Prognostic factors for contralateral recurrence of upper tract urothelial carcinoma after nephroureterectomy: A large multiregional study

Tsu Ming Chien, Hsiang Ying Lee, Nirmish Singla, Vitaly Margulis, Yair Lotan, Solomon Lukasz Woldu, Chun Nung Huang, Ching Chia Li, Hung Lung Ke, Wei Ming Li, Chia Yang Li, A. Mei Huang, Sheau Fang Yang, Hung Pin Tu, Wen Jeng Wu, Hsin Chih Yeh

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Article number5935
JournalCancers
Volume13
Issue number23
DOIs
StatePublished - Dec 1 2021
Externally publishedYes

Keywords

  • Chronic kidney disease
  • Contralateral recurrence
  • Inflammation
  • Nephroureterectomy
  • Upper tract urothelial carcinoma
  • White blood cell

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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