Predictive role of preoperative hydronephrosis on poor pathological outcomes and prognosis in upper tract urothelial carcinoma patients: Experience from a nationwide high-volume center in China

Abstract

Abstract.To validate the predictive value of preoperative hydronephrosis (HN) with regard to clinicopathological outcome and prognosis in a large cohort of upper tract urothelial carcinoma (UTUC) patients, a retrospective analysis was conducted using the clinicopathological data of 520 consecutive patients treated between 2000 and 2010 at a nationwide high-volume center in China. Preoperative computed tomography or magnetic resonance imaging scans were evaluated for the presence of ipsilateral HN, and the associations between HN and pathological outcomes, patient survival and urinary tract recurrences were assessed. Ipsilateral HN was present in 271 patients (52.1%). Preoperative HN was associated with advanced age (P=0.007), sessile tumor architecture (P<0.001), ureteral location (P<0.001), higher tumor stage (P<0.001) and higher histological grade (P=0.002). Univariate and multivariate analyses revealed that poorer cancer-specific survival (CSS) and overall survival (OS) times were correlated with preoperative HN (P=0.004 and P=0.009, respectively). The 5-year CSS and OS rates for patients with HN were 86.9 and 86.2%, respectively, compared to 93.3 and 91.9% for patients without HN. For patients with muscle-invasive disease, HN remained a risk factor for poor CSS and OS (P=0.009 and P=0.012, respectively). No association was identified between HN and bladder recurrence (P=0.552) or the development of contralateral upper tract carcinoma (P= 0.164). The findings indicated that preoperative HN is prevalent in UTUC. The presence of preoperative HN predicted poorer pathological outcomes and was a significant risk factor affecting survival. The evaluation of HN may be informative for decisions concerning surgical options, and the presence of HN should raise the possibility of employing an aggressive treatment approach.

The significance of the initial symptom in Chinese patients with upper tract urothelial carcinoma: Regular health examination is still underutilized

“…Although in recent years it has been commonly regarded that CT should be used more frequently than ultrasound in the diagnosis of UTUC [13,14] and there's no recommendation for the evaluation of UTUC patients by ultrasound per EAU guidelines [9], ultrasound is commonly used in regular health examinations in China (not only for kidney diseases but also for some intra‐peritoneal diseases), with hydronephrosis as the most suggestive finding of UTUC. It has been confirmed that the presence of hydronephrosis indicates worse pathological and prognostic outcomes [15–19]. In the current study, although no survival difference was observed, the relatively less aggressive pathological outcome in the S1 group supported the role of regular health examinations in the early diagnosis of UTUC.…”

Peer Review #1 of "Clinical and prognostic value of preoperative hydronephrosis in upper tract urothelial carcinoma: a systematic review and meta-analysis (v0.1)"

“…Hydronephrosis may also induce increased outward centrifugal pressure causing counter flow in lymphatics and vasculature, which may lead to increased cancer seeding (Chung et al, 2014). The presence of preoperative hydronephrosis is more common in UTUC than in bladder cancer, which may be attributed to a urinary tract obstruction of a small mass being more likely to occur in the ureter (Zhang et al, 2015). In addition, Stravodimos et al (Stravodimos et al, 2009), using immunohistochemical and morphological studies, found that hydronephrosis could lead to ischemic changes, along with increased expression of hypoxia-inducible factor-1a (HIF-1a), in UTUC.…”

“…Of the 14 studies, provided HR and % CI values directly; of the other 2 studies, one paper provided the relative risk (RR), and the other article provided OR values, which we used to estimate HR. Of the 14 studies, a significant association between preoperative hydronephrosis and poor CSS, OS, RFS or MFS was demonstrated in six (Chung et al, 2014;Liang et al, 2016;Ng et al, 2011;Yeh et al, 2015;Zhang et al, 2013;Zhang et al, 2015), four (Chapman et al, 2009;Liang et al, 2016;Yeh et al, 2015;Zhang et al, 2015), three (Chung et al, 2014;Hwang et al, 2013;Luo et al, 2013) or one (Ng et al, 2011) studies, respectively. Of the literature, the six (Bozzini et al, 2013;Sakano et al, 2013;Xing et al, 2016;Yeh et al, 2015;Zhang et al, 2016;Zou et al, 2014), two (Bozzini et al, 2013;Yeh et al, 2015), four (Chung et al, 2014;Liang et al, 2016;Luo et al, 2013;Ng et al, 2011) or three (Bozzini et al, 2013;Colin et al, 2014;Luo et al, 2013) studies linking preoperative hydronephrosis with poor CSS, OS, RFS or MFS, respectively, lacked statistical significance.…”

“…Initially, our search strategy identified 357 articles. A total of 19 studies published between 2007 and 2016 were included in the final meta-analysis (Bozzini et al, 2013;Chapman et al, 2009;Chen et al, 2013;Cho et al, 2007;Chung et al, 2014;Colin et al, 2014;Fradet et al, 2014;Hwang et al, 2013;Liang et al, 2016;Luo et al, 2013;Messer et al, 2013;Ng et al, 2011;Sakano et al, 2013;Xing et al, 2016;Yeh et al, 2015;Zhang et al, 2016;Zhang et al, 2013;Zhang et al, 2015;Zou et al, 2014) (Fig. 1).…”

“…1). Thirteen studies provided original information of the relationships between preoperative hydronephrosis and the clinicopathological parameters of UTUC patients directly (Bozzini et al, 2013;Chapman et al, 2009;Chen et al, 2013;Cho et al, 2007;Chung et al, 2014;Fradet et al, 2014;Hwang et al, 2013;Liang et al, 2016;Messer et al, 2013;Ng et al, 2011;Yeh et al, 2015;Zhang et al, 2013;Zhang et al, 2015). Fourteen articles assessed the prognostic value of preoperative hydronephrosis (CSS/OS/RFS/MFS) of UTUC patients using the Kaplan-Meier method (Bozzini et al, 2013;Chapman et al, 2009;Chung et al, 2014;Colin et al, 2014;Hwang et al, 2013;Liang et al, 2016;Luo et al, 2013;Ng et al, 2011;Sakano et al, 2013;Xing et al, 2016;Yeh et al, 2015;Zhang et al, 2016;Zhang et al, 2013;Zhang et al, 2015).…”