This study aimed to identify preoperative risk factors and create a risk classification for intravesical recurrence of upper urinary tract urothelial carcinoma only after laparoscopic radical nephroureterectomy in a multi-institutional cohort.
We retrospectively analyzed 283 patients who had undergone laparoscopic radical nephroureterectomy for nonmetastatic upper tract urothelial cancer between March 2002 and March 2020. The cumulative incidence of intravesical recurrence for 224 patients without previous or concomitant bladder cancer was examined using multivariate Fine-Gray competing risks proportional hazards models. A risk stratification model was created to predict subsequent patient outcomes based on the results.
The median follow-up duration was 33.3 months, and 71 (31.7%) patients experienced intravesical recurrence. The estimated cumulative incidence of intravesical recurrence at one and 5 years was 23.5% and 36.4%, respectively. In multivariate analysis, the presence of ureter tumors and multiple tumors were shown to be independently significant predictive factors for intravesical recurrence. Based on the results, we classified patients into three risk groups. The cumulative incidence rates of intravesical recurrence within 5 years after surgery were 24.4%, 42.5%, and 66.7% in the low-, intermediate-, and high-risk groups, respectively.
We identified risk factors and created a risk classification model for intravesical recurrence of upper urinary tract urothelial carcinoma only after laparoscopic radical nephroureterectomy. Based on this model, an individualized surveillance protocol or adjuvant therapy could be provided.
International journal of urology : official journal of the Japanese Urological Association. 2023 Jun 06 [Epub ahead of print]
Shinya Somiya, Go Kobori, Katsuhiro Ito, Hiromichi Nakagawa, Toshifumi Takahashi, Shigeki Koterazawa, Naoto Takaoka, Takao Haitani, Kanji Nagahama, Masaaki Ito, Yuzuru Megumi, Yoshihito Higashi, Seiji Moroi, Toshiya Akao, Hitoshi Yamada, Toru Kanno
Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan., Department of Urology, Hamamatsu Rosai Hospital, Hamamatsu, Japan., Department of Urology, Rakuwakai Otowa Hospital, Kyoto, Japan.