Preoperative Risk Factors for Extraurothelial Recurrence in Patients with Ureteral Cancer Treated with Radical Nephroureterectomy
- 1 June 2014
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 191 (6), 1685-1692
- https://doi.org/10.1016/j.juro.2013.12.048
Abstract
Recent studies have suggested that lymph node dissection may improve the prognosis in patients with upper tract urothelial carcinoma. Therefore, patients who will benefit from lymph node dissection need to be selected before surgery. Because patients who have extraurothelial recurrence theoretically include those whose prognoses are improved by lymph node dissection, we conducted this study to determine the preoperative predictors of extraurothelial recurrence in patients with ureteral cancer. Because it is not appropriate to categorize the preoperative radiologic findings of ureteral cancer and those of renal pelvic cancer using the same classification criteria, we focused on ureteral cancer. We reviewed preoperative factors in 70 patients with ureteral cancer treated with radical nephroureterectomy. Laboratory tests including inflammatory indices, tumor markers and estimated glomerular filtration rate, along with radiologic findings, were evaluated. Multivariate analyses were performed to determine independent factors predicting extraurothelial recurrence in patients with ureteral cancer. Positive cytology, cT stage 3 or greater, length of ureteral cancer 3 cm or greater and estimated glomerular filtration rate less than 60 ml/minute/1.73 m2 were independent predictors of extraurothelial recurrence on multivariate analysis. When patients were stratified into 3 groups according to the number of risk factors, the 3-year extraurothelial recurrence-free survival rates were 95.2% in the low risk group, 75.8% in the intermediate risk group and 25.1% in the high risk group. Positive cytology, cT stage 3 or greater, length of ureteral cancer 3 cm or greater and estimated glomerular filtration rate less than 60 ml/minute/1.73 m2 were preoperative predictive factors of extraurothelial recurrence in patients with ureteral cancer and lymph node dissection may be omitted for low risk patients.Keywords
This publication has 23 references indexed in Scilit:
- Clinical significance of preoperative peripheral blood neutrophil count in patients with non-metastatic upper urinary tract carcinomaWorld Journal of Urology, 2012
- The role of lymph node dissection in the management of urothelial carcinoma of the upper urinary tractInternational Journal of Clinical Oncology, 2011
- Tumour Necrosis Is an Indicator of Aggressive Biology in Patients with Urothelial Carcinoma of the Upper Urinary TractEuropean Urology, 2010
- Outcomes of radical nephroureterectomy: A series from the Upper Tract Urothelial Carcinoma CollaborationCancer, 2009
- Lymphovascular Invasion Predicts Clinical Outcomes in Patients With Node-Negative Upper Tract Urothelial CarcinomaJournal of Clinical Oncology, 2009
- Laparoscopic Radical Nephroureterectomy for Upper Tract Transitional Cell Carcinoma: Oncological Outcomes at 7 YearsJournal of Urology, 2008
- Prognostic Value of Lymph Node Dissection in Patients with Muscle-Invasive Transitional Cell Carcinoma of the Upper Urinary TractEuropean Urology, 2008
- Lymphovascular Invasion is Independently Associated With Poor Prognosis in Patients With Localized Upper Urinary Tract Urothelial Carcinoma Treated SurgicallyJournal of Urology, 2007
- Impact of the Extent of Regional Lymphadenectomy on the Survival of Patients With Urothelial Carcinoma of the Upper Urinary TractJournal of Urology, 2007
- The impact of preoperative serum C‐reactive protein on the prognosis of patients with upper urinary tract urothelial carcinoma treated surgicallyBJU International, 2007