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. 2021 Nov 25;13(23):5935.
doi: 10.3390/cancers13235935.

Prognostic Factors for Contralateral Recurrence of Upper Tract Urothelial Carcinoma after Nephroureterectomy: A Large Multiregional Study

Tsu-Ming Chien  1   2 , Hsiang-Ying Lee  1   2   3   4 , Nirmish Singla  5 , Vitaly Margulis  6 , Yair Lotan  6 , Solomon Lukasz Woldu  6 , Chun-Nung Huang  2   3   4 , Ching-Chia Li  2   3 , Hung-Lung Ke  2   3   4 , Wei-Ming Li  2   3   7 , Chia-Yang Li  8   9 , A-Mei Huang  1   9   10 , Sheau-Fang Yang  11   12 , Hung-Pin Tu  13 , Wen-Jeng Wu  2   3   9 , Hsin-Chih Yeh  2   3   4   9
Affiliations

Prognostic Factors for Contralateral Recurrence of Upper Tract Urothelial Carcinoma after Nephroureterectomy: A Large Multiregional Study

Tsu-Ming Chien et al. Cancers (Basel). .

Abstract

This study aimed to examine the prognostic significance of preoperative inflammation-associated blood cell markers in the metachronous contralateral recurrence of upper tract urothelial carcinoma (UTUC). Patients with nonmetastatic UTUC treated in Taiwan and the U.S. between 1990 and 2017 were included. The Kaplan-Meier method was used to calculate the contralateral recurrence rate, and multivariate logistic regression was performed to study the association of blood cell markers and clinicopathological characteristics with contralateral recurrence. Overall, a total of 1039 patients were included in this study, 52 of whom (5.0%) developed metachronous recurrence of the contralateral side. Kaplan-Meier analysis indicated that a history of bladder cancer (p = 0.006), multiple tumors (p = 0.016), advanced chronic kidney disease (CKD; p < 0.001), elevated serum white blood cell (WBC) count (p < 0.001), and decreased hemoglobin levels (p = 0.001) significantly reduced the contralateral recurrence-free survival. Multivariate analysis showed that multiple tumors (hazard ratio (HR), 1.87; p = 0.030), advanced CKD (HR, 2.63; p = 0.002) and increased WBC count (HR, 2.60; p = 0.001) were independent risk factors for higher contralateral recurrence rate. Notably, advanced CKD was a significant factor regardless of the patient's region. In summary, multiple tumors, advanced CKD and elevated serum WBC count are independent predictors of contralateral recurrence in patients with UTUC. It is recommended that patients with these adverse characteristics be closely followed up to monitor the opposite upper urinary tract.

Keywords: chronic kidney disease; contralateral recurrence; inflammation; nephroureterectomy; upper tract urothelial carcinoma; white blood cell.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier analysis indicated that patients exhibiting (A) multiple tumors (log-rank p = 0.016), (B) advanced chronic kidney disease (CKD) (log-rank p < 0.001), (C) elevated white blood cell (WBC) count (log-rank p < 0.001), and (D) decreased hemoglobin level (log-rank p = 0.001) had significantly lower contralateral recurrence-free survival rates.
Figure 2
Figure 2
In Kaplan–Meier analysis, bladder cancer history, tumor number, and CKD stage of patients with upper tract urothelial carcinoma (UTUC) from Taiwan (A,C,E) or the U.S. (B,D,F) were significantly associated with contralateral recurrence.
See this image and copyright information in PMC

References

    1. Margulis V., Shariat S.F., Matin S.F., Kamat A.M., Zigeuner R., Kikuchi E., Lotan Y., Weizer A., Raman J.D., Wood C.G., et al. Outcomes of radical nephroureterectomy: A series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer. 2009;115:1224–1233. doi: 10.1002/cncr.24135. - DOI - PubMed
    1. Li C.C., Chang T.H., Wu W.J., Ke H.L., Huang S.P., Tsai P.C., Chang S.J., Shen J.T., Chou Y.H., Huang C.H. Significant predictive factors for prognosis of primary upper urinary tract cancer after radical nephroureterectomy in Taiwanese patients. Eur. Urol. 2008;54:1127–1134. doi: 10.1016/j.eururo.2008.01.054. - DOI - PubMed
    1. Yu L.C., Chang C.H., Huang C.P., Huang C.Y., Hong J.H., Tai T.Y., Weng H.Y., Lo C.W., Tsai C.Y., Lee Y.K., et al. Prognostic Significance of Primary Tumor Location in Upper Tract Urothelial Carcinoma Treated with Nephroureterectomy: A Retrospective, Multi-Center Cohort Study in Taiwan. J. Clin. Med. 2020;9:3866. doi: 10.3390/jcm9123866. - DOI - PMC - PubMed
    1. Kang C.H., Yu T.J., Hsieh H.H., Yang J.W., Shu K., Huang C.C., Chiang P.H., Shiue Y.L. The development of bladder tumors and contralateral upper urinary tract tumors after primary transitional cell carcinoma of the upper urinary tract. Cancer. 2003;98:1620–1626. doi: 10.1002/cncr.11691. - DOI - PubMed
    1. Wu K., Liang J., Lu Y. Risk factors and survival outcomes of metachronous contralateral upper tract urothelial carcinoma. Sci. Rep. 2020;10:16600. doi: 10.1038/s41598-020-73699-5. - DOI - PMC - PubMed

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