Efficiency Of Prophylactic Intravesical Chemotherapy After Nephroureterectomy For Primary Upper Tract Urothelial Carcinoma

BackgroundUTUCs consist of urothelial carcinomas(UCs)which located in pelvis and ureter,UTUCs are uncommon and account for only 5-10%of UCs,UTUCs have a peak incidence in individuals aged 70-90 yr and are more common in men.Radical nephroureterectomy(RNU)with partial bladder cuff excision is the gold standard treatment for localized UTUC.Recurrence in the bladder occurs in 22-47%of UTUC patients.Whether prophylactic intravesical instillation can reduce the recurrence rate in the bladder was undefined,scholars held different views.ObjectiveTo explore the efficiency of prophylactic intravesical chemotherapy after nephroureterectomy for primary upper tract urothelial carcinoma.MethodsEighty-one patients with primary upper tract urothelial carcinoma who underwent nephroureterectomy were retrospectively analyzed.There were 44 male and 37 female patients with mean age of 67.2 years.Patients were divided into HCPT purfusing group(n=32),Gemcitabin purfusing group(n=34)and Non-intravesical chemotherapy group(n=15).In the HCPT group,there were 14 male and 18 female patients with mean age of 70.3 years;20 cases located at left side while 12 at the right side.In the Gemcitabin group,there were 19 male and 15 female patients with mean age of 66.1 years;18 cases located at left side while 16 at the right side.In non-intravesical chemotherapy group,There were 11 male and 4 female patients with mean age of 65.0 years;10 cases located at left side while 5 at the right side.The age,gender,side of the three groups were not statistical different.The three groups were followed up,and the tumor location,size,stage,grade,recurrence rate,cancer-free survival time were compared.Result1.The pathology results of all cases were urothelial carcinoma.In the HCPT group,23 cases were high grade tumors with 9 low grade tumors,there were 15 cases of Ta-T1 stage,8 cases of T2 grade and 9 cases of T3 grade;the tumor of 19 cases located at pelvis,12 located at ureter,1 located at pelvis and ureter;the mean size of the tumors was(2.75 ±1.49)cm;8 cases were multiple while 24 were single.In the Gemcitabin group,27 cases were high grade tumors with 7 low grade tumors,there were 17 cases of Ta-T1 stage,9 cases of T2 grade and 8 cases of T3 grade;the tumor of 14 cases located at pelvis,18 located at ureter,2 located at pelvis and ureter;the mean size of the tumors was(2.65 ± 1.53)cm;5 cases were multiple while 27 were single.In the non-intravesical chemotherapy group,12 cases were high grade tumors with 3 low grade tumors,there were 6 cases of Ta-T1 stage,4 cases of T2 grade and 5 cases of T3 grade;the tumor of 11 cases located at pelvis,3 located at ureter,1 located at pelvis and ureter;the mean size of the tumors was(3.11±1.48)cm;6 cases were multiple while 9 were single.The items above-mentioned did not reach statistical difference between the two groups(P>0.05).2.6 patients recurred in HCPT purfusing group,5 patients recurred in Gemcitabine purfusing group while 7 in non-intravesical chemotherapy group,the recurrence rate of bladder cancer of HCPT group and Gemcitabine group were lower than the non-intravesical chemotherapy group(18.75%,14.7%VS.46.67%,χ2=6.520,P=0.038).Compared with non-intravesical chemotherapy group,HCPT group and Gemcitabine group had longer cancer-free survival time,but it did not reach statistical difference(F=3.047,p=0.218).3.It shows distinct relativity between voided urine cytology and the recurrence rate of bladder cancer,the recurrence rate was higher of the patients whose voided urine cytology were positive,meanwhile,the age,gender,tumor side,tumor stage,tumor size,location were not risk factors of bladder cancer recurrence.ConclusionProphylactic intravesical chemotherapy after nephroureterectomy for primary upper tract urothelial carcinoma could effectively reduce the recurrence rate of bladder cancer.It shows distinct relativity between urine exfoliated cells and the recurrence rate of bladder cancer.