Tumour multifocality and grade predict intravesical recurrence after nephroureterectomy in patients with upper urinary tract urothelial carcinoma without a history of bladder cancer

Abstract

Objective: Patients with upper urinary tract urothelial carcinoma (UUT-UC) without a history of bladder cancer have a different natural history of intravesical recurrence after nephroureterectomy compared with those with a history of bladder cancer. The aim of this study was to identify predictive factors for post-operative intravesical recurrence in patients with non-metastatic upper urinary tract-localized urothelial carcinoma without a history of bladder cancer and who were not taking medication during the perioperative period. Methods: This retrospective study included 133 patients who were treated between 1995 and 2012. Univariate and multivariate analyses were used to evaluate the clinical and pathological factors associated with the cumulative incidence of bladder cancer. Results: Of the 133 patients, 51 (38.3%) developed intravesical recurrence during a median follow-up of 71 months (range, 0.8-210.8). In the multivariate analysis, multifocality (P = 0.03) and high tumour grade (P = 0.007) were significantly associated with the cumulative incidence of bladder cancer. We constructed a prediction classification model on the basis of the total number of risk factors. The 2-year cumulative incidence rates were 5.6, 34.8 and 50.0% in individuals with no, one and two risk factors, respectively. There was a significant difference between patients with no risk factors and those with two risk factors (P = 0.01). Conclusions: Although this retrospective study had several limitations, tumour multifocality and tumour grade were found to be potential risk factors for intravesical recurrence in our cases.

Low-level Ki-67 expression as an independent predictor of bladder tumour recurrence in patients with primary upper tract urothelial carcinoma after radical nephroureterectomy

“…When these two papers are considered together, we found that the results have an internal consistency: Low-grade tumour was associated with a low level of Ki-67 expression as shown in our study. However, Narukawa et al (22) found that high-grade tumour predicted intravesical recurrence after nephroureterectomy in UTUC patients. Another Chinese scholar found there was no relationship between Ki-67 and bladder cancer recurrence in 88 UTUC patients, because some patients who receive neoadjuvant chemotherapy were included and patients with concomitant/previous bladder cancers were not excluded.…”

Developing a prediction model for disease‐free survival from upper urinary tract urothelial carcinoma in the Korean population

“…This study considered 3‐year DFS as a prognostic outcome because the intravesical recurrence after RNU was approximately 20%‐50% within 1‐1.5 years, and the OS or CSS was estimated at 3‐ or 5‐years . Therefore, the 3‐year DFS comprised local recurrence, cancer‐specific, and non–cancer‐specific death, but not intravesical recurrence.…”

“…Given the rarity of UTUC and difficulty of long-term follow-up because of poor prognosis, this study's strengths are that it provides a useful prediction model in Asian UTUC patients who underwent RNU and considers diverse parameters, whereas the only two existing Asian prediction models did not have similarly large cohorts for the development and validation sets, but instead used small cohorts to evaluate IVRFS and CSS. 6,11 This study considered 3-year DFS as a prognostic outcome 14 because the intravesical recurrence after RNU was approximately 20%-50% within 1-1.5 years, 22,23 and the OS or CSS was estimated at 3-or 5-years. 2,6,10 Therefore, the 3-year DFS comprised local recurrence, cancer-specific, and non-cancer-specific death, but not intravesical recurrence.…”

The predictive value of preoperative positive urine cytology for development of bladder cancer after nephroureterectomy in patients with upper urinary tract urothelial carcinoma: A retrospective multi-center case-control study and meta-analysis

“…One of the studies assessed patients from within Korea [22], 3 from China [24,25], and 8 from Japan [26][27][28][29][30][31][32][33]. Only one study was an RCT [30], 4 were casecontrol [22,27,31,32] studies, and the others were retrospective cohort searches [24-26, 28, 29, 33]. The size of the studies varied from 36 to 754, with a total number of 2942 patients.…”

“…The study was considered relevant if it met the inclusion criteria. Finally, 11 eligible articles [22,[24][25][26][27][28][29][30][31][32][33]] from 2010 to 2016 was selected. The primary information the investigators recorded included author, publication year, region, study type, recruitment period, number of patients, baseline characteristics (mean age and sex, etc.…”