Preoperative positive voided urine cytology predicts poor clinical outcomes in patients with upper tract urothelial carcinoma undergoing nephroureterectomy

Abstract

Background Performance of urinary cytology is recommended as the part of a standard diagnostic workup and base surveillance regimens in upper tract urothelial carcinoma (UTUC). However, the effect of positive voided urine cytology (VUC) on UTUC prognosis, compared with negative VUC, has not been fully demonstrated. This study aimed to evaluate the impact of preoperative VUC on predicting intravesical recurrence, disease recurrence, and mortality in patients with UTUC who underwent nephroureterectomy (RNU). Methods Clinicopathological information was collected from 315 UTUC patients treated with RNU. The association between VUC and oncological outcomes was analyzed using the Kaplan–Meier method with log-rank test and Cox proportional hazards regression models. Multiple logistic regression analysis was performed to identify the influence of VUC on tumor grade. Results Preoperative positive VUC, presenting in 101 patients (32%), was significantly associated with tumor multifocality (P = 0.017) and higher tumor grade (P = 0.010). On multivariable Cox regression analyses, preoperative positive VUC was an independent prognostic factor of intravesical recurrence-free survival (RFS) (hazard ratio [HR] = 2.21, 95% confidence interval [CI] 1.06–4.64; P = 0.035), RFS (HR = 1.80, 95% CI 1.08–2.99; P = 0.023), and cancer-specific survival (CSS) (HR = 1.87, 95% CI 1.10–3.18; P = 0.020), but not overall survival (HR = 1.32, 95% CI 0.80–2.18; P = 0.28). Logistic regression analysis revealed that VUC was related to high tumor grade in UTUC (odds ratio = 2.23, 95%CI 1.15–4.52). Conclusion Preoperative positive VUC significantly increases the risk of intravesical recurrence in UTUC patients undergoing RNU. In addition, positive VUC is an adverse predictor of RFS and CSS, which might be due to the association between positive VUC and high tumor grade.

Predictive Value of Preoperative Positive Urine Cytology for Development of Bladder Cancer After Nephroureterectomy in Patients With Upper Urinary Tract Urothelial Carcinoma: A Prognostic Nomogram Based on a Retrospective Multicenter Cohort Study and Systematic Meta-Analysis

“…According to the judgment of the physician, urine samples for cytological examination were collected one to three times. The specimens with preoperative positive urine cytology could be detected by the following findings: 1) malignancy voided urine cells, 2) suspicious voided urine cells, and 3) both (28,29). Other cases were all deemed negative samples.…”

“…One, four, and nine studies assessed patients from Korea (21), China (23,24,28), and Japan (30,(33)(34)(35)(36)(37)(38)(39)(40), respectively. In addition, one, three, and four studies were RCT (36), case-control (21,35,38), and single-arm studies (23,37,39,40), respectively, and the others were retrospective cohort searches (24,28,30,33,34). The size of the studies varied from 36 to 1,563, with a total number of 6,140 patients.…”

“…Considering the selected articles from 2007 to 2021, four studies were retrospective cohort studies (28,30,41), and the remaining were case-control studies (29,(42)(43)(44)(45)(46). There were four studies from China (28,42,45), two studies from America (29,41), one study from Germany (43), two studies from Japan (30,46), and one study from Spain (44). In these studies, nine of them involved the risk of high-grade UUT-UC (28)(29)(30)(41)(42)(43)(44)(45).…”

“…There were four studies from China (28,42,45), two studies from America (29,41), one study from Germany (43), two studies from Japan (30,46), and one study from Spain (44). In these studies, nine of them involved the risk of high-grade UUT-UC (28)(29)(30)(41)(42)(43)(44)(45). The risks of muscle-invasive UUT-UC and lymphovascular-invasive UUT-UC emerged in seven studies (30,(41)(42)(43)(44)(45) and three studies (28,30,46), respectively.…”

“…In these studies, nine of them involved the risk of high-grade UUT-UC (28)(29)(30)(41)(42)(43)(44)(45). The risks of muscle-invasive UUT-UC and lymphovascular-invasive UUT-UC emerged in seven studies (30,(41)(42)(43)(44)(45) and three studies (28,30,46), respectively.…”