Risk Factors And Oncological Outcome For Intravesical Recurrence In Organ-confined Upper Urinary Tract Urothelial Carcinoma Patients After Radical Nephroureterectomy

Purposes: Radical nephroureterectomy(RNU)is the primary treatment strategy for upper urinary tract urothelial carcinoma(UTUC);however,the prognosis is poor and recurrences are common.The risk factors for intravesical recurrence(IVR)remain inconsistent and unclear.Thus,we have identified the risk factors for IVR in patients with organ-confined UTUC.Methods: We retrospectively studied 229 patients with UTUC who underwent RNU combined with bladder cuff resection at our center between 1 January 2010 and 31 December 2015.Patient demographics,co-morbidities,and peri-operative data were recorded.Univariate and multivariate Cox proportional hazard regression were used to estimate the hazard ratio and 95% confidence intervals.Overall(OS)and cancer-specific survival(CSS)were measured using the Kaplan–Meier curve with a log-rank test.A pvalue <0.05 was considered statistically significant.Results: Of the 229 patients,42(18.3%)had IVR after 40 months(range,24-56 months)follow-up.The independent risk factors for IVR were tumor diameter(HR=2.416,p=0.046)and tumor stage(T3 vs.T1,HR=3.647,p=0.012;T2 vs.T1,HR=2.905,p=0.019).OS and CSS stratified according to IVR status were significantly different(p<0.0001).Conclusions: Tumor diameter and tumor stage were shown to be independent risk factors for IVR in patients with organ-confined UTUC.Moreover,patients with IVR had poor OS and CSS than patients without IVR.These findings could improve the treatment strategy and follow-up schedule for patients with organ-confined UTUC.