Preoperative sterile pyuria as a prognosticbiomarker for intravesical recurrence in upperurinary tract urothelial carcinoma

Jeon, Byeong Jo; Tae, Bum Sik; Choi, Hoon; Bae, Jae Hyun; Kim, Jong Wook; Park, Hong Seok; Park, Jae Young

doi:10.4111/icu.2020.61.1.51

Cited by 9 publications

(18 citation statements)

References 28 publications

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“…Four studies in our systematic review compared the effect of diabetes on IVR in UTUC patients after RNU (16,18,20,22). Jeon et al (18) and Lin et al (20) found that diabetes increases IVR in UTUC patients.…”

Section: Discussionmentioning

confidence: 97%

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The Impact of Diabetes on the Prognosis of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy: A Systematic Review and Meta-Analysis

Gao

Zhou

et al. 2021

Front. Oncol.

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BackgroundStudies have reported that diabetes is related to the prognosis of upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU), but this conclusion is still controversial. Here, we performed a meta-analysis to comprehensively explore the association between diabetes and UTUC prognosis.MethodsIn November 2020, we searched PubMed, Web of science and the Cochrane Library to find relevant studies that evaluated the effect of diabetes on the prognosis of UTUC. The Newcastle Ottawa Scale was used to assess the quality of the literature. Review Manager 5.3 was used to pool cancer-specific survival (CSS), overall survival (OS), recurrence-free survival (RFS) and intravesical recurrence (IVR).ResultsA total of 10 studies with 11,303 patients were included in this meta-analysis. Our pooled results showed that diabetes did not affect the survival outcome of UTUC, including CSS (HR: 1.33, 95% CI: 0.89-1.98; P = 0.16), OS (HR: 1.18, 95% CI: 0.77-1.80; P = 0.45) and RFS (HR: 1.37, 95% CI: 0.91-2.05; P = 0.13). However, diabetes increased the risk of IVR of UTUC patients (HR: 1.26, 95% CI: 1.11-1.43; P = 0.0004).ConclusionAlthough diabetes has no significant impact on the survival outcomes of UTUC after RNU, it increases the risk of IVR. Therefore, special attention should be paid to monitoring the IVR for UTUC patients with diabetes and the necessity of appropriate intravesical adjuvant treatment when needed.

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Section: Discussionmentioning

confidence: 97%

“…We initially identified 672 studies from the three databases mentioned above. Ten studies were ultimately included in this meta-analysis based on our inclusion and exclusion criteria (14)(15)(16)(17)(18)(19)(20)(21)(22)(23). A total of 12,865 patients had UTUC, and 2045 (15.9%) had diabetes.…”

Section: Literature Screening and Quality Assessmentmentioning

confidence: 99%

The Impact of Diabetes on the Prognosis of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy: A Systematic Review and Meta-Analysis

Gao

Zhou

et al. 2021

Front. Oncol.

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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: 98%

“…BCG unresponsiveness was defined as BCG refractory or BCG relapse with adequate BCG treatment [4]. Pyuria was defined as the presence of five or more white blood cells in a urine sample, as observed with a high-power field [12]. A tumour size of >3 cm was considered a large tumour.…”

Section: Patient Selection and Cohort Follow-up Protocolsmentioning

confidence: 99%

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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“…Interestingly, also postoperative pyuria was described as a negative prognostic factor in patients with bladder cancer [ 17 , 18 ]. Regarding upper urinary tract urothelial carcinoma, the impact of preoperative pyuria on the risk of bladder recurrence is uncertain due to conflicting results of published studies [ 19 , 20 , 21 ]. The mechanism by which pyuria can impact patients’ prognosis is not clear.…”

Section: Discussionmentioning

confidence: 99%

Preoperative pyuria predicts the presence of high-grade bladder carcinoma in patients with bladder tumors

Poletajew

Gajewska

Kaczmarek

et al. 2020

Cent european J Urol

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Introduction Preoperative identification of high-grade bladder cancer presence can optimize patient management. The aim of this study was to assess the association between preoperative pyuria and the pathological features of bladder cancer. Material and methods This retrospective analysis enrolled 943 patients undergoing transurethral resection of a bladder tumor. Patients were divided into two study groups based on the presence of pyuria in preoperative urine analysis, defined as the presence of >5 leukocytes in the high power field. Pyuria status as a potential predictive factor was then confronted with pathological features based on standard microscopic examination of the surgical specimen. Results Among 943 recruited patients, 294 (31.2%) presented with pyuria. Patients with pyuria were older (71 vs. 68 years, p <0.05), had higher rates of large (≥3 cm) tumors (37% vs. 26%, p <0.05), and more frequently presented concomitant hematuria (58% vs. 24%, p <0.05). In case of recurrent tumors patients with pyuria more often received intravesical chemotherapy in the past (4.8% vs. 1.4%, p <0.05). Regarding oncological data, patients with pyuria had significantly higher tumor stage and grade. On multivariable analysis pyuria was independently associated with high-grade tumors (OR 1.97, 95% CI 1.45–2.67). Specificity and negative predictive value of pyuria as a biomarker of high-grade tumors were 76% and 68%, respectively. Conclusions Preoperative pyuria can be regarded as a predictor of the presence of high-grade bladder carcinoma in patients with bladder tumors.

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Preoperative sterile pyuria as a prognosticbiomarker for intravesical recurrence in upperurinary tract urothelial carcinoma

Cited by 9 publications

References 28 publications

The Impact of Diabetes on the Prognosis of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy: A Systematic Review and Meta-Analysis

The Impact of Diabetes on the Prognosis of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy: A Systematic Review and Meta-Analysis

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

Preoperative pyuria predicts the presence of high-grade bladder carcinoma in patients with bladder tumors

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