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Prognostic factors of intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma

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World Journal of Urology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 26 February 2024

Abstract

Purpose

To evaluate predictive factors of increasing intravesical recurrence (IVR) rate in patients with upper tract urothelial carcinoma (UTUC) after receiving radical nephroureterectomy (RNUx) with bladder cuff excision (BCE).

Materials and methods

A total of 2114 patients were included from the updated data of the Taiwan UTUC Collaboration Group. It was divided into two groups: IVR-free and IVR after RNUx, with 1527 and 587 patients, respectively. To determine the factors affecting IVR, TNM stage, the usage of pre-operative ureteroscopy, and pathological outcomes were evaluated. The Kaplan–Meier estimator was used to estimate the rates of prognostic outcomes in overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS), and the survival curves were compared using the stratified log-rank test.

Results

Based on our research, ureter tumor, female, smoking history, age (< 70 years old), multifocal tumor, history of bladder cancer were determined to increase the risk of IVR after univariate analysis. The multivariable analysis revealed that female (BRFS for male: HR 0.566, 95% CI 0.469–0.681, p < 0.001), ureter tumor (BRFS: HR 1.359, 95% CI 1.133–1.631, p = 0.001), multifocal (BRFS: HR 1.200, 95% CI 1.001–1.439, p = 0.049), history of bladder cancer (BRFS: HR 1.480, 95% CI 1.118–1.959, p = 0.006) were the prognostic factors for IVR. Patients who ever received ureterorenoscopy (URS) did not increase the risk of IVR.

Conclusion

Patients with ureter tumor and previous bladder UC history are important factors to increase the risk of IVR after RNUx. Pre-operative URS manipulation is not associated with higher risk of IVR and diagnostic URS is feasible especially for insufficient information of image study. More frequent surveillance regimen may be needed for these patients.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Abbreviations

UTUC:

Upper tract urothelial carcinoma

UC:

Urothelial carcinoma

URS:

Ureterorenoscopy

RNUx:

Radical nephroureterectomy

BCE:

Bladder cuff excision

IVR:

Intravesical recurrence

OS:

Overall survival

CSS:

Cancer-specific survival

BRFS:

Bladder recurrence-free survival

HR:

Hazard ratio

CI:

Confidence index

References

  1. Margulis V, Shariat SF, Matin SF, Kamat AM, Zigeuner R, Kikuchi E et al (2009) Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer 115(6):1224–1233

    Article  PubMed  Google Scholar 

  2. Li CC, Chang TH, Wu WJ, Ke HL, Huang SP, Tsai PC et al (2008) Significant predictive factors for prognosis of primary upper urinary tract cancer after radical nephroureterectomy in Taiwanese patients. Eur Urol 54(5):1127–1134

    Article  PubMed  Google Scholar 

  3. Raman JD, Ng CK, Boorjian SA, Vaughan ED Jr, Sosa RE, Scherr DS (2005) Bladder cancer after managing upper urinary tract transitional cell carcinoma: predictive factors and pathology. BJU Int 96(7):1031–1035

    Article  PubMed  Google Scholar 

  4. Kikuchi E, Oya M (2016) Clinical practice patterns for upper tract urothelial carcinoma: a nationwide survey in Japan. Jpn J Clin Oncol 46(8):768–774

    Article  PubMed  Google Scholar 

  5. Xylinas E, Colin P, Audenet F, Phe V, Cormier L, Cussenot O et al (2013) Intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinomas: predictors and impact on subsequent oncological outcomes from a national multicenter study. World J Urol 31(1):61–68

    Article  PubMed  Google Scholar 

  6. Yu LC, Chang CH, Huang CP, Huang CY, Hong JH, Tai TY et al (2020) Prognostic significance of primary tumor location in upper tract urothelial carcinoma treated with nephroureterectomy: a retrospective, multi-center cohort study in Taiwan. J Clin Med. https://doi.org/10.3390/jcm9123866

    Article  PubMed  PubMed Central  Google Scholar 

  7. Audenet F, Isharwal S, Cha EK, Donoghue MTA, Drill EN, Ostrovnaya I et al (2019) Clonal relatedness and mutational differences between upper tract and bladder urothelial carcinoma. Clin Cancer Res 25(3):967–976

    Article  CAS  PubMed  Google Scholar 

  8. Jones TD, Wang M, Eble JN, MacLennan GT, Lopez-Beltran A, Zhang S et al (2005) Molecular evidence supporting field effect in urothelial carcinogenesis. Clin Cancer Res 11(18):6512–6519

    Article  CAS  PubMed  Google Scholar 

  9. Eau guidelines. Uroweb. (n.d.). Retrieved December 31, 2022, from https://uroweb.org/guidelines

  10. Soria F, Shariat SF, Lerner SP, Fritsche HM, Rink M, Kassouf W et al (2017) Epidemiology, diagnosis, preoperative evaluation and prognostic assessment of upper-tract urothelial carcinoma (UTUC). World J Urol 35(3):379–387

    Article  PubMed  Google Scholar 

  11. Chung JH, Song W, Kang M, Jeon HG, Jeong BC, Seo SI et al (2021) Conditional intravesical recurrence-free survival rate after radical nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma. Front Oncol 11:730114

    Article  PubMed  PubMed Central  Google Scholar 

  12. Douglawi A, Ghoreifi A, Lee R, Yip W, Seyedian SSL, Ahmadi H et al (2022) Bladder recurrence following diagnostic ureteroscopy in patients undergoing nephroureterectomy for upper tract urothelial cancer: is ureteral access sheath protective? Urology 160:142–146

    Article  PubMed  Google Scholar 

  13. Marchioni M, Primiceri G, Cindolo L, Hampton LJ, Grob MB, Guruli G et al (2017) Impact of diagnostic ureteroscopy on intravesical recurrence in patients undergoing radical nephroureterectomy for upper tract urothelial cancer: a systematic review and meta-analysis. BJU Int 120(3):313–319

    Article  PubMed  Google Scholar 

  14. Li YR, Yu KJ, Chang YH, Lin PH, Shao IH, Kan HC et al (2020) Predictors of intravesical recurrence after radical nephroureterectomy and prognosis in patients with upper tract urothelial carcinoma. Cancer Manag Res 12:7439–7450

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Luo HL, Kang CH, Chen YT, Chuang YC, Lee WC, Cheng YT et al (2013) Diagnostic ureteroscopy independently correlates with intravesical recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma. Ann Surg Oncol 20(9):3121–3126

    Article  PubMed  Google Scholar 

  16. Mertens LS, Sharma V, Matin SF, Boorjian SA, Houston Thompson R, van Rhijn BWG et al (2023) Bladder recurrence following upper tract surgery for urothelial carcinoma: a contemporary review of risk factors and management strategies. Eur Urol Open Sci 49:60–66

    Article  PubMed  PubMed Central  Google Scholar 

  17. Lee HY, Yeh HC, Wu WJ, He JS, Huang CN, Ke HL et al (2018) The diagnostic ureteroscopy before radical nephroureterectomy in upper urinary tract urothelial carcinoma is not associated with higher intravesical recurrence. World J Surg Oncol 16(1):135

    Article  PubMed  PubMed Central  Google Scholar 

  18. Novara G, De Marco V, Dalpiaz O, Gottardo F, Bouygues V, Galfano A et al (2008) Independent predictors of metachronous bladder transitional cell carcinoma (TCC) after nephroureterectomy for TCC of the upper urinary tract. BJU Int 101(11):1368–1374

    Article  PubMed  Google Scholar 

  19. Seisen T, Granger B, Colin P, Léon P, Utard G, Renard-Penna R et al (2015) A systematic review and meta-analysis of clinicopathologic factors linked to intravesical recurrence after radical nephroureterectomy to treat upper tract urothelial carcinoma. Eur Urol 67(6):1122–1133

    Article  PubMed  Google Scholar 

  20. Zhang X, Bu R, Liu Z, Wu B, Bai S (2020) Development and validation of a model for predicting intravesical recurrence in organ-confined upper urinary tract urothelial carcinoma patients after radical nephroureterectomy: a retrospective study in one center with long-term follow-up. Pathol Oncol Res 26(3):1741–1748

    Article  PubMed  Google Scholar 

  21. Roupret M, Babjuk M, Burger M, Capoun O, Cohen D, Comperat EM et al (2021) European association of urology guidelines on upper urinary tract urothelial carcinoma: 2020 update. Eur Urol 79(1):62–79

    Article  CAS  PubMed  Google Scholar 

  22. Lee CH, Ku JY, Jeong CW, Ku JH, Kwak C, Kim HH et al (2017) Predictors for intravesical recurrence following radical nephroureterectomy for upper tract urothelial carcinoma: a national multicenter analysis. Clin Genitourin Cancer 15(6):e1055–e1061

    Article  PubMed  Google Scholar 

  23. Uhlig A, Strauss A, Seif Amir Hosseini A, Lotz J, Trojan L, Schmid M et al (2018) Gender-specific differences in recurrence of non-muscle-invasive bladder cancer: a systematic review and meta-analysis. Eur Urol Focus 4(6):924–36

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

All members of the Taiwan Upper Tract Urothelial Carcinoma Collaboration group: Allen W. Chiu, Bing-Juin Chiang, Chao-Hsiang Chang, Chao-Yuan Huang, Cheng-Huang Shen, Cheng-Kuang Yang, Cheng-Ling Lee, Chen-Hsun Ho, Che-Wei Chang, Chia-Chang Wu, Chieh-Chun Liao, Chien-Hui Ou, Chih-Chen Hsu, Chih-Chin Yu, Chih-Hung Lin, Chih-Ming Lu, Chih-Yin Yeh, Ching-Chia Li, Chi-Ping Huang, Chi-Rei Yang, Chi-Wen Lo, Chuan-Shu Chen, Chung-Hsin Chen, Chung-You Tsai, Chung-Yu Lin, Chun-Hou Liao, Chun-Kai Hsu, Fang-Yu Ku, Hann-Chorng Kuo, Han-Yu Weng, Hao-Han Chang, Hong-Chiang Chang, Hsiao-Jen Chung, Hsin-Chih Yeh, Hsu-Che Huang, Ian-Seng Cheong, I-Hsuan Alan Chen, Jen-Kai Fang, Jen-Shu Tseng, Jen-Tai Lin, Jian-Hua Hong, Jih-Sheng Chen, Jungle Chi-Hsiang Wu, Kai-Jie Yu, Keng-Kok Tan, Kuan-Hsun Huang, Kun-Lin Hsieh, Lian-Ching Yu, Lun-Hsiang Yuan, Hao-Lun Luo, Marcelo Chen, Min-Hsin Yang, Pai-Yu Cheng, Po-Hung Lin, Richard Chen-Yu Wu, See-Tong Pang, Shin-Hong Chen, Shin-Mei Wong, Shiu-Dong Chung, Shi-Wei Huang, Shuo-Meng Wang, Shu-Yu,Wu, Steven Kuan-Hua Huang, Ta-Yao Tai, Thomas Y. Hsueh, Ting-En Tai, Victor Chia-Hsiang Lin, Wei-Chieh Chen, Wei-Ming Li, Wei-Yu Lin, Wen-Hsin Tseng, Wen-Jeng Wu, Wun-Rong Lin, Yao-Chou Tsai, Yen-Chuan Ou, Yeong-Chin Jou, Yeong-Shiau Pu, Yi-Chia Lin, Yi-Hsuan Wu, Yi-Huei Chang , Yi-sheng Lin, Yi-Sheng Tai, Yu-Khun Lee, Yuan-Hong Jiang, Yu-Che Hsieh, Yu-Chi Chen, Yu-Ching Wen, Yung-Tai Chen, Zhe-Rui Yang.

Funding

This study was supported partially by the Ministry of Science and Technology (MOST 111-2314-B-037-100-MY2), Kaohsiung Medical University Hospital (KMUH-DK(C)110006, kmuh-110-0R57), Kaohsiung Medical University Hospital Department of Urology (MOHW110-TDU-B-212-124006), Kaohsiung Medical University Regenerative Medicine and Cell Therapy Research Center (KMU-TC109A02), and Kaohsiung Medical University Center for Liquid Biopsy and Cohort Research (KMU-TC109B05).

Author information

Authors and Affiliations

  1. Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    Chen-Ya Chen, Wei-Ming Li & Hsiang-Ying Lee

  2. Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Wei-Ming Li & Hsiang-Ying Lee

  3. Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan

    Hsiang-Ying Lee

  4. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Hsiang-Ying Lee

  5. Department of Urology, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan

    Wei-Ming Li

  6. Department of Urology, China Medical University and Hospital, Taichung, Taiwan

    Chao-Hsiang Chang

  7. School of Medicine, China Medical University, Taichung, Taiwan

    Chao-Hsiang Chang

  8. Department of Urology, China Medical University Hospital, Taichung, Taiwan

    Chi-Rei Yang

  9. Division of Urology, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan

    Kun-Lin Hsieh & Wen-Hsin Tsing

  10. Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Kun-Lin Hsieh

  11. Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan

    Wen-Hsin Tsing

  12. Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan

    I-Hsuan Alan Chen & Jen-Tai Lin

  13. Department of Urology, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan

    Chao-Yuan Huang & Jian-Hua Hong

  14. Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan

    Jian-Hua Hong

  15. Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan

    Jen-Shu Tseng & Wun-Rong Lin

  16. Mackay Medical College, Taipei, Taiwan

    Jen-Shu Tseng & Wun-Rong Lin

  17. Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Jen-Shu Tseng

  18. Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan

    Yao-Chou Tsai & Shu-Yu Wu

  19. School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan

    Yao-Chou Tsai

  20. Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan

    Yao-Chou Tsai & Shih-Hsiu Lo

  21. Department of Urology, School of Medicine, Tzu Chi University, Hualien, Taiwan

    Shu-Yu Wu

  22. Department of Urology, Ditmanson Medical Foundation, Chiayi Christian Hospital, Chiayi, Taiwan

    Cheng-Huang Shen & Ian-Seng Cheong

  23. Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan

    Chuan-Shu Chen & Cheng-Kuang Yang

  24. Institute of Medicine, Chung Shan Medical University, Taichung City, Taiwan

    Chuan-Shu Chen

  25. Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung City, Taiwan

    Chuan-Shu Chen

  26. Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan

    Yuan-Hong Jiang

  27. Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan

    Chung-You Tsai

  28. Department of Electrical Engineering, Yuan Ze University, Taoyuan City, Taiwan

    Chung-You Tsai

  29. Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei City, Taiwan

    Thomas Y. Hsueh

  30. Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Thomas Y. Hsueh

  31. Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan

    Yung-Tai Chen

  32. Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Chia-Chang Wu

  33. Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Chia-Chang Wu

  34. TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan

    Chia-Chang Wu

  35. College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan

    Bing-Juin Chiang

  36. Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan

    Bing-Juin Chiang

  37. Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan

    Bing-Juin Chiang

  38. Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan

    Wei Yu Lin

  39. Chang Gung University of Science and Technology, Chia-Yi, Taiwan

    Wei Yu Lin

  40. Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Wei Yu Lin

  41. Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan

    Po-Hung Lin

  42. Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Po-Hung Lin

  43. School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Po-Hung Lin

  44. Department of Urology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan

    Ta-Yao Tai

Authors
  1. Chen-Ya Chen
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  2. Chao-Hsiang Chang
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  3. Chi-Rei Yang
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  18. Yuan-Hong Jiang
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  24. Bing-Juin Chiang
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  25. Wei Yu Lin
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  26. Po-Hung Lin
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  28. Wei-Ming Li
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Contributions

CYC: Data analysis, Manuscript writing and editing CHC: Data collection CRY: Data collection KLH: Data management WHT: Data management IHAC: Data management JTL: Data management CYH: Data collection JHH: Data collection JST: Data collection WRL: Data collection YCT: Data collection SYW: Data collection CHS: Data collection ISC: Data collection CSC: Data collection CKY: Data collection YHJ: Data collection CYT: Data collection TYH: Data collection YTC: Data collection CCW: Data collection SHL: Data collection BJC: Data collection WYL: Data collection PHL: Data collection TYT: Data management WML: Protocol development, Data analysis HYL: Project development, Data analysis.

Corresponding author

Correspondence to Hsiang-Ying Lee.

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None to be declared.

Ehics statement

The study was performed in agreement with the applicable laws and regulations, good clinical practices, and ethical principles described in the Declaration of Helsinki. This study was approved by the Institutional Review Board of Kaohsiung Medical University Hospital (KMUHIRB-E(I)-20180214). Requirement for informed consent was waived by the Board.

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Chen, CY., Chang, CH., Yang, CR. et al. Prognostic factors of intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma. World J Urol 42, 22 (2024). https://doi.org/10.1007/s00345-023-04700-9

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