Investig Clin Urol.  2020 Mar;61(2):158-165. 10.4111/icu.2020.61.2.158.

Impact of diagnostic ureteroscopy before radical nephroureterectomy on intravesical recurrence in patients with upper tract urothelial cancer

• Chung Y
• Lee DH
• Lee M
• Kim H
• Lee S
• Hong SK
• Byun SS
• Lee SE
• Oh JJ

• KMID: 2471071
• DOI: http://doi.org/10.4111/icu.2020.61.2.158

Abstract

PURPOSE
To evaluate the impact of diagnostic ureteroscopy performed before radical nephroureterectomy (RNU) on intravesical recurrence (IVR) in patients with upper tract urothelial carcinoma (UTUC).
MATERIALS AND METHODS
From May 2003 to December 2018, patients who underwent RNU for UTUC were enrolled and divided into two groups according to whether they underwent preoperative ureteroscopy (Pre-U vs. Non-U). We excluded patients who had a history of bladder cancer and did not receive bladder cuff resection during surgery. Perioperative parameters were compared between the two groups by use of t-tests or chi-square tests. Kaplan-Meier and Cox proportional hazards analyses were used to assess the association between Pre-U and IVR.
RESULTS
Of the 453 total patients, 226 patients (49.9%, Pre-U group) had received diagnostic ureteroscopy before RNU, and 227 patients (50.1%, Non-U group) had not. IVR occurred in 99 patients (43.8%) in the Pre-U group and 61 patients (26.9%) in the Non-U group (p=0.001). The median time to recurrence was 107 months. The 5-year IVR-free survival rates were 56.2% and 73.1% in the Pre-U and Non-U groups, respectively (log rank test, p<0.001). Multivariate Cox proportional hazards analysis showed that Pre-U was a significant factor (hazard ratio, 1.413; 95% confidence interval, 1.015-1.965; p=0.040) after adjustment for other factors including tumor stage, location, etc.
CONCLUSIONS
Preoperative diagnostic ureteroscopy before RNU was a significant factor for IVR. Therefore, we should carefully consider Pre-U before RNU for nonobvious ureteral lesions. These results should be validated in a prospective study.

Keyword

Carcinoma, transitional cell; Nephroureterectomy; Ureteroscopy

MeSH Terms

Carcinoma, Transitional Cell
Humans
Prospective Studies
Recurrence*
Survival Rate
Ureter
Ureteroscopy*
Urinary Bladder
Urinary Bladder Neoplasms

Figure

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  Fig. 1 (A) Kaplan–Meier curves showing recurrence-free survival rate in patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy according to preoperative ureteroscopy. (B) Kaplan–Meier curves showing cancer-specific survival rate in patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy according to preoperative ureteroscopy. (C) Kaplan–Meier curves showing overall survival rate in patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy according to preoperative ureteroscopy.

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