Prognostic Significance of Primary Tumor Location in Upper Tract Urothelial Carcinoma Treated with Nephroureterectomy: A Retrospective, Multi-Center Cohort Study in Taiwan

Abstract

We sought to examine the effect of tumor location on the prognosis of patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). This retrospective study came from the Taiwan UTUC Collaboration Group, which consisted of 2658 patients at 15 institutions in Taiwan from 1988 to 2019. Patients with kidney-sparing management, both renal pelvic and ureteral tumors, as well as patients lacking complete data were excluded; the remaining 1436 patients were divided into two groups: renal pelvic tumor (RPT) and ureteral tumor (UT), with 842 and 594 patients, respectively. RPT was associated with more aggressive pathological features, including higher pathological T stage (p < 0.001) and the presence of lymphovascular invasion (p = 0.002), whereas patients with UT often had synchronous bladder tumor (p < 0.001), and were more likely to bear multiple lesions (p = 0.001). Our multivariate analysis revealed that UT was a worse prognostic factor compared with RPT (overall survival: HR 1.408, 95% CI 1.121–1.767, p = 0.003; cancer-specific survival: HR 1.562, 95% CI 1.169–2.085, p = 0.003; disease-free survival: HR 1.363, 95% CI 1.095–1.697, p = 0.006; bladder-recurrence-free survival: HR 1.411, 95% CI 1.141–1.747, p = 0.002, respectively). Based on our findings, UT appeared to be more malignant and had a worse prognosis than RPT.

Low Hemoglobin-to-Red Cell Distribution Width Ratio Is Associated with Disease Progression and Poor Prognosis in Upper Tract Urothelial Carcinoma

“…Unlike Western populations [3], the gender distribution of UTUC patients in Taiwan is dominated by women. A multicenter cohort study of 1436 patients from 15 institutions in Taiwan showed that 58% were female [4]. Currently, radical nephroureterectomy with bladder cuff excision remains the gold standard for the treatment of high-risk UTUC [5].…”

The Predictive Value of Systemic Immune-inflammation Index on Bladder Recurrence on Upper Tract Urothelial Carcinoma Outcomes After Radical Nephroureterectomy

“…Several studies have attempted to identify prognostic factors in patients with UTUC [3][4][5][6]. These models are based on age, tumor grade, pathologic tumor grade, lymph node metastasis, lymphovascular invasion, tumor multifocality, and tumor architecture [3][4][5][6]. With the development of current genomics studies of UTUC [7], physicians can integrate the clinical pathologic characteristics with genetic and molecular subtyping of UTUC.…”

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

“…The current standard treatment for high-risk lesions is radical nephroureterectomy (RNU). However, disease recurrence or metastasis occurs in approximately 20–30% of patients 3 – 5 . Hence, to provide patients with better management options, a more precise and comprehensive UTUC assessment is needed.…”

“…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 . Whether the prognosis of the two tumors is different has therefore been a matter of debate, but recent studies agree that RPTs are associated with better outcomes 3 , 5 , 6 , 8 , 9 .…”

“…Conversely, UTs are more likely to be organ-confined and have a greater association with bladder tumor history or recurrence 5 , 7 . Whether the prognosis of the two tumors is different has therefore been a matter of debate, but recent studies agree that RPTs are associated with better outcomes 3 , 5 , 6 , 8 , 9 . A possible explanation for this includes the difference in the anatomical nature of RPTs vs UTs.…”