Department of Urology, Seoul National University Hospital, Seoul, Korea.
Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
Investig Clin Urol. 2023 Jul;64(4):353-362. doi: 10.4111/icu.20230066.
About one-third of patients who undergo radical nephroureterectomy (RNUx) for upper tract urothelial carcinoma (UTUC) experience intravesical recurrence (IVR). This study investigated whether pyuria is a feasible predictor of IVR after RNUx in patients with UTUC.
Seven hundred forty-three patients with UTUC who underwent RNUx at a single institute were analyzed in this study. The participants were divided into two groups: those without pyuria (non-pyuria) and those with pyuria. Kaplan-Meier survival analysis was performed, and p-values were assessed using the log-rank test. Cox regression analyses were performed to identify the independent predictors of survival.
The pyuria group had a shorter IVR-free survival period (p=0.009). The five-year IVR-free survival rate was 60.0% in the non-pyuria group vs. 49.7% in the pyuria group according to the Kaplan-Meier survival analysis. After the multivariate Cox regression analysis, pyuria (hazard ratio [HR]=1.368; p=0.041), a concurrent bladder tumor (HR=1.757; p=0.005), preoperative ureteroscopy (HR=1.476; p=0.013), laparoscopic surgery (HR=0.682; p=0.048), tumor multiplicity (HR=1.855; p=0.007), and a larger tumor (HR=1.041; p=0.050) were predictors of risk for IVR. There was no association between pyuria and recurrence-free survival (p=0.057) or cancer-specific survival (p=0.519) in the Kaplan-Meier survival analysis.
This study concluded that pyuria was an independent predictor of IVR in patients with UTUC after RNUx.
约三分之一接受根治性肾输尿管切除术（RNUx）治疗上尿路上皮癌（UTUC）的患者会出现膀胱内复发（IVR）。本研究旨在探讨脓尿是否是 UTUC 患者 RNUx 后 IVR 的一个可行预测因子。
本研究分析了在单家机构接受 RNUx 的 743 例 UTUC 患者。将患者分为两组：无脓尿组（非脓尿组）和脓尿组。进行 Kaplan-Meier 生存分析，并使用对数秩检验评估 p 值。进行 Cox 回归分析以确定生存的独立预测因子。
脓尿组的 IVR 无复发生存期较短（p=0.009）。Kaplan-Meier 生存分析显示，非脓尿组的五年 IVR 无复发生存率为 60.0%，脓尿组为 49.7%。经过多变量 Cox 回归分析，脓尿（风险比 [HR]=1.368；p=0.041）、同期膀胱肿瘤（HR=1.757；p=0.005）、术前输尿管镜检查（HR=1.476；p=0.013）、腹腔镜手术（HR=0.682；p=0.048）、肿瘤多发性（HR=1.855；p=0.007）和较大肿瘤（HR=1.041；p=0.050）是 IVR 风险的预测因子。在 Kaplan-Meier 生存分析中，脓尿与无复发生存（p=0.057）或癌症特异性生存（p=0.519）之间无关联。
本研究表明，脓尿是 RNUx 后 UTUC 患者 IVR 的独立预测因子。
