Impact of diagnostic ureteroscopy before radical nephroureterectomy on intravesical recurrence in patients with upper tract urothelial cancer

Abstract

Purpose: To evaluate the impact of diagnostic ureteroscopy performed before radical nephroureterectomy (RNU) on intravesical recurrence (IVR) in patients with upper tract urothelial carcinoma (UTUC). Materials and Methods: From May 2003 to December 2018, patients who underwent RNU for UTUC were enrolled and divided into two groups according to whether they underwent preoperative ureteroscopy (Pre-U vs. Non-U). We excluded patients who had a history of bladder cancer and did not receive bladder cuff resection during surgery. Perioperative parameters were compared between the two groups by use of t-tests or chi-square tests. Kaplan-Meier and Cox proportional hazards analyses were used to assess the association between Pre-U and IVR. Results: Of the 453 total patients, 226 patients (49.9%, Pre-U group) had received diagnostic ureteroscopy before RNU, and 227 patients (50.1%, Non-U group) had not. IVR occurred in 99 patients (43.8%) in the Pre-U group and 61 patients (26.9%) in the Non-U group (p=0.001). The median time to recurrence was 107 months. The 5-year IVR-free survival rates were 56.2% and 73.1% in the Pre-U and Non-U groups, respectively (log rank test, p<0.001). Multivariate Cox proportional hazards analysis showed that Pre-U was a significant factor (hazard ratio, 1.413; 95% confidence interval, 1.015-1.965; p=0.040) after adjustment for other factors including tumor stage, location, etc. Conclusions: Preoperative diagnostic ureteroscopy before RNU was a significant factor for IVR. Therefore, we should carefully consider Pre-U before RNU for nonobvious ureteral lesions. These results should be validated in a prospective study.

The Impact of Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma: A Comprehensive Systematic Review and Meta-analysis

“…The median or mean age of patients in included studies ranged from 63.8 to 73 years, with no statistically significant differences observed between URS (+) and URS (-) groups. The male predominance was reported in twelve [11][12][13][14][15][16]18,[22][23][24][25][26] out of sixteen articles. Six studies [11,13,16,18,19,23] presented populations without history of bladder cancer prior to RNU.…”

“…The male predominance was reported in twelve [11][12][13][14][15][16]18,[22][23][24][25][26] out of sixteen articles. Six studies [11,13,16,18,19,23] presented populations without history of bladder cancer prior to RNU. The proportion of patients with history of bladder cancer in ten remaining articles [12,14,15,17,20,21,22,24,25,26] ranged from 4.5% -42.7% and 0% -44% in URS (+) and URS (-) groups, respectively.…”

“…In accordance with the study inclusion criteria, 12 and 4 articles were excluded for insufficient outcome and inclusion of patients who received tumour ablation during URS, respectively. Finally, sixteen studies were included in this systematic review and meta-analysis [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26].…”

“…Among a total of 5489 patients in the selected papers, 2387 (43.4%) and (%) underwent diagnostic URS before RNU [URS (+) group] and 3102 (56.6%) did not [URS (-) group]. Geographically, nine studies were conducted in Asia [13,15,[17][18][19][20][21]25,26], four in North America [12,14,23,24], and three in Europe [11,16,22]. Included articles reported cases from the year 1985 to 2019.…”

“…The median follow-up periods for whole or individual cohorts ranged from 21.4 months to 76.8 months. Among sixteen selected papers, thirteen provided data regarding IVRFS [11,13,[15][16][17][18][19][20][21][23][24][25][26] whilst seven [13,15,17,[20][21][22][23], seven [12,13,14,17,21,23,24] and five [14,17,20,22,23] studies reported CSS, OS and MFS, respectively.…”