Investig Clin Urol.  2020 Jan;61(1):51-58. 10.4111/icu.2020.61.1.51.

Preoperative sterile pyuria as a prognostic biomarker for intravesical recurrence in upper urinary tract urothelial carcinoma

• Jeon BJ
• Tae BS
• Choi H
• Bae JH
• Kim JW
• Park HS
• Park JY

• KMID: 2466792
• DOI: http://doi.org/10.4111/icu.2020.61.1.51

Abstract

PURPOSE
To evaluate if preoperative sterile pyuria can be a prognostic factor for intravesical recurrence (IVR) and overall survival (OS)in patients with upper tract urothelial carcinoma (UTUC) undergoing surgery.
MATERIALS AND METHODS
We retrospectively reviewed the medical records of patients who were diagnosed with UTUC from October 2003 to December 2016 at Korea University Medical Center. Sterile pyuria was defined as urine containing five or more white blood cells per high-power field in the absence of bacteria in urine culture. We used a stepwise multivariable Cox proportional hazards model to assess the independent effects of the prognostic factors for IVR and OS.
RESULTS
We investigated a total of 176 patients who were diagnosed with UTUC. Among them, 91 (51.7%) patients had preoperative sterile pyuria. There were no significant differences in the baseline characteristics between the pyuria and non-pyuria groups concerning tumor grade, T stage, tumor multiplicity, and recurrence history. However, there was a significant difference in the IVR between the two groups. In the multivariable analysis, preoperative sterile pyuria, diabetes mellitus, high-grade tumor, and lymphovascular invasion were revealed as independent risk factors for IVR, and only lymphovascular invasion was identified as an independent risk factor for OS.
CONCLUSIONS
Preoperative sterile pyuria is significantly associated with IVR in patients with UTUC undergoing surgery, but it is not associated with OS. Furthermore, diabetes mellitus, high-grade tumor, and lymphovascular invasion are also independent prognostic factors for these patients.

Keyword

Prognosis; Pyuria; Recurrence; Urinary bladder; Urologic neoplasms

MeSH Terms

Academic Medical Centers
Bacteria
Diabetes Mellitus
Humans
Korea
Leukocytes
Medical Records
Prognosis
Proportional Hazards Models
Pyuria*
Recurrence*
Retrospective Studies
Risk Factors
Urinary Bladder
Urinary Tract*
Urologic Neoplasms

Figure

• 

  Fig. 1 Kaplan–Meier plots showing the probability of intravesical recurrence-free survival in 176 patients with upper tract urothelial carcinoma, stratifiedby the following predictors for intravesical recurrence: (A) preoperative pyuria, (B) lymphovascular invasion (LVI), (C) diabetes mellitus (DM), and (D) tumorgrade.

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