Significant clinicopathologic prognostic factors for bladder recurrence, progression, and cancer-specific survival after surgery among patients with upper urinary tract urothelial carcinoma

Abstract

PurposeThis study aimed to identify prognostic factors for outcomes after radical nephroureterectomy among patients with upper urinary tract urothelial carcinoma (UTUC).Materials and MethodsWe retrospectively reviewed 184 nonmetastatic cases of UTUC after radical nephroureterectomy, bladder cuffing, and/or partial cystectomy (2004–2016). Bladder recurrence-free survival (BRFS), disease progression-free survival (DPFS), and cancer-specific survival (CSS) were estimated. The prognostic values of clinicopathologic parameters were evaluated by using Cox logistic regression analysis.ResultsThe median BRFS, DPFS, and CSS values were 19.0 months, 38.5 months, and 67.0 months, respectively. We identified cases of bladder recurrence (64 cases, 34.8%), disease progression (54 cases, 29.3%), and cancer-specific death (23 cases, 12.5%). BRFS was independently associated with lymphovascular invasion (hazard ratio [HR], 0.421); DPFS was associated with intravesical instillation (HR, 0.290), active smoking (HR, 0.367), synchronous bladder lesions (HR, 2.355), and pT2 (HR, 5.199) and pT3 and pT4 (HR, 13.281) stages; and CSS was associated with alkaline phosphatase levels (HR, 0.966). Among 123 cases without previous bladder cancer, DPFS was associated with intravesical instillation (HR, 0.264), multifocal ureteral tumors (HR, 4.823), and pT3 and pT4 stages (HR, 10.899), whereas CSS was associated with pTis (HR, 32.071).ConclusionsPatients with the factors we identified should receive adjuvant intravesical/systemic chemotherapy and intensive surveillance.

Albumin-to-alkaline phosphatase ratio serves as a prognostic indicator in unresectable pancreatic ductal adenocarcinoma: a propensity score matching analysis

“…Accordingly, oxidative stress plays a vital role in the tumorigenesis of PDAC [40]. Elevated ALP levels may serve as a potential predictor of oxidative stress [41], thereby contributing to cancer progression and poor disease outcomes [42] [43]. Because of this, patients with low AAPR might have a poor prognosis.…”

A Novel Nomogram for Predicting the Survival of Patients with Invasive Upper Tract Urothelial Carcinoma

“…The age at the time of RNU is an independent indicator of patient outcomes [18]. The primary recognized prognostic factors are the tumor stage and grade [18][19][20][21][22][23]. Different nomograms based on the French Collaborative National Database that incorporate several variables have been developed [9][10][11].…”

Albumin-to-alkaline phosphatase ratio serves as a prognostic indicator in unresectable pancreatic ductal adenocarcinoma: a propensity score matching analysis

“…Accordingly, oxidative stress plays a vital role in the tumorigenesis of PDAC [45]. Elevated ALP levels may serve as a potential predictor of oxidative stress [46], thereby contributing to cancer progression and poor disease outcomes [47,48]. Because of this, patients with low AAPR might have a poor prognosis.…”