Analysis Of Risk Factors Of Bladder Tumor Recurrence After RUN In UTUC Patients

Objective The rate of recurrence of bladder after upper urinary tract urothelial carcinoma(UTUC)is higher,but the risk factors associated with tumor recurrence are not yet clear.The purpose of this study is to determine the risk factors for recurrence of bladder cancer after UTUC,and to provide a theoretical basis for clinical reduction of tumor recurrence after UTUC.Methods Review the clinical data of UTUC patients undergoing RUN surgery at the Second Hospital of Tianjin Medical University from 2008 to 2017,including: gender,age,preoperative glomerular filtration rate,tumor size,tumor location(kidney,ureter),whether the tumor is multifocal,the results of preoperative urine exfoliative cytology,clinical stage of the tumor,pathological grade,lymphovascular invasion,whether ureteroscopy before surgery,surgical methods(laparoscopic or open),and whether immediate postoperative bladder Perfusion chemotherapy,intraoperative ureteral ligation and so on.The end point of the follow-up period was from the time of RUN until the follow-up of bladder tumor.Ultimately,the clinicopathologic features,risk factors,and intravesical recurrence–free survival were analyzed using the Kaplan-Meier method.Univariate analysis by log-rank test and multivariate analysis by Cox proportional hazards regression model were used to determine the independent risk factors for IVR in patients with primary upper urothelial carcinoma after RUN.Results A total of 244 patients are suitable for this study.78 patients had postoperative recurrence of bladder cancer during follow-up,and there are two peaks for IVR,4-6months?17-19 months respectively.Univariate analysis suggested that men(P=0.0039),GFR ? 60ml/min(P=0.0202),tumor multifocaly(P=0.00126),lower ureteral tumors(P=0.036),positive urine cytology(P=0.000323),preoperative ureteroscopy(P=0.000791),laparoscopic surgery(P=0.035),Don't immediate postoperative bladder Perfusion chemotherapy(P=0.032),Lately ureteral ligation(P=0.0011)is an risk factor for intravesical recurrence after RUN,respectively.in multivariate analysis:male(P=0.037),tumor multifocaly(P=0.021),GFR? 60ml/min(P=0.026),lower ureteral tumor(P=0.032),urine cytology positive(P=0.017),preoperative ureteroscopy(P=0.025),laparoscopic surgery(P=0.020),Don't immediate postoperative bladder Perfusion chemotherapy(P=0.024),Lately ureteral ligation(P=0.039)is still Independent risk factors for intravesical recurrence,but the relation of age,size,CIS,lymphovascular invasion(LVI),tumor staging and grading,and postoperative bladder tumors with intravesical recurrence were not statistically significant.Kplan-Meier survival analysis showed that male(P=0.023),lower ureteral tumor(P=0.038),ipsilateral glomerular filtration rate ?60 ml/min(P=0.032),multifocal tumor(P=0.002),Preoperative urine cytology was positive(P=0.046),laparoscopic RUN(P=0.016),preoperative ureteroscopy(0.045),postoperative don't intravesical instillation chemotherapy(P=0.024),and Lately ureteral ligation,the rate of tumor recurrence was significantly higher after RUN.Bladder cancer was more likely to recur after RUN..and patients with these factors were shown to be more likely to developed subsequent bladder tumor.Conclusions 1?This study found that 33.3% of UTUC patients had recurrence of bladder cancer after RUN.2?The two peaks of postoperative bladder cancer recurrence in UTUC patients were April to June and 17 to 19 months respectively.3?Male,multifocal tumor,ipsilateral glomerular filtration rate ? 60ml/min,lower ureteral tumor,urine cytology positive,preoperative ureteroscopy,laparoscopic RUN,immediate postoperative intravesical instillation chemotherapy,No early ureteral ligation was an independent risk factor for bladder cancer recurrence after primary upper urinary tract urothelial carcinoma.