Predictors of Intravesical Recurrence After Radical Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma: An Inflammation-Based Prognostic Score

Abstract

PurposeSystemic inflammatory responses, which are defined in terms of the Glasgow prognostic score (GPS), have been reported to be independent predictors of unfavorable outcomes in various human cancers. We assessed the utility of the GPS as a predictor of intravesical recurrence after radical nephroureterectomy (RNU) in upper urinary tract carcinoma (UTUC).Materials and MethodsWe collected data for 147 UTUC patients with no previous history of bladder cancer who underwent RNU from 2004 to 2012. Associations between perioperative clinicopathological variables and intravesical recurrence were analyzed by using univariate and multivariate Cox regression models.ResultsOverall, 71 of 147 patients (48%) developed intravesical recurrence, including 21 patients (30%) diagnosed with synchronous bladder tumor. In the univariate analysis, performance status, diabetes mellitus (DM), serum albumin, C-reactive protein, GPS, and synchronous bladder tumor were associated with intravesical recurrence. In the multivariate analysis, performance status (hazard ratio [HR], 2.33; 95% confidence interval [CI], 1.41-3.85; p=0.001), DM (HR, 2.04; 95% CI, 1.21-3.41; p=0.007), cortical thinning (HR, 2.01; 95% CI, 1.08-3.71; p=0.026), and GPS (score of 1: HR, 6.86; 95% CI, 3.69-12.7; p=0.001; score of 2: HR, 5.96; 95% CI, 3.10-11.4; p=0.001) were independent predictors of intravesical recurrence.ConclusionsOur results suggest that the GPS as well as performance status, DM, and cortical thinning are associated with intravesical recurrence after RNU. Thus, more careful follow-up, coupled with postoperative intravesical therapy to avoid bladder recurrence, should be considered in these patients.

Role of systemic inflammatory response markers in urological malignancy

“…reported non‐organ‐confined disease and Cho et al . reported intravesical recurrence . Four studies showed a prognostic value of GPS/mGPS in relation to OS or RFS: increased GPS/mGPS was significantly associated with worse prognosis.…”

“…A summary of six studies investigating the prognostic role of GPS/mGPS in UC is shown in Table . Four studies examined patients with bladder cancer, and two studies examined patients with upper tract UC.…”

Can lymphovascular invasion replace the prognostic value of lymph node involvement in patients with upper tract urothelial carcinoma after radical nephroureterectomy?

“…28,29,32,33 A recent study among Korean UTUC patients showed that LVI was not a significant predictor for OS. 9 In a Taiwanese study by Lee et al, LVI represented a significant prognosticator for both CSS and MFS in multivariate analysis only in patients with ureteral tumours, but not in those with pyelocaliceal tumours. 34 In other words, LVI failed to be independently associated with CSS and MFS in pyelocaliceal tumours.…”

“…[1][2][3][4][5] Approximately 20-40% of patients initially present with locally advanced disease and lymph node (LN) metastases at the time of diagnosis. [6][7][8][9] Recently, Margulis et al identified age, high tumour grade, high pathological T stage, LN metastasis, sessile architecture, an infiltrative growth pattern, and lymphovascular invasion (LVI) as independent prognostic indicators of disease recurrence and cancer-specific survival (CSS). 8 Tumour stage, grade, and LVI are independent predictors of clinical outcome in patients with UTUC; 10,11 however, knowledge of assessable prognostic factors in UTUC is still limited.…”

Managing noninvasive recurrences after definitive treatment for muscle-invasive bladder cancer or high-grade upper tract urothelial carcinoma

“…3) Recurrence rates following definitive therapy vary widely, reflecting differences in location and extent of disease at presentation, including higher stages/ grades of disease, smoking, positive surgical margins, and success of the primary treatment modality [9,33]. Specifically, risk factors for UTUC recurrence include: tumor characteristics (size, location, multifocality, lymphovascular invasion, higher disease stage, positive surgical margins) and patient characteristics (male gender, Glasgow prognostic score, performance status, diabetes, prior positive urine cytology) [34][35][36][37]. An accepted standard of care for recurrent disease of the UTUC remains elusive to date.…”