Intravesical recurrence in upper tract urothelial carcinoma patients after radical nephroureterectomy in Rajavithi Hospital

Abstract

Objective: Upper tract urothelial carcinoma (UTUC) is a malignant disease which is challenging to manage. The modalities for diagnosis and accurate clinical staging are limited, radical nephroureterectomy (RNU) with bladder cuff excision being the gold standard for treatment of UTUC. Subsequent intravesical recurrence (IVR) following RNU is a common problem. This study investigated the risk factors that affect IVR in Rajavithi Hospital. The objective of this study is to investigate whether the risk factors affect intravesical recurrence in UTUC patients after RNU. Materials and Methods: This retrospective study evaluated 94 patients who had undergone RNU in Rajavithi Hospital for UTUC between November 2006 and February 2021; 69 patients were included in the analysis. Data was analyzed to investigate risk factors that impact IVR and IVR-free survival using Kaplan-Meier and Cox proportional regression methods. Results: Out of 69 patients, at a mean follow up of 24 months, IVR occurred in 27 patients (39.1%). The overall postoperative 5-year IVR-free survival was 51.3%. Multivariate analysis indicated significant risk factors were high- grade tumor (adjusted HR = 3.47, 95%CI: 1.12-10.76, p = 0.031), ureterorenoscopy (URS) (adjusted HR = 3.45, 95%CI: 1.35-8.81, p = 0.01) and tumor multifocality (adjusted HR = 2.75, 95%CI: 1.02-7.38, p = 0.045). Postoperative 5-year IVR-free survival was significantly different for high-grade tumor compared with low-grade tumor (36.6% vs 82%, p = 0.006) and multiple tumors compared with a solitary tumor (18.4% vs 68.8%, p = 0.003) but there was no significant difference in URS compared with no URS (46.3% VS 51.6, p = 0.158). Conclusion: The risk factors that affect intravesical recurrence in UTUC patients after Radical nephroureterectomy are high-grade tumor, tumor multifocality, and URS.