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. 2020 Jun 3;20(1):166.
doi: 10.1186/s12906-020-2861-5.

Clinicopathologic characteristics and prognosis of upper tract urothelial carcinoma complicated with aristolochic acid nephropathy after radical nephroureterectomy

Hongli Shan  1 , Wen Tian  2 , Yazhao Hong  3 , Bo Xu  3 , Chunxi Wang  3 , Bing Yu  4 , Xiaoqing Wang  5
Affiliations

Clinicopathologic characteristics and prognosis of upper tract urothelial carcinoma complicated with aristolochic acid nephropathy after radical nephroureterectomy

Hongli Shan et al. BMC Complement Med Ther. .

Abstract

Background: The purpose of this study was to identify the clinicopathologic characteristics and prognosis of upper tract urothelial carcinoma (UTUC) patients complicated with aristolochic acid nephropathy(AAN) after radical nephroureterectomy (RNU).

Methods: The clinical data of 42 UTUC patients with AAN (AAN group) and 238 UTUC patients without AAN (Non-AAN group) were retrospectively reviewed. All patients received a RNU with excision of bladder cuff. Demographic and clinical data, including preoperative indexes, intraoperative indexes and surgical outcomes were compared.

Results: There were no significant differences in age, tumor location, surgery approach, tumor pathologic grade, stage, the mean operative time and estimated blood loss between the two groups (all p > 0.05). There were more female patients in the AAN group (p < 0.001), and 57.1% were high grade tumors. The AAN group showed a higher complications rate (p = 0.003). The median follow-up time was 43.2 months. The AAN group showed a worse estimated 5-year overall survival rate (35.1% vs. 63.0%, p = 0.014), however, no significant difference was found between the two groups with regard to disease specific survival (63.5% vs. 81.5%, p = 0.091). Multivariate binary logistic regression analysis showed that AAN was an independent factor related with overall and disease specific survival. 38.9% of all patients experienced any types of recurrence, and the estimated 5-year recurrence-free survival rate was lower in the AAN group (37.1% vs. 63.7%, p = 0.001). In the comparison of subgroups stratified by recurrence type, the AAN group had a higher intravesical (p = 0.030) and contralateral recurrence rate (p = 0.040).

Conclusion: UTUC with AAN occurred more frequently in female patients who were more likely to develop high-grade tumors. However, these patients showed a worse overall survival and a lower recurrence-free survival rate than the other patients. AA-related UTUC might be associate with an increased risk of intravesical and contralateral recurrence after RUN.

Keywords: Aristolochic acid; Carcinogenesis; Nephroureterectomy; Survival; Upper tract urothelial carcinoma.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Cumulative incidence of overall survival following radical nephroureterectomy between AAN and Non-AAN group
Fig. 2
Fig. 2
Cumulative incidence of disease specific survival following radical nephroureterectomy between AAN and Non-AAN group
Fig. 3
Fig. 3
Kaplan-Meier estimates of recurrence-free probabilities following radical nephroureterectomy between AAN and Non-AAN group
Fig. 4
Fig. 4
Kaplan-Meier estimates of intravesical recurrence-free probabilities following radical nephroureterectomy between AAN and Non-AAN group
See this image and copyright information in PMC

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