Preoperative Pyuria Predicts for Intravesical Recurrence in Patients With Urothelial Carcinoma of the Upper Urinary Tract After Radical Nephroureterectomy Without a History of Bladder Cancer
| Autor: | Goro Sato, Takashi Yoshida, Ryoichi Saito, Tadashi Matsuda, Masaaki Yanishi, Hidefumi Kinoshita, Takashi Murota, Gen Kawa |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Urology Urinary Bladder 030232 urology & nephrology Kaplan-Meier Estimate Kidney Nephroureterectomy Risk Assessment 03 medical and health sciences 0302 clinical medicine Risk Factors Interquartile range medicine Humans Pyuria Aged Proportional Hazards Models Retrospective Studies Upper urinary tract Carcinoma Transitional Cell Univariate analysis Bladder cancer Ureteral Neoplasms business.industry Proportional hazards model Hazard ratio Margins of Excision medicine.disease Kidney Neoplasms Survival Rate Urinary Bladder Neoplasms Oncology 030220 oncology & carcinogenesis Preoperative Period Regression Analysis Female Ureter medicine.symptom Positive Surgical Margin business Follow-Up Studies |
| Zdroj: | Clinical Genitourinary Cancer. 18:e167-e173 |
| ISSN: | 1558-7673 |
| Popis: | Background We assessed preoperative pyuria as a significant predictor of intravesical recurrence (IVR) in patients with upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). Patients and Methods We evaluated the data from 268 patients with UTUC without a history of bladder cancer who had undergone RNU from 2006 to 2016 at 4 academic institutions. The associations between the clinical variables and the presence of pyuria were evaluated by univariate analysis. IVR was assessed using the Kaplan-Meier method and Cox regression analysis. Results The median postoperative follow-up of patients with IVR-free survival was 29.1 months (interquartile range, 15.4-55.3 months). The rate of IVR was significantly greater in the patients with than in those without pyuria (P = .025). Multivariate analysis showed that preoperative pyuria (hazard ratio [HR], 1.70; P = .007), a ureteral tumor site (HR, 1.64; P = .012), and positive surgical margins (HR, 2.70; P = .013) were associated with a significantly increased risk of IVR. A postoperative risk stratification model using these factors showed significant differences among the 3 subgroups of patients with low, intermediate, and high risk. The 5-year IVR-free survival rates for the patients with low, intermediate, and high risk were 69.1%, 51.8%, and 18.8%, respectively (P = .004). Conclusion Preoperative pyuria, a ureteral tumor site, and positive surgical margins were associated with a significantly increased risk of IVR. Although external validation is required, the presence of preoperative pyuria could be a significant predictor of IVR in patients with UTUC after RNU. |
| Databáze: | OpenAIRE |
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