Significant clinicopathologic prognostic factors for bladder recurrence, progression, and cancer-specific survival after surgery among patients with upper urinary tract urothelial carcinoma.
Purpose
This study aimed to identify prognostic factors for outcomes after radical nephroureterectomy among patients with upper urinary tract urothelial carcinoma (UTUC).


Materials and Methods
We retrospectively reviewed 184 nonmetastatic cases of UTUC after radical nephroureterectomy, bladder cuffing, and/or partial cystectomy (2004-2016). Bladder recurrence-free survival (BRFS), disease progression-free survival (DPFS), and cancer-specific survival (CSS) were estimated. The prognostic values of clinicopathologic parameters were evaluated by using Cox logistic regression analysis.


Results
The median BRFS, DPFS, and CSS values were 19.0 months, 38.5 months, and 67.0 months, respectively. We identified cases of bladder recurrence (64 cases, 34.8%), disease progression (54 cases, 29.3%), and cancer-specific death (23 cases, 12.5%). BRFS was independently associated with lymphovascular invasion (hazard ratio [HR], 0.421); DPFS was associated with intravesical instillation (HR, 0.290), active smoking (HR, 0.367), synchronous bladder lesions (HR, 2.355), and pT2 (HR, 5.199) and pT3 and pT4 (HR, 13.281) stages; and CSS was associated with alkaline phosphatase levels (HR, 0.966). Among 123 cases without previous bladder cancer, DPFS was associated with intravesical instillation (HR, 0.264), multifocal ureteral tumors (HR, 4.823), and pT3 and pT4 stages (HR, 10.899), whereas CSS was associated with pTis (HR, 32.071).


Conclusions
Patients with the factors we identified should receive adjuvant intravesical/systemic chemotherapy and intensive surveillance.
['Kim|Sung Han|SH|0000-0002-1689-5203', 'Song|Mi Kyung|MK|0000-0003-3799-0426', 'Joung|Jae Young|JY|0000-0003-2954-1663', 'Chung|Jinsoo|J|0000-0003-2251-5331', 'Lee|Kang Hyun|KH|0000-0003-0041-2243', 'Seo|Ho Kyung|HK|0000-0003-2601-1093']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D002295:Carcinoma, Transitional Cell D018450:Disease Progression D018572:Disease-Free Survival D005260:Female D006801:Humans D007680:Kidney Neoplasms D008297:Male D008875:Middle Aged D009364:Neoplasm Recurrence, Local D009392:Nephrectomy D011379:Prognosis D012189:Retrospective Studies D015996:Survival Rate D014513:Ureter D014516:Ureteral Neoplasms D055815:Young Adult
Survival Nephroureterectomy Prognosis Risk factors Ureteral neoplasms