Effect Of Urinary Exfoliative Cytology On Postoperative Intravesical Recurrence And Prognosis In Patients With Upper Urinary Tract Urothelial Carcinoma

Objective: To investigate the effect of urinary exfoliative cytology on postoperative intravesical tumor recurrence and prognosis in patients with upper urinary tract urothelial carcinoma(UTUC)by retrospective analysis.Methods: This study retrospectively analyzed the laparoscopic or open radical rheumatoid arterial resection plus bladder sleeve resection in the Department of Urology,Qingdao University Hospital from January 2010 to December 2015.In patients with UTUC,all patients underwent urinary exfoliative cytology before surgery,and the pathological diagnosis was urothelial carcinoma.The patient’s clinical and pathological data were sorted out for outpatient review and telephone follow-up.The patients enrolled were divided into urinary exfoliative cytology-positive UTUC group(n=59)and urine exfoliative cytology-negative UTUC group(n=92).SPSS23.0 software was used to analyze the variables of the two groups,so that the two groups were compared.The clinicopathological features of the group of patients.Among them,the Kaplan-Meier curve was used to map the survival curve of 5-year total survival(OS)after UTUC radical operation.The single factor and multi-factor risk factors were analyzed using COX regression model.Rsults: A total of 151 patients with UTUC were enrolled in the study,including 59patients(39.07%)with positive urinary exfoliative cytology and 92 patients(60.93%)with negative patients.The median follow-up was 47 months.A total of 44 patients(29.14%)had intravesical tumor recurrence,and 107 patients(70.86%)had no intravesical tumor recurrence.A total of 61 patients died.In the urine-free cytologypositive group,31(52.54%)patients died;in the negative group,30(32.61%)patients died.Compared with patients with urinary exfoliative cytology-negative UTUC,exfoliated cells were more easily detected in the urine of patients with multiple tumors(P= 0.021),high grade(P = 0.046),and high stage(P = 0.012).To compare the distribution of postoperative bladder recurrence in patients with UTUC under different variables,the results showed: diabetes(P = 0.009),BMI ≥ 25(P = 0.040),multiple tumors(P = 0.016),and urine exfoliative cytology(P = 0.012)The probability of tumor recurrence in the bladder was greater,and the difference was statistically significant(P<0.05).Univariate analysis suggested that diabetes,obesity,multiple tumors,and urinary exfoliative cytology were closely related to intravesical recurrence after UTUC radical resection(P<0.05).Multivariate analysis showed that diabetes(HR=3.061,P=0.023),multiple tumors(HR=3.244,P=0.046),and urinary exfoliative cytology(HR=3.001,P=0.011) were affected by UTUC after radical surgery.Independent risk factors for tumor recurrence(P<0.05).Obesity(HR=1.239,P=0.672)was not an independent risk factor for recurrence of intravesical tumor recurrence after UTUC radical surgery(P>0.05).Fiveyear overall survival(OS)and risk factors analysis of patients with UTUC after radical surgery.The urinary exfoliated cell-positive group had a shorter OS than the negative group(P = 0.007),and the tumor-prone group had a shorter OS than the single-shot group(P = 0.008),and the tumor-high staging group had a shorter OS than the low-stage group.(P = 0.006),the tumor high grade group had a shorter OS than the low grade group(P =0.001).Univariate analysis showed multiple tumors(P = 0.028),tumor diameter ≥ 3 cm(P= 0.010),high tumor stage(P = 0.000),high tumor grade(P = 0.000),positive urine exfoliated cells(P = 0.009).There was a close relationship with the overall survival(OS)after UTUC(P<0.05).Multivariate analysis results: high tumor stage(HR=27.994,P=0.000)and high tumor grade(HR=12.985,P=0.000)were independent risk factors for OS after UTUC.The number of tumors(HR=1.760,P = 0.147),tumor size(HR=1.344,P= 0.327),and urine exfoliated cells(HR=1.242,P=0.490)were not independent risk factors for OS after UTUC.Conclusions: Of the 151 patients enrolled in the study,urinary exfoliative cytology was approximately 39.07%.Exfoliated cells were more easily detected in the urine of patients with multiple tumors,high-grade,high-grade tumors(p<0.05).Diabetes,multiple tumors,and urinary exfoliative cytology are independent risk factors for recurrence of intravesical tumors after utuc radical surgery.High tumor stage and high tumor level are independent risk factors for os after utuc.Patients with utuc who have the above risk factors should have a detailed follow-up plan after radical surgery and actively follow up.