Prognostic Impact Of Subsequent Bladder Cancer Following Radical Surgery On Upper Tract Urothelial Carcinoma Patients And The Risk Factors And Models For Predicting Its Occurrence

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Prognostic Impact of Subsequent Bladder Cancer Following Radical Surgery on Organ-confined Upper Tract Urothelial Carcinoma PatientsObjective:To investigate the impact of subsequent bladder cancer(SBCa)following radical surgery on organ-confined upper tract urothelial carcinoma(UTUC)patients.Methods:We retrospectively analyzed the data of organ-localized UTUC patients who underwent radical surgery in our hospital between January 2004 and February 2019 to explore the impact of SBCa on tumor-specific survival(CSS).Additionally,the clinicopathological data from the surveillance,epidemiology and end results(SEER)database between 2004 and 2017 were also analyzed to investigate the impact of SBCa on Western UTUC population.The sample was divided into SBCa and non-SBCa groups.Propensity score-matched(PSM)analysis was then conducted with a 1:1 ratio using an optimal matching algorithm to adjust for confounding factors.Multivariate analysis was utilized to identify independent risk factors associated with CSS.Subgroup analysis was performed to explore the clinicopathological characteristics of SBCa and its detailed influence on patients.Results:(1)A total of 134 patients from our hospital were included.Multivariate analysis indicated that patients with SBCa had a worse prognosis(p<0.05).(2)979 patients from SEER database were enrolled in the original cohort before PSM.At a median follow-up of 47.0 months,191 patients died of UTUC and 164 patients developed SBCa.Multivariate analysis indicated that advanced age,ureteral carcinoma and high-grade tumor were independent risk factors for CSS(all p<0.05).(3)After PSM,328 patients were enrolled in the new cohort,and there was no significant difference in demographic characteristics.At a median follow-up of 66.5 months,64 patients died of UTUC.Multivariate analysis indicated that SBCa,high-grade tumors and African American were independent risk factors for CSS(all p<0.05).(4)133 patients were finally included in the subgroup.Multivariate analysis showed that SBCa stage,recurrence time and recurrence site were independent risk factors for CSS(all p<0.05).Conclusion:In organ-confined UTUC populations,SBCa is associated with worse survial.Moreover,patients with SBCa located at the bladder operation area,advanced stage,and shorter recurrence interval had worse CSS.Part ? Impact of of Different Distal Ureter Managements on Subsequent Bladder Cancer Following Radical Resection of Upper Tract Urothelial CarcinomaObjective:To assess the impact of different distal ureter managements(DUM)on SBCa following radical resection of UTUC.Methods:263 primary UTUC patients who underwent radical surgery in our hospital between January 2004 and February 2019 were retrospectively enrolled in this study.The sample was divided into open,laparoscopy,and transurethral group according to the DUM techniques.Results:With a median follow-up of 44.1 months,SBCa developed in 52 patients,and 62 patients died.Multivariate Cox regression analysis demonstrated that the three methods had equivalent efficacy regarding the non-SBCa survival,CSS and overall survival(p>0.05).Survival analysis also showed no significant differences in SBCa-free survival,CSS,and OS among 248 patients with no previous bladder cancer(p>0.05).Conclusions:All three techniques had equivalent efficacy;although,laparoscopy and transurethral methods are minimally invasive.Part ? Developing a Nomogram for Predicting Subsequent Bladder Cancer after Radical Resection of Upper Tract Urothelial CarcinomaObjective:To develop a clinicopathologic and biomarker based risk assessment model for predicting SB Ca following radical resection of UTUC.Methods:489 primary UTUC patients who underwent radical surgery in two hospitals between January 2004 and February 2019 were enrolled in this study.Immunohistochemical analysis was used to assess the immunoreactivity of the biomarker Ki-67,in the tumor tissues.The data set was randomly split into a training cohort of 293 patients and a validation cohort of 196 patients.A multivariable Cox regression model was utilized to identify independent SBCa predictors before constructing a nomographic model.Performance was then quantified through time-depend receiver operating characteristic curves and calibration plots.Decision curve analysis was performed to evaluate the clinical benefit of models.Results:With a median follow-up of 54.0 months,SBCa developed in 28.2%of this sample(n=13 7).Tumor stage,location,multifocality,surgical approach,bladder cancer history and Ki-67 expression levels were independently associated with SBCa(all p<0.05).Both of the full model and the basic model outperformed the Xylinas model in terms of discriminative capacity(all p<0.05).Decision-making analysis also suggests the more comprehensive model can also improve patients'net benefit.Conclusions:Current new model were more sensitive than nomograms previously tested across mainland Chinese populations.It would be useful for determining risk-stratified surveillance protocols.