Risk Factors and Predictive Value of Local Recurrence in Chinese Upper Tract Urothelial Carcinoma Patients: Implication for Postoperative Adjuvant Radiation Therapy

Abstract

Lymph node dissection (LND) for UTUC at the time of radical nephroureterectomy (RNU) is not routine. Patients experienced local relapse rate after surgery, this ratio can reach up to 30% in advanced stage. There is little research about the risk factors of local recurrence in UTUC patients after surgery, especially in the Chinese population. This study aim to evaluate the influence of factors and the predictive value of local recurrence in patents with upper tract urothelial carcinoma (UTUC) after nephroureterectomy and found implications for postoperative adjuvant radiotherapy. We retrospectively analyzed the clinical and pathological data of the patients with upper tract urothelial carcinoma (UTUC), who underwent nephroureterectomy between 2010 and 2016 in our center. Patients with postadjuvant radiation therapy were not enrolled in our study. We retrospectively analyzed the clinical data 330 patients after radical nephroureterectomy. With a median follow-up of 47 m (range: 4-110 months), local recurrence occurred in 73 patients (22.1%). The median interval of local recurrence was 39 months (range: 1-80 months). The probability of local recurrence-free survival at 12, 36, and 60 m was 96.2%, 90.9%, and 86.8%, respectively. Univariate and multivariate logistic regression analysis was used to address the prediction for local recurrence. In univariate analyses, statistically significant factors influencing the local recurrence were tumor multifocality, T stage, G grade, tumor location, LVI, and positive margin. In multivariate analysis tumor multifocality, T stage, G grade were significant risk factors influencing the local recurrence (P < 0.001). Local recurrence rate in T1-4 were 9.0%, 17.2%, 43%, and 37.5%. No patients experienced local recurrence in G1 grade, while 39.4% patients in G3 grade had local recurrence. Local recurrence rate was much higher in patients with multifocality (39.3% vs 18.6%, P < 0.001). Between the local recurrence group and non-local recurrence group there were statistically significant differences in 5-year metastasis recurrence-free survival (51.2% vs 93.9%, p < 0.01)and 5-year overall survival (47.1% vs 78.2%, p < 0.01). There were no significant differences in 5-year bladder recurrence survival between the two groups (66.5% vs 68.5%, P = 0.321). Local recurrence after RNU is a common event in patients with UTUC especially in T3 and T4 group. Patients with high Grade and multifocality were at high risk of recurrence. Patients with local recurrence tended to develop a metastasis recurrence and have a poor OS. This study implies some patients with high-risk local recurrence may benefit from postoperative adjuvant radiation therapy.