Preoperative Pyuria Predicts for Intravesical Recurrence in Patients With Urothelial Carcinoma of the Upper Urinary Tract After Radical Nephroureterectomy Without a History of Bladder Cancer

Sato, G.; Yoshida, Takashi; Yanishi, Masaaki; Saito, Ryoichi; Mizutani, Takashi; Kawa, Gen; Kinoshita, Hidefumi; Matsuda, Tadashi

doi:10.1016/j.clgc.2019.09.017

Cited by 14 publications

(13 citation statements)

References 21 publications

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“…This study has several limitations. The definition of pyuria is not objective and varies in the literature [12,28]. Moreover, pyuria is associated with numerous conditions such as infection, autoimmune disease and TURBT itself [29]; thus, we need to interpret the results of this study cautiously.…”

Section: Discussionmentioning

confidence: 97%

Pyuria as a Predictive Marker of Bacillus Calmette–Guérin Unresponsiveness in Non-Muscle Invasive Bladder Cancer

Suh

Yuk

Jeong

et al. 2021

JCM

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This study aims to investigate the clinical role of preoperative pyuria for predicting bacillus Calmette–Guérin (BCG) unresponsiveness in non-muscle invasive bladder cancer (NMIBC). We performed a logistic regression analysis on 453 patients with NMIBC who were treated with BCG immunotherapy after a transurethral resection of bladder tumours, to evaluate predictive factors of BCG unresponsiveness. We also analysed univariate and multivariable survival data to estimate the prognostic impact of pyuria. Of the total study population, 37.6% (170/453) of patients had BCG unresponsiveness. A multivariable logistic regression analysis revealed that a history of upper urinary tract cancer (odds ratio (OR): 1.86, 95% confidence interval (CI): 1.04–3.32, p-value = 0.035) and the presence of pyuria (OR: 1.51, 95% CI: 1.01–2.27, p = 0.047) and tumour multiplicity (OR: 1.80, 95% CI: 1.18–2.75, p-value < 0.001) were significant predictors of BCG unresponsiveness. A Cox proportional hazards analysis model showed that pyuria was a significant prognostic factor for progression-free survival (hazard ratio: 4.51, 95% CI: 1.22–16.66, p = 0.024). A history of upper urinary tract cancer and the presence of pyuria and tumour multiplicity are predictive markers of BCG unresponsiveness. For patients with NMIBC who have preoperative pyuria, treatment using BCG should be considered cautiously.

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Section: Discussionmentioning

confidence: 97%

Pyuria as a Predictive Marker of Bacillus Calmette–Guérin Unresponsiveness in Non-Muscle Invasive Bladder Cancer

Suh

Yuk

Jeong

et al. 2021

JCM

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“…The presence of ureter tumors and multiple tumors are identified as risk factors for IVR in previous studies. 2,6,7,[14][15][16]19 Though the exact mechanism of IVR after RNU for UTUC has remained unknown, one possible mechanism was "the intraluminal tumor seeding theory," which proposed that cancer cells disseminate via the urinary stream from the upper tract to the bladder. 25 Zigeuner et al suggested that more mechanical irritation in the ureter made tumor cells more likely to detach because intraluminal pressure and urine flow rate were higher than those in the renal pelvis.…”

Section: Discussionmentioning

confidence: 99%

“…Variables considered clinically important were age, ureter tumor, multifocality, hydronephrosis, preoperative ureteroscopy, clinical T stage (≥T2), and total operating time. 2,[6][7][8][13][14][15][16][17][18][19] Pathological information was not included to create a risk classification at the end of the operation. All statistical tests were two-sided, and p < 0.05 was considered statistically significant.…”

Section: Methodsmentioning

confidence: 99%

Preoperative risk classification for intravesical recurrence after laparoscopic radical nephroureterectomy for upper tract urothelial carcinoma in a multi‐institutional cohort

et al. 2023

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IntroductionThis study aimed to identify preoperative risk factors and create a risk classification for intravesical recurrence of upper urinary tract urothelial carcinoma only after laparoscopic radical nephroureterectomy in a multi‐institutional cohort.MethodsWe retrospectively analyzed 283 patients who had undergone laparoscopic radical nephroureterectomy for nonmetastatic upper tract urothelial cancer between March 2002 and March 2020. The cumulative incidence of intravesical recurrence for 224 patients without previous or concomitant bladder cancer was examined using multivariate Fine‐Gray competing risks proportional hazards models. A risk stratification model was created to predict subsequent patient outcomes based on the results.ResultsThe median follow‐up duration was 33.3 months, and 71 (31.7%) patients experienced intravesical recurrence. The estimated cumulative incidence of intravesical recurrence at one and 5 years was 23.5% and 36.4%, respectively. In multivariate analysis, the presence of ureter tumors and multiple tumors were shown to be independently significant predictive factors for intravesical recurrence. Based on the results, we classified patients into three risk groups. The cumulative incidence rates of intravesical recurrence within 5 years after surgery were 24.4%, 42.5%, and 66.7% in the low‐, intermediate‐, and high‐risk groups, respectively.ConclusionsWe identified risk factors and created a risk classification model for intravesical recurrence of upper urinary tract urothelial carcinoma only after laparoscopic radical nephroureterectomy. Based on this model, an individualized surveillance protocol or adjuvant therapy could be provided.

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“…Although a number of studies have investigated the risk of intravesical recurrence (IVR) after RNU for UTUC, there are no large scale investigations of treatment strategies for this secondary bladder cancer (BC) (2,(6)(7)(8). Currently, the disease management of patients with IVR after RNU for UTUC (UTUC-BC) is based on the guidelines for primary BC.…”

Section: Introductionmentioning

confidence: 99%

Intravesical Recurrence After Radical Nephroureterectomy of Upper Urinary Tract Urothelial Carcinoma: A Large Population-Based Investigation of Clinicopathologic Characteristics and Survival Outcomes

Luo

et al. 2021

Front. Surg.

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Background: Of patients with upper urinary tract urothelial carcinoma (UTUC), 22–47% developed bladder recurrence after radical nephroureterectomy. Furthermore, the effect of surgery for UTUC-bladder cancer (BC) has not been well validated. The aim of this study was to assess the impact of standard primary BC surgical strategy on survival of patients diagnosed with UTUC-BC.Patients and Methods: A total of 676 UTUC-BC patients and 197,753 primary BC patients diagnosed from 2004 to 2016, were identified based on the SEER database. The Kaplan-Meier method and the Fine and Gray competing risks analysis were performed to assess overall survival (OS) and cancer-specific mortality (CSM). Multivariate Cox regression model and competing risks regression model were used to identify independent risk factors. Propensity score matching (PSM) was also performed to adjust potential confounding factors.Results: The baseline characteristics and survival outcomes of the two BC patient cohorts are quite different. For UTUC-BC patients, no significant difference in OS (NMIBC: p = 0.88; MIBC: p = 0.98) or cumulative incidence of CSM (NMIBC: p = 0.12; MIBC: p = 0.96) were noted for various surgical procedures. Local tumor treatment and partial cystectomy for UTUC-NMIBC patients produced lower 1-year (6.1%) and 3-year CSM (16.2%). Radical cystectomy for UTUC-MIBC patients produced lower 1-year (11.8%) but higher 3-year CSM (62.7%). After PSM for covariates, UTUC-BC patients still had a worse prognosis after surgery compared with primary BC patients. Based on regression models, older age, advanced T stage, N positive disease, M positive disease, and shorter interval between UTUC and BC were identified as independent risk factors for UTUC-BC patients.Conclusion: Standard primary BC surgical strategy did not provide significant survival benefit for UTUC-BC patients. Compared with primary BC patients, UTUC-BC patients had a worse prognosis after surgery, suggesting that current primary BC surgical guidelines are not entirely appropriate for UTUC-BC patients. Our findings underscore the continued importance and need for better prognosis and improved guidelines for management of UTUC-BC patients.

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Preoperative Pyuria Predicts for Intravesical Recurrence in Patients With Urothelial Carcinoma of the Upper Urinary Tract After Radical Nephroureterectomy Without a History of Bladder Cancer

Cited by 14 publications

References 21 publications

Pyuria as a Predictive Marker of Bacillus Calmette–Guérin Unresponsiveness in Non-Muscle Invasive Bladder Cancer

Pyuria as a Predictive Marker of Bacillus Calmette–Guérin Unresponsiveness in Non-Muscle Invasive Bladder Cancer

Preoperative risk classification for intravesical recurrence after laparoscopic radical nephroureterectomy for upper tract urothelial carcinoma in a multi‐institutional cohort

Intravesical Recurrence After Radical Nephroureterectomy of Upper Urinary Tract Urothelial Carcinoma: A Large Population-Based Investigation of Clinicopathologic Characteristics and Survival Outcomes

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