684 PREOPERATIVE RISK FACTORS FOR EXTRAVESICAL RECURRENCE IN PATIENTS WITH URETERAL CANCER WHO UNDERWENT RADICAL NEPHROURETERECTOMY

Abstract

You have accessJournal of UrologyUrothelial Cancer: upper Tract Tumors (I)1 Apr 2013684 PREOPERATIVE RISK FACTORS FOR EXTRAVESICAL RECURRENCE IN PATIENTS WITH URETERAL CANCER WHO UNDERWENT RADICAL NEPHROURETERECTOMY Keiichi Ito, Kenji Kuroda, Junichi Asakuma, Shinsuke Hamada, Kazuyoshi Tachi, Shinsuke Tasaki, Akinori Sato, Akio Horiguchi, Kenji Seguchi, and Tomohiko Asano Keiichi ItoKeiichi Ito Saitama, Japan More articles by this author , Kenji KurodaKenji Kuroda Saitama, Japan More articles by this author , Junichi AsakumaJunichi Asakuma Saitama, Japan More articles by this author , Shinsuke HamadaShinsuke Hamada Saitama, Japan More articles by this author , Kazuyoshi TachiKazuyoshi Tachi Saitama, Japan More articles by this author , Shinsuke TasakiShinsuke Tasaki Saitama, Japan More articles by this author , Akinori SatoAkinori Sato Saitama, Japan More articles by this author , Akio HoriguchiAkio Horiguchi Saitama, Japan More articles by this author , Kenji SeguchiKenji Seguchi Saitama, Japan More articles by this author , and Tomohiko AsanoTomohiko Asano Saitama, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.240AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent studies have suggested that lymph node dissection (LND) might improve prognosis in patients with upper tract urothelial carcinoma. Therefore, we have to select patients who need LND or those do not, preoperatively. Because patients who have extravesical recurrence (EVR) potentially include those whose prognosis are improved by LND, the present study was undertaken to determine preoperative predictors for EVR in ureteral cancer (UC). METHODS Because it is not appropriate to categorize preoperative radiological findings of UC and those of renal pelvic cancer using same classification criteria, we focused on the patients with UC in the present study. We reviewed preoperative factors including radiological findings and laboratory tests in 70 patients with UC who underwent radical nephroureterectomy since 1999 and whose tumors were pathologically diagnosed as urothelial carcinoma. Preoperative factors including age, gender, tumor side, tumor location, history of bladder cancer, urine cytology, laboratory tests (c-reactive protein, white blood cell counts, carcinoembryonic antigen, squamous cell carcinoma antigen, CA19-9, lactate dehydrogenase, neutrophil-to-lymphocyte ratio, and estimated glomerular filtration rate (eGFR)), multiplicity of UC in radiological examinations, grade of hydronephrosis, clinical T stage (cT3> or cT3≤), length of UC along the ureter (LUC), and maximal diameter of UC in the ureteral section (MDUC) of CT or MRI were evaluated. Extravesical recurrence-free survival (EV-RFS) rates were calculated by Kaplan-Meier method. To determine independent factors predicting EVR in patients with UC univariate and multivariate analyses were performed by cox's proportional hazards model. RESULTS The 1-, 3-, and 5-year EV-RFS rates were 77.7, 65.2, 62.7%, respectively. Positive cytology, cT3≤, LUC≥3 cm, MDUC≥1.5 cm, and eGFR<60 ml/min/1.73m2 were significant factors by univariate analysis. Positive cytology (p=0.0485), cT3≤ (p=0.0004), LUC≥3 cm (p=0.014), and eGFR<60 (p=0.0013) were independent predictors for EVR by multivariate analysis. When we stratified the patients to three groups according to the number of risk factors, the 3-year E-VRFS rates were 100% in low risk group (0 risk factor); 78.3% in intermediate risk group (1 or 2 risk factors); and 16.7% in high risk group (3 or 4 risk factors). CONCLUSIONS The 4 preoperative factors are predictors for extravesical recurrence in ureteral cancer. We may omit lymph node dissection at least for the patients who do not have the 4 factors. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e281 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Keiichi Ito Saitama, Japan More articles by this author Kenji Kuroda Saitama, Japan More articles by this author Junichi Asakuma Saitama, Japan More articles by this author Shinsuke Hamada Saitama, Japan More articles by this author Kazuyoshi Tachi Saitama, Japan More articles by this author Shinsuke Tasaki Saitama, Japan More articles by this author Akinori Sato Saitama, Japan More articles by this author Akio Horiguchi Saitama, Japan More articles by this author Kenji Seguchi Saitama, Japan More articles by this author Tomohiko Asano Saitama, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...