Zhao Hang, Jiao Binbin, Liu Kunpeng, Luo Zhenkai, Ding Zhenshan, Lai Shicong, Ren Jian, Zhang Guan
Department of Urology, China-Japan Friendship Hospital, Beijing, China.
China-Japan Friendship School Clinical Medicine, Peking University, Beijing, China.
Front Oncol. 2022 Aug 18;12:984014. doi: 10.3389/fonc.2022.984014. eCollection 2022.
The risk factors for intravesical recurrence (IVR) after radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC) remain inconsistent and unclear. Thus, the risk factors of IVR after RNU and the prognostic significance of the risk indicators were explored herein.
We retrospectively analyzed UTUC patients upon RNU in our center from January 2009 to December 2019. After propensity score matching, 139 patients were included in this study. Univariate and multivariate Cox proportional hazard regressions were used to estimate the hazard ratio and 95% confidence intervals. Overall survival (OS), cancer-specific survival (CSS) and recurrence-free survival (RFS) were measured using the Kaplan-Meier curve with a log-rank test. A -value < 0.05 was considered statistically significant.
We included 139 patients with a median follow-up of 42 months, of which 48 patients had an intravesical recurrence. Multivariate Cox regression analysis showed cytological abnormalities in urine (HR=3.101, =0.002), hydronephrosis (HR=1.852, =0.042), adjuvant chemotherapy (HR=0.242, <0.001), and previous history of bladder cancer (HR=5.51, <0.001) were independent risk factors for IVR. As for clinical outcomes, OS and CSS suggested disadvantages in patients with IVR compared with patients without recurrence (=0.042 for OS, <0.0001 for CSS), OS of patients with abnormal urine cytology and OS and CSS of patients receiving adjuvant chemotherapy did not present clinical significance, and other risk factors all affected the clinical outcome.
In this propensity-score matching study, cytological abnormality of urine, hydronephrosis, adjuvant chemotherapy and previous history of bladder cancer were shown to be independent risk factors for IVR. Moreover, risk factors also influence clinical outcomes, thereby rendering it necessary to adopt more active postoperative surveillance and treatment strategies for these patients, which may help improve treatment outcomes.
上尿路尿路上皮癌（UTUC）患者根治性肾输尿管切除术（RNU）后膀胱内复发（IVR）的危险因素仍不一致且不明确。因此，本文探讨了RNU后IVR的危险因素及风险指标的预后意义。
我们回顾性分析了2009年1月至2019年12月在本中心接受RNU的UTUC患者。经过倾向评分匹配后，本研究纳入了139例患者。采用单因素和多因素Cox比例风险回归来估计风险比和95%置信区间。使用Kaplan-Meier曲线和对数秩检验测量总生存期（OS）、癌症特异性生存期（CSS）和无复发生存期（RFS）。P值<0.05被认为具有统计学意义。
我们纳入了139例患者，中位随访时间为42个月，其中48例患者发生膀胱内复发。多因素Cox回归分析显示，尿细胞学异常（HR=3.101，P=0.002）、肾积水（HR=1.852，P=0.042）、辅助化疗（HR=0.242，P<0.001）以及既往膀胱癌病史（HR=5.51，P<0.001）是IVR的独立危险因素。至于临床结局，与未复发患者相比，IVR患者的OS和CSS显示出劣势（OS为P=0.042，CSS为P<0.0001），尿细胞学异常患者的OS以及接受辅助化疗患者的OS和CSS未显示出临床意义，其他危险因素均影响临床结局。
在这项倾向评分匹配研究中表明，尿细胞学异常、肾积水、辅助化疗和既往膀胱癌病史是IVR的独立危险因素。此外，危险因素也会影响临床结局，因此有必要对这些患者采取更积极的术后监测和治疗策略，这可能有助于改善治疗效果。
