Abstract
BackgroundTo clarify if diagnostic ureteroscopy (URS) before radical nephroureterectomy for patients with upper tract urothelial carcinoma (UTUC) will increase the risk of intravesical recurrence.MethodsFrom retrospective review of cohort at our institution, 502 patients with UTUC who underwent radical nephroureterectomy with bladder cuff excision were enrolled from 1990 to 2013. Cox proportional hazards model was used to analyze the overall survival (OS), disease-free survival (DFS), metastasis-free survival (MFS), and intravesical recurrence-free survival (IVRFS). The log-rank test was used for comparing survival curves. All potential risk factors were included in the multivariate Cox proportional hazards model to recognize independent predictors. From NHI database, we included patients of UTUC without bladder cancer history using population-based database in Taiwan from 1996 to 2013. In total, 3079 URS and 2634 non-URS patients with UTUC were identified. Univariate and multivariate Cox proportional hazards regressions were performed to measure the risk of IVRFS and all-cause mortality.ResultsFrom our database, the comparison of clinicopathological characteristics in UTUC patients between with URS biopsy group (URS+) (n = 206, 41%) and without URS biopsy group (URS−) (n = 296, 59%) was insignificantly different excluding surgical method. URS biopsy is not associated with worse OS (p = 0.720), DFS (p = 0.294), MFS (p = 0.808), and IVRFS (p = 0.560) by multivariate analysis. Only bladder cancer history is an independent significant factor to predict IVR (p < 0.001). The same result from NHI database, URS before radical surgery will not increase the risk of IVRFS [adjusted HR 1.136, 95% CI 1.00–1.30; P = 0.059] and OS [adjusted HR 0.919, 95% CI 0.82–1.04; P = 0.164].ConclusionsPreoperative URS manipulation is not associated with higher risk of IVRFS even in patients without bladder cancer history. Diagnostic URS is feasible to compensate the insufficient information of image in patients with UTUC.
Highlights
To clarify if diagnostic ureteroscopy (URS) before radical nephroureterectomy for patients with upper tract urothelial carcinoma (UTUC) will increase the risk of intravesical recurrence
We evaluated the influence of URS biopsy on survival, metastasis, and especially focus on intravesical recurrence (IVR) and to analyze if delay of the curative treatment will cause worse survival
From the univariate analysis indicated that advanced T stage, higher tumor grade, lymph node involvement, and multifocality were significantly related to lower DSS rates
Summary
To clarify if diagnostic ureteroscopy (URS) before radical nephroureterectomy for patients with upper tract urothelial carcinoma (UTUC) will increase the risk of intravesical recurrence. Upper tract urothelial carcinoma (UTUC), involving renal pelvis and ureter, is rare in western countries but presents an unusual feature in Taiwan. Because URS allows direct visualization of the entire collecting system, when combined with biopsies, it can increase the detection rate of UTUC lesions [6, 7]. The raising about the possibility of backflow of malignant urothelial cells and tumor seeding during URS evaluation is to be considered to induce higher risk of intravesical recurrence (IVR). URS has been reported to be safe [10,11,12], more evidences are needed to establish that this procedure is not harmful for patients with UTUC. The impact of delay radical treatment because of previous URS biopsy is still controversial
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