Predictors for Intravesical Recurrence Following Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A National Multicenter Analysis

Abstract

The purpose of this study was to identify the prognostic impact of intravesical recurrence (IVR) on oncologic outcomes and the clinicopathologic factors that predict IVR in patients who undergo radical nephroureterectomy (RNU) for upper tract urothelial carcinoma. Between January 2000 and December 2015, 760 patients with upper tract urothelial carcinoma underwent RNU at 5 institutions in Korea, and patient data were retrospectively collected. Clinicopathologic factors were analyzed for intravesical recurrence-free survival, cancer-specific survival (CSS), and overall survival (OS). Univariate and multivariate Cox proportional hazards regression models were used to test the clinicopathologic factors on IVR. Of the 760 patients, 231 (30.3%) patients experienced IVR within 10 months of the median interval between RNU and the first IVR. The overall estimated probabilities of 5-year CSS, intravesical recurrence-free survival, and OS were 84.2%, 63.8%, and 79.2%, respectively. No difference was noted in terms of CSS and OS between the patients who did or did not experience IVR. The multivariate Cox analysis showed an association between IVR and positive hydronephrosis, tumor size, positive preoperative urinary cytology, and ureterorenoscopy before RNU (all P< .05). However, a significantly decreased riskof IVR was associated with female gender, laparoscopic RNU, and receipt of adjuvant systemic chemotherapy (allP< .05). The occurrence of IVR following RNU did not affect CSS and OS. Patients with larger tumor size, preoperative hydronephrosis, positive preoperative urinary cytology, and ureterorenoscopy before RNU had a higher risk of IVR following RNU.