Concurrent Preoperative Presence of Hydronephrosis and Flank Pain Independently Predicts Worse Outcome of Upper Tract Urothelial Carcinoma

Abstract

ObjectivesTo investigate the impact of preoperative hydronephrosis and flank pain on prognosis of patients with upper tract urothelial carcinoma.MethodsIn total, 472 patients with upper tract urothelial carcinoma managed by radical nephroureterectomy were included from Kaohsiung Medical University Hospital Healthcare System. Clinicopathological data were collected retrospectively for analysis. The significance of hydronephrosis, especially when combined with flank pain, and other relevant factors on overall and cancer-specific survival were evaluated.ResultsOf the 472 patients, 292 (62%) had preoperative hydronephrosis and 121 (26%) presented with flank pain. Preoperative hydronephrosis was significantly associated with age, hematuria, flank pain, tumor location, and pathological tumor stage. Concurrent presence of hydronephrosis and flank pain was a significant predictor of non-organ-confined disease (multivariate-adjusted hazard ratio = 2.10, P = 0.025). Kaplan-Meier analysis showed significantly poorer overall and cancer-specific survival in patients with preoperative hydronephrosis (P = 0.005 and P = 0.026, respectively) and in patients with flank pain (P < 0.001 and P = 0.001, respectively) than those without. However, only simultaneous hydronephrosis and flank pain independently predicted adverse outcome (hazard ratio = 1.98, P = 0.016 for overall survival and hazard ratio = 1.87, P = 0.036 for and cancer-specific survival, respectively) in multivariate Cox proportional hazards models. In addition, concurrent presence of hydronephrosis and flank pain was also significantly predictive of worse survival in patient with high grade or muscle-invasive disease. Notably, there was no difference in survival between patients with hydronephrosis but devoid of flank pain and those without hydronephrosis.ConclusionConcurrent preoperative presence of hydronephrosis and flank pain predicted non-organ-confined status of upper tract urothelial carcinoma. When accompanied with flank pain, hydronephrosis represented an independent predictor for worse outcome in patients with upper tract urothelial carcinoma.

The significance of the initial symptom in Chinese patients with upper tract urothelial carcinoma: Regular health examination is still underutilized

“…Flank pain in patients with UTUC is reported to be correlated with hydronephrosis, in that the sudden occurrence of hydronephrosis can result in intense pain in the flank area, while the gradual development of hydronephrosis generally cause dull pain with no attacks of renal colic [20]. Still it's notable that many asymptomatic patients had hydronephrosis, which possibly due to different sensations among patients.…”

Preoperative pyuria predicts advanced pathologic tumor stage and worse survival in patients with urothelial carcinoma of the upper urinary tract treated by radical nephroureterectomy

“…And it is noteworthy that preoperative hydronephrosis, a potential prognostic predictor discussed in some studies [23][24][25][26], was also found to be an independent predictor of survival. Additionally, we also investigated the association between preoperative pyuria and bladder recurrence following RNU (Supplementary Table S1).…”

Peer Review #1 of "Clinical and prognostic value of preoperative hydronephrosis in upper tract urothelial carcinoma: a systematic review and meta-analysis (v0.1)"

“…Of the 14 studies, provided HR and % CI values directly; of the other 2 studies, one paper provided the relative risk (RR), and the other article provided OR values, which we used to estimate HR. Of the 14 studies, a significant association between preoperative hydronephrosis and poor CSS, OS, RFS or MFS was demonstrated in six (Chung et al, 2014;Liang et al, 2016;Ng et al, 2011;Yeh et al, 2015;Zhang et al, 2013;Zhang et al, 2015), four (Chapman et al, 2009;Liang et al, 2016;Yeh et al, 2015;Zhang et al, 2015), three (Chung et al, 2014;Hwang et al, 2013;Luo et al, 2013) or one (Ng et al, 2011) studies, respectively. Of the literature, the six (Bozzini et al, 2013;Sakano et al, 2013;Xing et al, 2016;Yeh et al, 2015;Zhang et al, 2016;Zou et al, 2014), two (Bozzini et al, 2013;Yeh et al, 2015), four (Chung et al, 2014;Liang et al, 2016;Luo et al, 2013;Ng et al, 2011) or three (Bozzini et al, 2013;Colin et al, 2014;Luo et al, 2013) studies linking preoperative hydronephrosis with poor CSS, OS, RFS or MFS, respectively, lacked statistical significance.…”

“…Initially, our search strategy identified 357 articles. A total of 19 studies published between 2007 and 2016 were included in the final meta-analysis (Bozzini et al, 2013;Chapman et al, 2009;Chen et al, 2013;Cho et al, 2007;Chung et al, 2014;Colin et al, 2014;Fradet et al, 2014;Hwang et al, 2013;Liang et al, 2016;Luo et al, 2013;Messer et al, 2013;Ng et al, 2011;Sakano et al, 2013;Xing et al, 2016;Yeh et al, 2015;Zhang et al, 2016;Zhang et al, 2013;Zhang et al, 2015;Zou et al, 2014) (Fig. 1).…”

“…1). Thirteen studies provided original information of the relationships between preoperative hydronephrosis and the clinicopathological parameters of UTUC patients directly (Bozzini et al, 2013;Chapman et al, 2009;Chen et al, 2013;Cho et al, 2007;Chung et al, 2014;Fradet et al, 2014;Hwang et al, 2013;Liang et al, 2016;Messer et al, 2013;Ng et al, 2011;Yeh et al, 2015;Zhang et al, 2013;Zhang et al, 2015). Fourteen articles assessed the prognostic value of preoperative hydronephrosis (CSS/OS/RFS/MFS) of UTUC patients using the Kaplan-Meier method (Bozzini et al, 2013;Chapman et al, 2009;Chung et al, 2014;Colin et al, 2014;Hwang et al, 2013;Liang et al, 2016;Luo et al, 2013;Ng et al, 2011;Sakano et al, 2013;Xing et al, 2016;Yeh et al, 2015;Zhang et al, 2016;Zhang et al, 2013;Zhang et al, 2015).…”