Wu Yi-Ru, Li Ching-Chia, Juan Yung-Shun, Li Wei-Ming, Wu Wen-Jeng, Chien Tsu-Ming
Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan.
Department of Urology, Kaohsiung Medical University Gangshan Hospital, Kaohsiung 820111, Taiwan.
Cancers (Basel). 2025 Feb 16;17(4):664. doi: 10.3390/cancers17040664.
The objective of the present study was to evaluate the impact of dialysis on patients with upper tract urothelial carcinoma (UTUC) who are undergoing surgical intervention, as well as to identify predictive factors linked to contralateral recurrence.
A retrospective review was conducted on patients who underwent radical nephroureterectomy (RNU) for non-metastatic UTUC at our institution from 2000 to 2013. The contralateral recurrence rate was calculated using the Kaplan-Meier method, and multivariate logistic regression analysis was employed to examine the relationship between clinicopathological characteristics and contralateral recurrence.
A total of 593 patients were included in this analysis, of which 31 (5.8%) experienced metachronous recurrence on the contralateral side. Kaplan-Meier analysis indicated a statistically significant reduction in the contralateral recurrence-free survival rate among female patients ( = 0.040), those with a prior history of bladder cancer ( < 0.001), individuals presenting with multiple tumors ( = 0.011), patients with advanced chronic kidney disease (CKD) ( < 0.001), and those requiring postoperative dialysis ( < 0.001). In contrast, preoperative hemodialysis status did not show a significant correlation with contralateral recurrence ( = 0.08). The multivariate analysis identified a history of bladder cancer (hazard ratio (HR), 3.19; 95% confidence interval (CI), 1.2-8.4; = 0.018), the necessity for new hemodialysis postoperatively (HR, 5.34; 95% CI, 1.3-25.6; = 0.034), and advanced CKD (HR, 2.52; 95% CI, 1.4-4.9; = 0.021) as independent risk factors associated with an increased rate of contralateral recurrence.
In conclusion, advanced CKD, a history of bladder cancer, and the initiation of new dialysis following surgery were identified as independent prognostic indicators for contralateral recurrence in patients with initial unilateral UTUC undergoing RNU. It is recommended that patients exhibiting these three adverse characteristics undergo rigorous monitoring of the contralateral upper urinary tract throughout the follow-up period.
本研究的目的是评估透析对接受手术干预的上尿路尿路上皮癌（UTUC）患者的影响，并确定与对侧复发相关的预测因素。
对2000年至2013年在本机构接受根治性肾输尿管切除术（RNU）治疗非转移性UTUC的患者进行回顾性研究。使用Kaplan-Meier方法计算对侧复发率，并采用多因素逻辑回归分析来研究临床病理特征与对侧复发之间的关系。
本分析共纳入593例患者，其中31例（5.8%）出现对侧异时性复发。Kaplan-Meier分析表明，女性患者（P = 0.040）、有膀胱癌病史者（P < 0.001）、出现多发肿瘤者（P = 0.011）、患有晚期慢性肾脏病（CKD）者（P < 0.001）以及需要术后透析者（P < 0.001）的对侧无复发生存率在统计学上显著降低。相比之下，术前血液透析状态与对侧复发无显著相关性（P = 0.08）。多因素分析确定膀胱癌病史（风险比（HR），3.19；95%置信区间（CI），1.2 - 8.4；P = 0.018）、术后需要新的血液透析（HR，5.34；95% CI，1.3 - 25.6；P = 0.034）和晚期CKD（HR，2.52；95% CI，1.4 - 4.9；P = 0.021）是与对侧复发率增加相关的独立危险因素。
总之，晚期CKD、膀胱癌病史以及术后开始新的透析被确定为接受RNU的初始单侧UTUC患者对侧复发的独立预后指标。建议具有这三个不良特征的患者在整个随访期间对侧上尿路进行严格监测。
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