Abstract
BackgroundTo investigate the prognostic risk factors and postoperative recurrence of bladder cancer in patients with upper urinary tract urothelial carcinomas (UTUCs).MethodsData of 439 UTUC patients were retrospectively analyzed. Follow-up and analysis of smoking effects, consumption of traditional Chinese medicine containing aristolochic acid, history of bladder cancer, age, sex, presence or absence of diabetes mellitus (DM), metformin use, tumor characteristics (number, location, stage, grade), and open or laparoscopic surgery on the prognosis of UTUCs were performed. Cox proportional hazard regression analysis was performed to analyze the relationship between various factors and the postoperative survival rate. The survival rate was analyzed using the Kaplan-Meier method. Moreover, logistic regression analysis was performed to analyze the relationship between the above mentioned factors and postoperative recurrence of bladder cancer.ResultsOverall, 439 patients met, including 236 males (53.7%) and 203 females (46.3%), the criteria for the final statistical analysis, and the average age was 66.7 years. The 1-, 3-, and 5-year overall survival rates of 439 UTUC patients were 90.0, 76.4, and 67.7%, respectively. The 5-year survival rates of T1, T2, T3, and T4 patients were 90.2%, 78%, 43.8%, and 18.5%, respectively. Factors influencing the long-term survival rate of UTUC patients were smoking, taking traditional Chinese medicine containing aristolochic acid, history of bladder cancer, age, tumor size, tumor stage, tumor grade, and lymph node metastasis. The risk factors related to postoperative bladder cancer recurrence were advanced tumor stage, high grade tumor, preoperative ureteroscopy, ureteral urothelial carcinoma, no postoperative bladder perfusion chemotherapy and DM without metformin use.ConclusionsAdvanced tumor stage and presence of a high-grade tumor were risk factors for not only poor UTUC prognosis but also BC recurrence. In addition, preoperative ureteroscopy, ureteral urothelial carcinoma and DM without metformin use were high risk factors for BC recurrence, whereas regular postoperative bladder perfusion chemotherapy was a protective factor.
Highlights
To investigate the prognostic risk factors and postoperative recurrence of bladder cancer in patients with upper urinary tract urothelial carcinomas (UTUCs)
Since the epidemiology and disease characteristics may be related to different areas, along with factors influencing survival and tumor recurrence remain controversial, we developed a database of UTUC in our region to investigate the prognostic risk factors of UTUC and bladder cancer (BC) recurrence in central China
Tumor-associated death, BC recurrence rate, survival rate, risk factors for UTUCs, and BC recurrence were analyzed to predict the prognosis of patients with UTUC
Summary
To investigate the prognostic risk factors and postoperative recurrence of bladder cancer in patients with upper urinary tract urothelial carcinomas (UTUCs). UTUCs account for 20–30% of all transitional cell carcinomas (TCCs) in China, which is more common than that in Western countries [3, 4]. Contrary to findings in Western countries, UTUC with an advanced stage, large tumor size, and lymph node metastasis (LNM) are less likely to progress in female Chinese patients than in male Chinese patients [7]. This may be associated with diverse environmental factors, such as pure-arsenic exposure in drinking water and consumption of aristolochic acid in Chinese herbs [3, 8]
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