Detecting asymptomatic recurrence after radical nephroureterectomy contributes to better prognosis in patients with upper urinary tract urothelial carcinoma.

Hirotaka Horiguchi,Chikara Ohyama,Hirotake Kodama,Masaki Momota,Yuka Kubota,Go Anan,Makoto Sato,Toshiaki Kawaguchi,Kazuaki Yoshikawa,Yuki Tobisawa,Yasuhiro Hashimoto,Takahiro Yoneyama,Hiroyuki Ito,Tohru Yoneyama,Hayato Yamamoto,Takuya Koie,Koichi Kido,Shingo Hatakeyama

doi:10.18632/oncotarget.23982

Abstract

BackgroundThe prognostic benefit of regular follow-up to detect asymptomatic recurrence after radical nephroureterectomy (RNU) remains unclear. We aimed to assess whether regular follow-up to detect asymptomatic recurrence after RNU improves patient survival.Materials and MethodsWe retrospectively analysed 415 patients who underwent RNU for upper tract urothelial carcinoma at four hospitals between January 1995 and February 2017. All patients had regular follow-up examinations after RNU including urine cytology, blood biochemical tests, and computed tomography. We investigated the first site and date of tumor recurrence. Overall survivals of patients who developed recurrence, stratified by mode of recurrence (asymptomatic vs. symptomatic group), were estimated using the Kaplan–Meier method with the log–rank test. Cox proportional hazards regression analysis was performed using inverse probability of treatment weighting (IPTW) to evaluate the impact of the mode of recurrence on survival.ResultsOf the 415 patients, 108 (26%) experienced disease recurrences after RNU. Of these, 62 (57%) were asymptomatic and 46 (43%) were symptomatic at the time of diagnosis. The most common recurrence site and symptom were lymph nodes and pain, respectively. Overall survival after RNU and time from recurrence to death in the asymptomatic group were significantly longer than that in the symptomatic group. Multivariate Cox regression analysis showed that symptomatic recurrence was an independent risk factor for overall survival after RNU and survival from recurrence to death.ConclusionsRoutine oncological follow-up for detection of asymptomatic recurrence contributes to a better prognosis after RNU.

Highlights

Upper tract urothelial carcinoma (UTUC) is a relatively rare disease, and prognosis of patients with advanced UTUC has not improved over the past two decades [1, 2]
Multivariate Cox regression analysis showed that symptomatic recurrence was an independent risk factor for overall survival after radical nephroureterectomy (RNU) and survival from recurrence to death
Routine oncological follow-up for detection of asymptomatic recurrence contributes to a better prognosis after RNU

Summary

Introduction

Upper tract urothelial carcinoma (UTUC) is a relatively rare disease, and prognosis of patients with advanced UTUC has not improved over the past two decades [1, 2]. Radical nephroureterectomy with bladder cuff excision (RNU) remains the standard treatment modality for UTUC patients, and regular oncological surveillance after RNU is necessary. The rationale for regular oncological surveillance is to detect tumor recurrence at an early stage so that it can be cured or at least treated with a better prognosis. Most studies found no survival benefit accruing from regular follow-up of patients with colorectal [3, 4], breast [5], endometrial [6], and lung cancers [7]. In UTUC, there is no evidence to prove if routine oncological follow-up after RNU to detect asymptomatic recurrence improves patient survival. The prognostic benefit of regular follow-up to detect asymptomatic recurrence after radical nephroureterectomy (RNU) remains unclear. We aimed to assess whether regular follow-up to detect asymptomatic recurrence after RNU improves patient survival

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