Prognosis and risk factors of patients with upper urinary tract urothelial carcinoma and postoperative recurrence of bladder cancer in central China

Abstract

Background To investigate the prognostic risk factors and postoperative recurrence of bladder cancer in patients with upper urinary tract urothelial carcinomas (UTUCs). Methods Data of 439 UTUC patients were retrospectively analyzed. Follow-up and analysis of smoking effects, consumption of traditional Chinese medicine containing aristolochic acid, history of bladder cancer, age, sex, presence or absence of diabetes mellitus (DM), metformin use, tumor characteristics (number, location, stage, grade), and open or laparoscopic surgery on the prognosis of UTUCs were performed. Cox proportional hazard regression analysis was performed to analyze the relationship between various factors and the postoperative survival rate. The survival rate was analyzed using the Kaplan-Meier method. Moreover, logistic regression analysis was performed to analyze the relationship between the above mentioned factors and postoperative recurrence of bladder cancer. Results Overall, 439 patients met, including 236 males (53.7%) and 203 females (46.3%), the criteria for the final statistical analysis, and the average age was 66.7 years. The 1-, 3-, and 5-year overall survival rates of 439 UTUC patients were 90.0, 76.4, and 67.7%, respectively. The 5-year survival rates of T1, T2, T3, and T4 patients were 90.2%, 78%, 43.8%, and 18.5%, respectively. Factors influencing the long-term survival rate of UTUC patients were smoking, taking traditional Chinese medicine containing aristolochic acid, history of bladder cancer, age, tumor size, tumor stage, tumor grade, and lymph node metastasis. The risk factors related to postoperative bladder cancer recurrence were advanced tumor stage, high grade tumor, preoperative ureteroscopy, ureteral urothelial carcinoma, no postoperative bladder perfusion chemotherapy and DM without metformin use. Conclusions Advanced tumor stage and presence of a high-grade tumor were risk factors for not only poor UTUC prognosis but also BC recurrence. In addition, preoperative ureteroscopy, ureteral urothelial carcinoma and DM without metformin use were high risk factors for BC recurrence, whereas regular postoperative bladder perfusion chemotherapy was a protective factor.

Retroperitoneal laparoscopic partial resection of the renal pelvis for urothelial carcinoma: A case report

“…For example, patients with unifocal, < 2 cm, and low-grade lesions without local invasion are considered to have low-risk disease[ 9 ]. In the case of low-grade/low-stage TCC of the renal pelvis, open surgery is being replaced by endoscopic surgery[ 10 , 11 ]. However, ureteroscopic tumor ablation remains associated with a high risk of disease recurrence and progression due to inadequate assessment of risk stratification by imaging or tumor biopsy[ 9 ].…”

Pattern and risk factors of local recurrence after nephroureterectomy for upper tract urothelial carcinoma

“…Approximately 30% of patients with UTUC will have bladder recurrence (BR) [27,28]. Series of studies have been done on the prognosis and risk factors of bladder recurrence after surgery [28,29]. Our previous study found lower tumor grade, tumor multifocality, concomitant carcinoma in situ, and tumors located in the lower ureter were significant risk factors of bladder recurrence after RNU [27].…”

Tumor distribution affects bladder recurrence but not survival outcome of multifocal upper tract urothelial carcinoma treated with radical nephroureterectomy

“…The fact that UTUC spans two neighboring localities has led to the comparison of RPTs and UTs. The incidence of RPTs seem to be higher 3 , 6 , 7 than that of UTs and RPTs often present a more advanced disease stage at the time of diagnosis 6 , 7 . Conversely, UTs are more likely to be organ-confined and have a greater association with bladder tumor history or recurrence 5 , 7 .…”