The predictive value of positive urine cytology for outcomes following radical nephroureterectomy in patients with primary upper tract urothelial carcinoma: A multi-institutional study

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• 作者：Nobuyuki Tanaka ; Eiji Kikuchi ; Kent Kanao ; Kazuhiro Matsumoto ; Suguru Shirotake ; Hiroaki Kobayashi ; Yasumasa Miyazaki ; Hiroki Ide ; Jun Obata ; Katsura Hoshino ; Nozomi Hayakawa ; Takeo Kosaka ; Masafumi Oyama ; Akira Miyajima ; Tetsuo Momma ; Ken Nakagawa ; Masahiro Jinzaki ; Yosuke Nakajima ; Mototsugu Oya
• 关键词：Urothelial carcinoma ; Upper urinary tract ; Nephroureterectomy ; Intravesical recurrence ; Urine cytology
• 刊名：Urologic Oncology: Seminars and Original Investigations
• 出版年：January, 2014
• 年：2014
• 卷：32
• 期：1
• 页码：48.e19-48.e26
• 全文大小：413 K

文摘

Background and objective

Few studies have addressed the predictive value of positive urine cytology for prognosis in patients with upper tract urothelial carcinoma (UTUC). We investigated whether the status of preoperative urine cytology could provide additional prognostic information following radical nephroureterectomy (RNU).

Materials and methods

The study included 474 patients with primary nonmetastatic UTUC (pTa-4N0M0) from a retrospective multi-institutional cohort. The median follow-up period was 35 months. Associations between the status of urine cytologic evaluation and outcomes were analyzed using multivariate Cox regression models. Urine cytology was evaluated preoperatively using voided samples. Disease recurrence was defined as any relapse in nonbladder lesions and was coded separately from intravesical recurrence.

Results

Positive urine cytology was detected in 184 patients (38.8%) preoperatively. Disease recurrence occurred in 127 patients, while intravesical recurrence occurred in 219 patients; 83 patients died of UTUC during follow-up. Kaplan-Meier analysis revealed that only the incidence of intravesical recurrence was significantly associated with the status of urine cytologic evaluation (P = 0.024); the intravesical recurrence-free survival rates at 1 and 3 years following RNU were 61.4% and 46.2% in patients with positive urine cytology and 71.1% and 51.6% in their counterparts, respectively. Multivariate analysis showed that gender (hazard ratio [HR] = 1.74, 95% confidence interval [CI]; 1.28-2.43), tumor multifocality in RNU specimens (HR = 1.64, 95% CI; 1.09-2.47), and positive urine cytology (HR = 1.41, 95% CI; 1.08-1.85) were independent risk factors for subsequent intravesical recurrence.

Conclusions

The results showed the prognostic value of positive urine cytology in patients with primary UTUC, and preoperative positive urine cytology may be associated with a significant increase in the prevalence of intravesical recurrence following RNU.