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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.
- 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.)
- Subjects :
- Aged
Carcinoma, Transitional Cell secondary
Carcinoma, Transitional Cell surgery
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Kidney pathology
Kidney surgery
Kidney Neoplasms mortality
Kidney Neoplasms pathology
Kidney Neoplasms urine
Male
Margins of Excision
Preoperative Period
Proportional Hazards Models
Regression Analysis
Retrospective Studies
Risk Assessment methods
Risk Factors
Survival Rate
Ureter pathology
Ureter surgery
Ureteral Neoplasms mortality
Ureteral Neoplasms pathology
Ureteral Neoplasms urine
Urinary Bladder pathology
Urinary Bladder Neoplasms secondary
Urinary Bladder Neoplasms surgery
Urinary Bladder Neoplasms urine
Carcinoma, Transitional Cell epidemiology
Kidney Neoplasms surgery
Nephroureterectomy
Pyuria epidemiology
Ureteral Neoplasms surgery
Urinary Bladder Neoplasms epidemiology
Subjects
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