Risk Factors For Prognosis Of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy

Objectives To investigate oncologic outcomes and prognostic risk factors in patients with upper tract urothelial carcinoma(UTUC)treated by radical nephroureterectomy(RNU).Material and Methods Clinical data of 176 UTUC patients treated by RNU from January 2001 to December 2014 were retrospectively reviewed.Logistic regression was used to investigate risk factors of pathologic features and preoperative renal function.Kaplan-Meier analysis was used to evaluate postoperative survival and bladder recurrence.Cox proportional hazard models was used to evaluate prognostic risk factors.ResultsAmong this cohort,the median age was 70 year.81(46%)cases were renal pelvic tumors,67(38%)were ureteral tumors and the remaining 28(16%)cases were multifocal tumors.17(10%)cases were accompanied with squamous or glandular differentiation.39(22%)cases presented with previous or synchronous non-muscle-invasive bladder cancer(NMIBC).36(20.5%)cases presented with preoperative pyuria.116(66%)cases presented with severe preoperative hydronephrosis.Logistic regression revealed that pyuria(p=0.001)was significantly associated with advanced pT stage.And hydronephrosis was significantly associated with LNI or LVI(lymph node or lymphovascular invasion)(p=0.005)and worse renal function(p=0.002).The median follow-up was 41 months.During the follow-up,a total of 65(37%)patients died,including 54(31%)from UTUC.Bladder recurrence occurred in 32(18%)patients after a median time of 14 months.The 3-year probabilities for overall survival(OS),cancer-specific survival(CSS)and bladder-recurrence-free survival(Bladder-RFS)were 76.7%,78.7% and 82.7%,respectively.In the univariate analysis,age,pyuria,hydronephrosis,multifocality,pT,grade,LNI and LVI,squamous or glandular differentiation were significantly associated with OS and CSS(all p<0.05).And previous or synchronous NMIBC and multifocality were significantly associated with Bladder-RFS(all p<0.05).In the multivariate analysis,age,multifocality,pT,LNI,squamous or glandular differentiation were independent predictors for postoperative survival(all p<0.05).And previous or synchronous NMIBC(p=0.001)was an independent predictor for Bladder-RFS.After incorporating only preoperative factors,pyuria and hydronephrosis were found to be independent predictors of OS and CSS(all p<0.05).Conclusions Pyuria was significantly associated with advanced pT stage.Hydronephrosis was significantly associated with LNI or LVI and worse renal function.The prognosis of UTUC after RNU remained unsatisfactory.Pyuria,severe hydronephrosis,squamous or glandular differentiation were potentially independent risk factors for postoperative survival.Multifocality,previous or synchronous NMIBC were the most crucial risk factors for bladder recurrence.