Pattern and risk factors of local recurrence after nephroureterectomy for upper tract urothelial carcinoma

Abstract

Purpose: This study aims to identify predictive local recurrence risk factors and site-specific local recurrence pattern of upper tract urothelial carcinoma (UTUC) with different primary tumor locations. Methods: Three hundred and eighty-nine UTUC patients with radical nephroureterectomy were included in this study. Univariate and multivariate Cox proportional hazards regressions were performed to measure the risk of local recurrence. We also mapped the position of local recurrence sites stratified by primary tumor locations. Results: A total of 73 patients (18.7%) developed local recurrence within a median follow-up of 41 months (range, 3-80 months). For patients with local recurrence, the median interval of local recurrence was 9 months. Ureter tumor, multifocality, T stage, G grade, lymph node metastasis (LNM), lymph node dissection (LND), and lymph vascular invasion (LVI) were all significantly associated with increased local recurrence by univariable analyses (P < 0.05). Only multifocality, T3-4, G3, and LNM remained independent predictors of increased local recurrence by multivariable analyses. Adjuvant radiotherapy could reduce the local recurrence (HR = 0.177; 95% CI 0.064-0.493, P = 0.001). Patients with local recurrence had poorer cancer-specific survival (4-year cancer-specific survival rate 36 ± 7.5% vs 88.4 ± 2.2%, P = 0.000). We evaluated local recurrence pattern stratified by tumor locations. Para-aortic lymph node region was the most common recurrence area for all the patients. Left-sided UTUC had more than 70% recurrent lymph nodes in the left para-aortic region (LPA). For right-sided UTUC patients, recurrent para-aortic lymph nodes distributed in the LPA (33.3%), aortocaval (AC) (41.5%), and right paracaval (RPC) (25.2%) regions. Recurrence in the internal and external iliac regions was only found in the distal ureter group (P < 0.05). Renal pelvic fossa recurrence was only found in renal pelvic tumor (22.2%, P = 0.007). The ureter tumor bed recurrence rate was higher for ureter patients (P = 0.001). Conclusions: Multifocality, T3-4, G3, and LNM are predictors of higher local recurrence rate of UTUC. Adjuvant radiotherapy can reduce local recurrence rate. Local recurrence patterns are different according to primary tumor locations.

Complete transperitoneal laparoscopic nephroureterectomy in a single position for upper urinary tract urothelial carcinoma and comparative outcomes

“…It has been demonstrated that laparoscopic nephroureterectomy (LNU) can achieve the same oncologic efficacy, tumor-free margins, and recurrence rates, regardless of the used laparoscopic approach types [ 11 , 12 ]. Previous study indicated that the multifocality, T stage 3–4, and G grade 3 were predictors of higher local recurrence rate of UTUC [ 13 ]. In our study, the T stage, G grade, location of tumor, and tumor recurrence rate were comparable between the CTLNU and LNOBE groups.…”

Incidence trends and survival prediction of urothelial cancer of the bladder: a population-based study

“…The data available are also subject to the limitations of the SEER database. Finally, for patients with bladder cancer to have a good prognosis, preventing relapse is also an important indicator for the clinical treatment of the disease [ 37 , 38 ], but we did not analyze the risk of recurrence in patients.…”

Oncological Outcomes of Adjuvant Radiotherapy for Partial Ureterectomy in Distal Ureteral Urothelial Carcinoma Patients

“…Compared with nonmuscular infiltrating tumors, pT3 increased the risk of local recurrence and distal metastasis up to 163% (95%CI: 1.08-2.46, p=0.01) and 430% (95%CI:1.97-9.35, p<0.001), respectively. However, several studies showed that adjuvant radiotherapy can improve RFS, DMF or even OS in patients with high-risk pathological factors (T3, G3) UTUC (5)(6)(7)(8). Jwa (5) found ART could improve RFS, and Chen (6) found a benefit from ART in OS.…”

“…The value of adjuvant radiotherapy (ART) for UC after RNU is still controversial (1). However, several studies from Asian countries showed that adjuvant radiotherapy after RNU can improve LRFS, distant metastasis free survival (DMFS) or even OS in patients with high-risk pathological factors (T3, G3) UC (5)(6)(7)(8). It is worthwhile to investigate whether postoperative radiotherapy can improve the survival of patients with adverse factors such as G3 or T3 after PU.…”