Investigative and Clinical Urology

The Korean Urological Association (대한비뇨의학회)
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Significant clinicopathologic prognostic factors for bladder recurrence, progression, and cancer-specific survival after surgery among patients with upper urinary tract urothelial carcinoma

  • Kim, Sung Han (Department of Urology, Center for Urologic Cancer, National Cancer Center) ;
  • Song, Mi Kyung (Biometrics Research Branch, Division of Cancer Epidemiology and Prevention, Research Institute and Hospital of National Cancer Center) ;
  • Joung, Jae Young (Department of Urology, Center for Urologic Cancer, National Cancer Center) ;
  • Chung, Jinsoo (Department of Urology, Center for Urologic Cancer, National Cancer Center) ;
  • Lee, Kang Hyun (Department of Urology, Center for Urologic Cancer, National Cancer Center) ;
  • Seo, Ho Kyung (Department of Urology, Center for Urologic Cancer, National Cancer Center)
  • Received : 2019.04.09
  • Accepted : 2019.06.30
  • Published : 2019.11.22
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Abstract

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.

Keywords

Acknowledgement

We thank Ms. Eun Ji Lee for creating the database and performing the sorting processes. This work was supported by a grant (NCC1610230) from the National Cancer Center of the Republic of Korea.

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