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Preoperative Pyuria Predicts for Intravesical Recurrence in Patients With Urothelial Carcinoma of the Upper Urinary Tract After Radical Nephroureterectomy Without a History of Bladder Cancer.

Authors :
Sato G
Yoshida T
Yanishi M
Saito R
Murota T
Kawa G
Kinoshita H
Matsuda T
Source :
Clinical genitourinary cancer [Clin Genitourin Cancer] 2020 Apr; Vol. 18 (2), pp. e167-e173. Date of Electronic Publication: 2019 Sep 27.
Publication Year :
2020

Abstract

Background: We assessed preoperative pyuria as a significant predictor of intravesical recurrence (IVR) in patients with upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU).<br />Patients and Methods: We evaluated the data from 268 patients with UTUC without a history of bladder cancer who had undergone RNU from 2006 to 2016 at 4 academic institutions. The associations between the clinical variables and the presence of pyuria were evaluated by univariate analysis. IVR was assessed using the Kaplan-Meier method and Cox regression analysis.<br />Results: The median postoperative follow-up of patients with IVR-free survival was 29.1 months (interquartile range, 15.4-55.3 months). The rate of IVR was significantly greater in the patients with than in those without pyuria (P = .025). Multivariate analysis showed that preoperative pyuria (hazard ratio [HR], 1.70; P = .007), a ureteral tumor site (HR, 1.64; P = .012), and positive surgical margins (HR, 2.70; P = .013) were associated with a significantly increased risk of IVR. A postoperative risk stratification model using these factors showed significant differences among the 3 subgroups of patients with low, intermediate, and high risk. The 5-year IVR-free survival rates for the patients with low, intermediate, and high risk were 69.1%, 51.8%, and 18.8%, respectively (P = .004).<br />Conclusion: Preoperative pyuria, a ureteral tumor site, and positive surgical margins were associated with a significantly increased risk of IVR. Although external validation is required, the presence of preoperative pyuria could be a significant predictor of IVR in patients with UTUC after RNU.<br /> (Copyright © 2019 Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1938-0682
Volume :
18
Issue :
2
Database :
MEDLINE
Journal :
Clinical genitourinary cancer
Publication Type :
Academic Journal
Accession number :
31635939
Full Text :
https://doi.org/10.1016/j.clgc.2019.09.017