Frontiers in Oncology (Jun 2022)
The Value of Preoperative Local Symptoms in Prognosis of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy: A Retrospective, Multicenter Cohort Study
- Hsin-Chih Yeh,
- Hsin-Chih Yeh,
- Hsin-Chih Yeh,
- Hsin-Chih Yeh,
- Chao-Hsiang Chang,
- Chao-Hsiang Chang,
- Chao-Hsiang Chang,
- Jen-Kai Fang,
- I-Hsuan Alan Chen,
- Jen-Tai Lin,
- Jian-Hua Hong,
- Jian-Hua Hong,
- Chao-Yuan Huang,
- Shian-Shiang Wang,
- Shian-Shiang Wang,
- Shian-Shiang Wang,
- Chuan-Shu Chen,
- Chuan-Shu Chen,
- Chuan-Shu Chen,
- Chi-Wen Lo,
- Chih-Chin Yu,
- Chih-Chin Yu,
- Jen-Shu Tseng,
- Jen-Shu Tseng,
- Jen-Shu Tseng,
- Wun-Rong Lin,
- Wun-Rong Lin,
- Yeong-Chin Jou,
- Yeong-Chin Jou,
- Ian-Seng Cheong,
- Yuan-Hong Jiang,
- Chung-You Tsai,
- Chung-You Tsai,
- Thomas Y. Hsueh,
- Thomas Y. Hsueh,
- Yung-Tai Chen,
- Hsu-Che Huang,
- Hsu-Che Huang,
- Yao-Chou Tsai,
- Yao-Chou Tsai,
- Wei-Yu Lin,
- Wei-Yu Lin,
- Wei-Yu Lin,
- Chia-Chang Wu,
- Chia-Chang Wu,
- Chia-Chang Wu,
- Po-Hung Lin,
- Po-Hung Lin,
- Po-Hung Lin,
- Te-Wei Lin,
- Wen-Jeng Wu,
- Wen-Jeng Wu,
- Wen-Jeng Wu,
- Wen-Jeng Wu
Affiliations
- Hsin-Chih Yeh
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Hsin-Chih Yeh
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Hsin-Chih Yeh
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Hsin-Chih Yeh
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Chao-Hsiang Chang
- Department of Urology, China Medical University, Taichung, Taiwan
- Chao-Hsiang Chang
- School of Medicine, China Medical University, Taichung, Taiwan
- Chao-Hsiang Chang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
- Jen-Kai Fang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
- I-Hsuan Alan Chen
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Jen-Tai Lin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Jian-Hua Hong
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- Jian-Hua Hong
- 0Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Chao-Yuan Huang
- 0Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Shian-Shiang Wang
- 1Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Shian-Shiang Wang
- 2Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Shian-Shiang Wang
- 3Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan
- Chuan-Shu Chen
- 1Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Chuan-Shu Chen
- 2Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Chuan-Shu Chen
- 4Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung, Taiwan
- Chi-Wen Lo
- 5Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan
- Chih-Chin Yu
- 5Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan
- Chih-Chin Yu
- 6School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
- Jen-Shu Tseng
- 7Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
- Jen-Shu Tseng
- 8Mackay Medical College, New Taipei City, Taiwan
- Jen-Shu Tseng
- 9Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Wun-Rong Lin
- 7Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
- Wun-Rong Lin
- 8Mackay Medical College, New Taipei City, Taiwan
- Yeong-Chin Jou
- 0Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
- Yeong-Chin Jou
- 1Department of Health and Nutrition Biotechnology, Asian University, Taichung, Taiwan
- Ian-Seng Cheong
- 0Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
- Yuan-Hong Jiang
- 2Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
- Chung-You Tsai
- 3Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Chung-You Tsai
- 4Department of Healthcare Information & Management, Ming Chuan University, Taoyuan, Taiwan
- Thomas Y. Hsueh
- 5Division of Urology, Department of Surgery, Taipei City Hospital renai branch, Taipei, Taiwan
- Thomas Y. Hsueh
- 6Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Yung-Tai Chen
- 7Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
- Hsu-Che Huang
- 8Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan
- Hsu-Che Huang
- 9Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
- Yao-Chou Tsai
- 0Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Yao-Chou Tsai
- 1Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
- Wei-Yu Lin
- 2Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Wei-Yu Lin
- 3Chang Gung University of Science and Technology, Chiayi, Taiwan
- Wei-Yu Lin
- 4Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Chia-Chang Wu
- 0Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Chia-Chang Wu
- 5Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Chia-Chang Wu
- 6Taipei Medical University Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
- Po-Hung Lin
- 7Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Po-Hung Lin
- 8Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Po-Hung Lin
- 9School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Te-Wei Lin
- 0School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Wen-Jeng Wu
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Wen-Jeng Wu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Wen-Jeng Wu
- 1Cohort Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- DOI
- https://doi.org/10.3389/fonc.2022.872849
- Journal volume & issue
-
Vol. 12
Abstract
PurposeWe aimed to evaluate the impact of preoperative local symptoms on prognosis after radical nephroureterectomy in patients with upper tract urothelial carcinoma (UTUC).MethodsThis retrospective study consisted of 2,662 UTUC patients treated at 15 institutions in Taiwan from 1988 to 2019. Clinicopathological data were retrospectively collected for analysis by the Taiwan UTUC Collaboration Group. The Kaplan-Meier method was used to calculate overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS). The prognostic value of preoperative local symptoms in OS, CSS, DFS, and BRFS was investigated using Cox proportional hazards models.ResultsThe median follow-up was 36.6 months. Among 2,662 patients, 2,130 (80.0%) presented with hematuria and 398 (15.0%) had symptomatic hydronephrosis at diagnosis. Hematuria was associated with less symptomatic hydronephrosis (p <0.001), more dialysis status (p = 0.027), renal pelvic tumors (p <0.001), and early pathological tumor stage (p = 0.001). Symptomatic hydronephrosis was associated with female patients (p <0.001), less dialysis status (p = 0.001), less bladder cancer history (p <0.001), ureteral tumors (p <0.001), open surgery (p = 0.006), advanced pathological tumor stage (p <0.001), and postoperative chemotherapy (p = 0.029). Kaplan-Meier analysis showed that patients with hematuria or without symptomatic hydronephrosis had significantly higher rates of OS, CSS, and DFS (all p <0.001). Multivariate analysis confirmed that presence of hematuria was independently associated with better OS (HR 0.789, 95% CI 0.661–0.942) and CSS (HR 0.772, 95% CI 0.607–0.980), while symptomatic hydronephrosis was a significant prognostic factor for poorer OS (HR 1.387, 95% CI 1.142–1.683), CSS (HR 1.587, 95% CI 1.229–2.050), and DFS (HR 1.378, 95% CI 1.122–1.693).ConclusionsPreoperative local symptoms were significantly associated with oncological outcomes, whereas symptomatic hydronephrosis and hematuria had opposite prognostic effects. Preoperative symptoms may provide additional information on risk stratification and perioperative treatment selection for patients with UTUC.
Keywords
- hematuria
- flank pain
- symptomatic hydronephrosis
- upper tract urothelial carcinoma (UTUC)
- radical nephroureterectomy (RNU)
- prognosis
