Multivariate Analysis Of Prognosis After Upper Urinary Tract Urothelial Carcinoma Surgery

Objective: To investigate the predictive value of clinicopathological factors of upper urinary tract urothelial carcinoma(UTUC)on bladder recurrence and long-term prognosis after radical nephroureterectomy(RNU);Methods: The clinical and pathological data of all UTUC patients admitted in the Affiliated Hospital of Qingdao University from January 2011 to July 2017 were retrospectively analyzed.After strict inclusion and exclusion,the UTUC patients who met the research criteria were finally selected.The clinicopathological data of patients(symptoms,BMI,NLR,smoking history,hypertension,diabetes,hydronephrosis,gender,age,preoperative ureteroscopy;pathological data including tumor side,location,size,grading and staging)were sorted out and followed up through outpatient return visit and telephone inquiry.All data collected were entered into SPSS 26.0 software,Statistical analysis was carried out.Prism9 software was used to draw the ROC curve of NLR predicting IVR,according to which NLR was divided into two groups.Single factor ANOVA was used to analyze the risk factors of IVR after UTUC and its significant factors were included in the binary logistic regression analysis,so as to obtain the independent risk factors of bladder recurrence after UTUC.In the prognostic analysis,the median NLR was used for grouping,Cox regression model was used for univariate and multivariate analysis of the risk factors affecting the prognosis of UTUC,Kaplan Meier method was used to analyze the survival curve of each factor,and Log rank test was used to compare the differences between groups,so as to obtain the relevant risk factors affecting the prognosis of UTUC;Results: A total of 317 UTUC patients were enrolled in this study,51 of whom had bladder recurrence after radical surgery,with a recurrence rate of 16.1%(51/317).The shortest recurrence time was 1 month,and the longest recurrence time was 86 months.Bladder recurrence mostly occurred within 2 years,accounting for 72.5%(37/51)of the total recurrence rate.With the increase of time,the recurrence rate showed a gradual downward trend.Univariate analysis of variance showed that abnormal body mass index,tumor stage,preoperative ureteroscopy,previous or combined bladder cancer,and high NLR were risk factors for bladder recurrence after UTUC(P<0.05);However,gender,age,smoking history,hypertension and diabetes history,hematuria and low back pain symptoms,preoperative hydronephrosis,tumor size,side and grade were not risk factors(P>0.05);Binary logistic regression analysis showed that all risk factors in one-way ANOVA were independent risk factors for bladder recurrence after UTUC(P<0.05).A total of 317 patients with UTUC were enrolled in this study.The 1-year overall survival rate was 95.3%,the 3-year overall survival rate was 75.7%,and the 5-year overall survival rate was 52.4%.Cox univariate analysis showed that patients with preoperative hydronephrosis(HR=1.660,P=0.002)and high tumor stage(HR=1.390,P=0.044)had shorter OS(total survival period),and the difference was statistically significant(P<0.05);PFS(progression free survival)was shorter in patients with preoperative hydronephrosis(HR=1.749,P=0.001)and bladder recurrence(HR=2.080,P=0.003),and the difference was statistically significant(P<0.05).Cox multivariate regression analysis showed that preoperative hydronephrosis(HR=1.789,P=0.001)and high tumor stage(HR=1.537,P=0.010)were independent risk factors for predicting postoperative OS in UTUC patients;Preoperative hydronephrosis(HR=1.821,P=0.000)and bladder recurrence(HR=2.280,P=0.001)were independent risk factors for predicting postoperative PFS in patients with UTUC.Kaplan Meier survival curve showed that high tumor stage(P=0.042)and preoperative hydronephrosis(P=0.002)were risk factors for OS in patients with UTUC after surgery;Intravesical recurrence(P=0.042)and preoperative hydronephrosis(P=0.001)were risk factors for PFS in patients with UTUC.Conclusion: Abnormal body mass index,tumor stage,preoperative ureteroscopy,previous or combined bladder cancer,and high NLR are independent risk factors for bladder recurrence after UTUC;Preoperative hydronephrosis and high tumor stage are independent risk factors for OS after UTUC,while preoperative hydronephrosis and bladder recurrence are independent risk factors for PFS after UTUC.In patients undergoing RNU,attention should be focused on whether the above risk factors exist,and more detailed follow-up plans should be developed for high-risk patients to actively treat them.