group: Allen W. Chiu, Bing-Juin Chiang, Chao-Hsiang Chang, Chao-Yuan Huang, Cheng-Huang Shen, Cheng-Kuang Yang, Cheng-Ling Lee, Chen-Hsun Ho, Che-Wei Chang, Chia-Chang Wu, Chieh-Chun Liao, Chien-Hui Ou, Chih-Chen Hsu, Chih-Chin Yu, Chih-Hung Lin, Chih-Ming Lu, Chih-Yin Yeh, Ching-Chia Li, Chi-Ping Huang, Chi-Rei Yang, Chi-Wen Lo, Chuan-Shu Chen, Chung-Hsin Chen, Chung-You Tsai, Chung-Yu Lin, Chun-Hou Liao, Chun-Kai Hsu, Fang-Yu Ku, Hann-Chorng Kuo, Han-Yu Weng, Hao-Han Chang, Hong-Chiang Chang, Hsiao-Jen Chung, Hsin-Chih Yeh, Hsu-Che Huang, Ian-Seng Cheong, I-Hsuan Alan Chen, Jen-Kai Fang, Jen-Shu Tseng, Jen-Tai Lin, Jian-Hua Hong, Jih-Sheng Chen, Jungle Chi-Hsiang Wu, Kai-Jie Yu, Keng-Kok Tan, Kuan-Hsun Huang, Kun-Lin Hsieh, Lian-Ching Yu, Lun-Hsiang Yuan, Hao-Lun Luo, Marcelo Chen, Min-Hsin Yang, Pai-Yu Cheng, Po-Hung Lin, Richard Chen-Yu Wu, See-Tong Pang, Shin-Hong Chen, Shin-Mei Wong, Shiu-Dong Chung, Shi-Wei Huang, Shuo-Meng Wang, Shu-Yu,Wu, Steven Kuan-Hua Huang, Ta-Yao Tai, Thomas Y. Hsueh, Ting-En Tai, Victor Chia-Hsiang Lin, Wei-Chieh Chen, Wei-Ming Li, Wei-Yu Lin, Wen-Hsin Tseng, Wen-Jeng Wu, Wun-Rong Lin, Yao-Chou Tsai, Yen-Chuan Ou, Yeong-Chin Jou, Yeong-Shiau Pu, Yi-Chia Lin, Yi-Hsuan Wu, Yi-Huei Chang , Yi-sheng Lin, Yi-Sheng Tai, Yu-Khun Lee, Yuan-Hong Jiang, Yu-Che Hsieh, Yu-Chi Chen, Yu-Ching Wen, Yung-Tai Chen, Zhe-Rui Yang.
Funding
This study was supported partially by the Ministry of Science and Technology (MOST 111-2314-B-037-100-MY2), Kaohsiung Medical University Hospital (KMUH-DK(C)110006, kmuh-110-0R57), Kaohsiung Medical University Hospital Department of Urology (MOHW110-TDU-B-212-124006), Kaohsiung Medical University Regenerative Medicine and Cell Therapy Research Center (KMU-TC109A02), and Kaohsiung Medical University Center for Liquid Biopsy and Cohort Research (KMU-TC109B05).
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CYC: Data analysis, Manuscript writing and editing CHC: Data collection CRY: Data collection KLH: Data management WHT: Data management IHAC: Data management JTL: Data management CYH: Data collection JHH: Data collection JST: Data collection WRL: Data collection YCT: Data collection SYW: Data collection CHS: Data collection ISC: Data collection CSC: Data collection CKY: Data collection YHJ: Data collection CYT: Data collection TYH: Data collection YTC: Data collection CCW: Data collection SHL: Data collection BJC: Data collection WYL: Data collection PHL: Data collection TYT: Data management WML: Protocol development, Data analysis HYL: Project development, Data analysis.
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The study was performed in agreement with the applicable laws and regulations, good clinical practices, and ethical principles described in the Declaration of Helsinki. This study was approved by the Institutional Review Board of Kaohsiung Medical University Hospital (KMUHIRB-E(I)-20180214). Requirement for informed consent was waived by the Board.
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Chen, CY., Chang, CH., Yang, CR. et al. Prognostic factors of intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma. World J Urol 42, 22 (2024). https://doi.org/10.1007/s00345-023-04700-9
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DOI: https://doi.org/10.1007/s00345-023-04700-9