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
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
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DOI：
10.1016/j.clgc.2019.09.017
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发表时间：
2020-04-01
影响因子：
3.2
通讯作者：
Matsuda, Tadashi
中科院分区：
文献类型：
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作者：
Sato, Goro;Yoshida, Takashi;Matsuda, Tadashi
我们评估了术前脓尿是上尿路上皮癌患者根治性肾输尿管切除术后膀胱内复发（IVR）的重要预测因素。在268例患者中，有脓尿者IVR发生率明显高于无脓尿者。术前脓尿、输尿管肿瘤部位和手术切缘阳性与IVR.Background的风险显著增加相关：我们评估了术前脓尿作为上尿路尿路上皮癌（UTUC）患者根治性肾输尿管切除术（RNU）后膀胱内复发（IVR）的重要预测因素。患者和方法：我们评估了2006年至2016年在4个学术机构接受RNU的268例无膀胱癌病史的UTUC患者的数据。通过单因素分析评估临床变量与脓尿存在之间的相关性。使用Kaplan-Meier方法和考克斯回归分析评估IVR。结果：无IVR患者的中位术后随访时间为29.1个月（四分位距，15.4-55.3个月）。有脓尿的患者IVR发生率显著高于无脓尿的患者（P= 0.025）。多变量分析显示，术前脓尿（风险比[HR]，1.70; P = 0.007）、输尿管肿瘤部位（HR，1.64; P = 0.012）和手术切缘阳性（HR，2.70; P = 0.013）与IVR风险显著增加相关。使用这些因素的术后风险分层模型显示，低、中、高风险患者3个亚组之间存在显着差异。低、中和高风险患者的5年无IVR生存率分别为69.1%、51.8%和18.8%（P = 0.004）。结论：术前脓尿、输尿管肿瘤部位和手术切缘阳性与IVR风险显著增加相关。虽然需要外部验证，但术前脓尿的存在可能是UTUC患者RNU后IVR的重要预测因素。(C)2019爱思唯尔公司All rights reserved.
We assessed preoperative pyuria as a significant predictor of intravesical recurrence (IVR) in patients with upper urinary tract urothelial carcinoma after radical nephroureterectomy. Among 268 patients, the rate of IVR was significantly greater in the patients with compared with those without pyuria. Preoperative pyuria, a ureteral tumor site, and a positive surgical margin were associated with a significantly increased risk of IVR.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). 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. 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). 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. (C) 2019 Elsevier Inc. All rights reserved.