Korean J Urol.  2014 Jul;55(7):453-459. 10.4111/kju.2014.55.7.453.

Predictors of Intravesical Recurrence After Radical Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma: An Inflammation-Based Prognostic Score

• Cho YH
• Seo YH
• Chung SJ
• Hwang I
• Yu HS
• Kim SO
• Jung SI
• Kang TW
• Kwon DD
• Park K
• Hwang JE
• Heo SH
• Kim GS
• Hwang EC

• KMID: 1794573
• DOI: http://doi.org/10.4111/kju.2014.55.7.453

Abstract

PURPOSE
Systemic inflammatory responses, which are defined in terms of the Glasgow prognostic score (GPS), have been reported to be independent predictors of unfavorable outcomes in various human cancers. We assessed the utility of the GPS as a predictor of intravesical recurrence after radical nephroureterectomy (RNU) in upper urinary tract carcinoma (UTUC).
MATERIALS AND METHODS
We collected data for 147 UTUC patients with no previous history of bladder cancer who underwent RNU from 2004 to 2012. Associations between perioperative clinicopathological variables and intravesical recurrence were analyzed by using univariate and multivariate Cox regression models.
RESULTS
Overall, 71 of 147 patients (48%) developed intravesical recurrence, including 21 patients (30%) diagnosed with synchronous bladder tumor. In the univariate analysis, performance status, diabetes mellitus (DM), serum albumin, C-reactive protein, GPS, and synchronous bladder tumor were associated with intravesical recurrence. In the multivariate analysis, performance status (hazard ratio [HR], 2.33; 95% confidence interval [CI], 1.41-3.85; p=0.001), DM (HR, 2.04; 95% CI, 1.21-3.41; p=0.007), cortical thinning (HR, 2.01; 95% CI, 1.08-3.71; p=0.026), and GPS (score of 1: HR, 6.86; 95% CI, 3.69-12.7; p=0.001; score of 2: HR, 5.96; 95% CI, 3.10-11.4; p=0.001) were independent predictors of intravesical recurrence.
CONCLUSIONS
Our results suggest that the GPS as well as performance status, DM, and cortical thinning are associated with intravesical recurrence after RNU. Thus, more careful follow-up, coupled with postoperative intravesical therapy to avoid bladder recurrence, should be considered in these patients.

Keyword

Inflammation; Recurrence; Risk factors; Transitional cell carcinoma

MeSH Terms

Adult
Aged
Aged, 80 and over
Carcinoma, Transitional Cell/pathology/secondary/*surgery
Female
Humans
Male
Middle Aged
Neoplasm Grading
Neoplasm Recurrence, Local/*etiology
Neoplasm Staging
Nephrectomy/*methods
Prognosis
Retrospective Studies
Risk Factors
Survival Analysis
Systemic Inflammatory Response Syndrome/etiology
Ureter/surgery
Urinary Bladder Neoplasms/secondary
Urologic Neoplasms/pathology/*surgery

Reference

1. Margulis V, Shariat SF, Matin SF, Kamat AM, Zigeuner R, Kikuchi E, et al. Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer. 2009; 115:1224–1233.

2. Roupret M, Zigeuner R, Palou J, Boehle A, Kaasinen E, Sylvester R, et al. European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update. Eur Urol. 2011; 59:584–594.

3. Raman JD, Ng CK, Boorjian SA, Vaughan ED Jr, Sosa RE, Scherr DS. Bladder cancer after managing upper urinary tract transitional cell carcinoma: predictive factors and pathology. BJU Int. 2005; 96:1031–1035.

4. Zigeuner RE, Hutterer G, Chromecki T, Rehak P, Langner C. Bladder tumour development after urothelial carcinoma of the upper urinary tract is related to primary tumour location. BJU Int. 2006; 98:1181–1186.

5. Novara G, De Marco V, Dalpiaz O, Gottardo F, Bouygues V, Galfano A, et al. Independent predictors of metachronous bladder transitional cell carcinoma (TCC) after nephroureterectomy for TCC of the upper urinary tract. BJU Int. 2008; 101:1368–1374.

6. Wheat JC, Weizer AZ, Wolf JS Jr, Lotan Y, Remzi M, Margulis V, et al. Concomitant carcinoma in situ is a feature of aggressive disease in patients with organ confined urothelial carcinoma following radical nephroureterectomy. Urol Oncol. 2012; 30:252–258.

7. Pieras E, Frontera G, Ruiz X, Vicens A, Ozonas M, Piza P. Concomitant carcinoma in situ and tumour size are prognostic factors for bladder recurrence after nephroureterectomy for upper tract transitional cell carcinoma. BJU Int. 2010; 106:1319–1323.

8. Fang D, Xiong GY, Li XS, Chen XP, Zhang L, Yao L, et al. Pattern and risk factors of intravesical recurrence after nephroureterectomy for upper tract urothelial carcinoma: a large Chinese center experience. J Formos Med Assoc. 2013; 13:pii: S0929-6646(13)00400-2.

9. Mullerad M, Russo P, Golijanin D, Chen HN, Tsai HH, Donat SM, et al. Bladder cancer as a prognostic factor for upper tract transitional cell carcinoma. J Urol. 2004; 172(6 Pt 1):2177–2181.

10. Xylinas E, Colin P, Audenet F, Phe V, Cormier L, Cussenot O, et al. Intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinomas: predictors and impact on subsequent oncological outcomes from a national multicenter study. World J Urol. 2013; 31:61–68.

11. Hisataki T, Miyao N, Masumori N, Takahashi A, Sasai M, Yanase M, et al. Risk factors for the development of bladder cancer after upper tract urothelial cancer. Urology. 2000; 55:663–667.

12. Terakawa T, Miyake H, Muramaki M, Takenaka A, Hara I, Fujisawa M. Risk factors for intravesical recurrence after surgical management of transitional cell carcinoma of the upper urinary tract. Urology. 2008; 71:123–127.

13. Li WM, Wu WJ, Li CC, Ke HL, Wei YC, Yeh HC, et al. The effect of tumor location on prognosis in patients with primary ureteral urothelial carcinoma. Urol Oncol. 2013; 31:1670–1675.

14. Fang D, Li XS, Xiong GY, Yao L, He ZS, Zhou LQ. Prophylactic intravesical chemotherapy to prevent bladder tumors after nephroureterectomy for primary upper urinary tract urothelial carcinomas: a systematic review and meta-analysis. Urol Int. 2013; 91:291–296.

15. Cho DS, Kim SI, Ahn HS, Kim SJ. Predictive factors for bladder recurrence after radical nephroureterectomy for upper urinary tract urothelial carcinoma. Urol Int. 2013; 91:153–159.

16. Pignot G, Colin P, Zerbib M, Audenet F, Soulie M, Hurel S, et al. Influence of previous or synchronous bladder cancer on oncologic outcomes after radical nephroureterectomy for upper urinary tract urothelial carcinoma. Urol Oncol. 2014; 32:23.e1–23.e8.

17. Luo HL, Kang CH, Chen YT, Chuang YC, Lee WC, Cheng YT, et al. Diagnostic ureteroscopy independently correlates with intravesical recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma. Ann Surg Oncol. 2013; 20:3121–3126.

18. Koda S, Mita K, Shigeta M, Usui T. Risk factors for intravesical recurrence following urothelial carcinoma of the upper urinary tract: no relationship to the mode of surgery. Jpn J Clin Oncol. 2007; 37:296–301.

19. Kikuchi E, Margulis V, Karakiewicz PI, Roscigno M, Mikami S, Lotan Y, et al. Lymphovascular invasion predicts clinical outcomes in patients with node-negative upper tract urothelial carcinoma. J Clin Oncol. 2009; 27:612–618.

20. Remzi M, Haitel A, Margulis V, Karakiewicz P, Montorsi F, Kikuchi E, et al. Tumour architecture is an independent predictor of outcomes after nephroureterectomy: a multi-institutional analysis of 1363 patients. BJU Int. 2009; 103:307–311.

21. Otto W, Shariat SF, Fritsche HM, Gupta A, Matsumoto K, Kassouf W, et al. Concomitant carcinoma in situ as an independent prognostic parameter for recurrence and survival in upper tract urothelial carcinoma: a multicenter analysis of 772 patients. World J Urol. 2011; 29:487–494.

22. Wu WJ, Ke HL, Yang YH, Li CC, Chou YH, Huang CH. Should patients with primary upper urinary tract cancer receive prophylactic intravesical chemotherapy after nephroureterectomy? J Urol. 2010; 183:56–61.

23. Espiritu PN, Sverrisson EF, Sexton WJ, Pow-Sang JM, Poch MA, Dhillon J, et al. Effect of tumor size on recurrence-free survival of upper tract urothelial carcinoma following surgical resection. Urol Oncol. 2014; 32:619–624.

24. Ha SH, Park J, Hong JH, Kim CS, Ahn H. Predictors of bladder tumor recurrence after curative surgery for upper urinary tract transitional cell carcinoma. Korean J Urol. 2009; 50:635–641.

25. McMillan DC. An inflammation-based prognostic score and its role in the nutrition-based management of patients with cancer. Proc Nutr Soc. 2008; 67:257–262.

26. Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ. Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG) in patients receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer. Br J Cancer. 2004; 90:1704–1706.

27. Crumley AB, Stuart RC, McKernan M, McDonald AC, McMillan DC. Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG-ps) in patients receiving palliative chemotherapy for gastroesophageal cancer. J Gastroenterol Hepatol. 2008; 23(8 Pt 2):e325–e329.

28. Leitch EF, Chakrabarti M, Crozier JE, McKee RF, Anderson JH, Horgan PG, et al. Comparison of the prognostic value of selected markers of the systemic inflammatory response in patients with colorectal cancer. Br J Cancer. 2007; 97:1266–1270.

29. Hwang EC, Kim YJ, Hwang IS, Hwang JE, Jung SI, Kwon DD, et al. Impact of diabetes mellitus on recurrence and progression in patients with non-muscle invasive bladder carcinoma: a retrospective cohort study. Int J Urol. 2011; 18:769–776.

30. Hwang I, Jung SI, Nam DH, Hwang EC, Kang TW, Kwon DD, et al. Preoperative hydronephrosis and diabetes mellitus predict poor prognosis in upper urinary tract urothelial carcinoma. Can Urol Assoc J. 2013; 7:E215–E220.