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KMID : 1011820200610020158
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Investigative and Clinical Urology
2020 Volume.61 No. 2 p.158 ~ p.165
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Impact of diagnostic ureteroscopy before radical nephroureterectomy on intravesical recurrence in patients with upper tract urothelial cancer
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Chung Youn-Soo
Lee Dong-Hwan
Lee Min-Seung
Kim Hak-Ju
Lee Sang-Chul
Hong Sung-Kyu
Byun Seok-Soo
Lee Sang-Eun
Oh Jong-Jin
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Abstract
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Purpose: To evaluate the impact of diagnostic ureteroscopy performed before radical nephroureterectomy (RNU) on intravesical recurrence (IVR) in patients with upper tract urothelial carcinoma (UTUC).
Materials and Methods: From May 2003 to December 2018, patients who underwent RNU for UTUC were enrolled and divided into two groups according to whether they underwent preoperative ureteroscopy (Pre-U vs. Non-U). We excluded patients who had a history of bladder cancer and did not receive bladder cuff resection during surgery. Perioperative parameters were compared between the two groups by use of t-tests or chi-square tests. Kaplan?Meier and Cox proportional hazards analyses were used to assess the association between Pre-U and IVR.
Results: Of the 453 total patients, 226 patients (49.9%, Pre-U group) had received diagnostic ureteroscopy before RNU, and 227 patients (50.1%, Non-U group) had not. IVR occurred in 99 patients (43.8%) in the Pre-U group and 61 patients (26.9%) in the Non-U group (p=0.001). The median time to recurrence was 107 months. The 5-year IVR-free survival rates were 56.2% and 73.1% in the Pre-U and Non-U groups, respectively (log rank test, p<0.001). Multivariate Cox proportional hazards analysis showed that Pre-U was a significant factor (hazard ratio, 1.413; 95% confidence interval, 1.015?1.965; p=0.040) after adjustment for other factors including tumor stage, location, etc.
Conclusions: Preoperative diagnostic ureteroscopy before RNU was a significant factor for IVR. Therefore, we should carefully consider Pre-U before RNU for nonobvious ureteral lesions. These results should be validated in a prospective study.
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KEYWORD
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Carcinoma, transitional cell, Nephroureterectomy, Ureteroscopy
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