Zhu Jun, Zhang Xiaoqing, Yu Wei, Li Xuesong, He Zhisong, Zhou Liqun, Zhang Zhongyuan, Xiong Gengyan
Department of Urology, Peking University First Hospital, Beijing, China.
Front Oncol. 2022 Apr 13;12:834692. doi: 10.3389/fonc.2022.834692. eCollection 2022.
Numerous studies have investigated the risk factors of intravesical recurrence (IVR) after radical nephroureterectomy (RNU) in patients with upper urinary tract urothelial carcinoma (UTUC). However, few studies explore the predictors for unfavorable pathological types of IVR following RNU.
We retrospectively reviewed 155 patients diagnosed with bladder cancer (BC) following RNU. Binary logistic regression was used for the univariable and multivariable analyses. Nomograms were developed based on the multivariable analysis. The concordance index (C-index) was used to assess the performance of the nomograms. We performed internal validation by generating calibration plots.
Muscle-invasive BC (MIBC) was significantly correlated with operation interval (p = 0.004) and UTUC T-stage (p = 0.016). Operation interval (p = 0.002) and UTUC T-stage (p = 0.028) were also risk factors for BC > 3 cm. UTUC grade (p = 0.015), operation interval (p = 0.003), and hydronephrosis (p = 0.049) were independent predictors for high-grade BC (HGBC). MIBC (p = 0.018) and surgical approach (p = 0.003) were associated with multifocal IVR. Besides, MIBC and HGBC were associated with UTUC grade (p = 0.009), operation interval (p = 0.001), and hydronephrosis (p = 0.023). Moreover, only operation interval (p = 0.036) was a predictor for BC with at least one unfavorable pathological type. We developed nomograms for MIBC, HGBC, BC > 3 cm, and MIBC and/or HGBC. The calibration curves of the nomograms showed good agreement between the observation and prediction cases. The C-indexes of the nomograms were 0.820 (95% CI, 0.747-0.894), 0.728 (95% CI, 0.649-0.809), 0.770 (95% CI, 0.679-0.861), and 0.749 (95% CI, 0.671-0.827), respectively.
The current study found that operation interval, UTUC T-stage, UTUC grade, surgical approach, and hydronephrosis are independent predictors for unfavorable pathological types of IVR following RNU. Nomograms based on these predictors were developed and internally validated to assess the risk of developing unfavorable pathological types of IVR. Furthermore, patients at high risk of developing unfavorable pathological types BC may benefit from more active follow-up 1 year after RNU by early detection of IVR.
众多研究已对肾盂输尿管癌（UTUC）患者根治性肾输尿管切除术（RNU）后膀胱内复发（IVR）的危险因素进行了调查。然而，很少有研究探讨RNU后IVR不良病理类型的预测因素。
我们回顾性分析了155例RNU术后诊断为膀胱癌（BC）的患者。采用二元逻辑回归进行单变量和多变量分析。基于多变量分析绘制列线图。一致性指数（C指数）用于评估列线图的性能。我们通过生成校准图进行内部验证。
肌层浸润性膀胱癌（MIBC）与手术间隔（p = 0.004）和UTUC T分期（p = 0.016）显著相关。手术间隔（p = 0.002）和UTUC T分期（p = 0.028）也是BC＞3 cm的危险因素。UTUC分级（p = 0.015）、手术间隔（p = 0.003）和肾积水（p = 0.049）是高级别膀胱癌（HGBC）的独立预测因素。MIBC（p = 0.018）和手术方式（p = 0.003）与多灶性IVR相关。此外，MIBC和HGBC与UTUC分级（p = 0.009）、手术间隔（p = 0.001）和肾积水（p = 0.023）相关。此外，只有手术间隔（p = 0.036）是至少有一种不良病理类型BC的预测因素。我们绘制了MIBC、HGBC、BC＞3 cm以及MIBC和/或HGBC的列线图。列线图的校准曲线显示观察病例和预测病例之间具有良好的一致性。列线图的C指数分别为0.820（95%CI，0.747 - 0.894）、0.728（95%CI，0.649 - 0.809）、0.770（95%CI，0.679 - 0.861）和0.749（95%CI，0.671 - 0.827）。
本研究发现手术间隔、UTUC T分期、UTUC分级、手术方式和肾积水是RNU后IVR不良病理类型的独立预测因素。基于这些预测因素绘制了列线图并进行了内部验证，以评估发生IVR不良病理类型的风险。此外，具有发生不良病理类型BC高风险的患者可能会从RNU术后1年通过早期检测IVR进行更积极的随访中获益。
