The Value of Preoperative Local Symptoms in Prognosis of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy: A Retrospective, Multicenter Cohort Study

Hsin Chih Yeh; Chao Hsiang Chang; Jen Kai Fang; I. Hsuan Alan Chen; Jen Tai Lin; Jian Hua Hong; Chao Yuan Huang; Shian Shiang Wang; Chuan Shu Chen; Chi Wen Lo; Chih Chin Yu; Jen Shu Tseng; Wun Rong Lin; Yeong Chin Jou; Ian Seng Cheong; Yuan Hong Jiang; Chung You Tsai; Thomas Y. Hsueh; Yung Tai Chen; Hsu Che Huang; Yao Chou Tsai; Wei Yu Lin; Chia Chang Wu; Po Hung Lin; Te Wei Lin; Wen Jeng Wu

doi:10.3389/fonc.2022.872849

The Value of Preoperative Local Symptoms in Prognosis of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy: A Retrospective, Multicenter Cohort Study

Hsin Chih Yeh, Chao Hsiang Chang, Jen Kai Fang, I. Hsuan Alan Chen, Jen Tai Lin, Jian Hua Hong, Chao Yuan Huang, Shian Shiang Wang, Chuan Shu Chen, Chi Wen Lo, Chih Chin Yu, Jen Shu Tseng, Wun Rong Lin, Yeong Chin Jou, Ian Seng Cheong, Yuan Hong Jiang, Chung You Tsai, Thomas Y. Hsueh, Yung Tai Chen, Hsu Che HuangYao Chou Tsai, Wei Yu Lin, Chia Chang Wu, Po Hung Lin, Te Wei Lin, Wen Jeng Wu

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

Purpose: We aimed to evaluate the impact of preoperative local symptoms on prognosis after radical nephroureterectomy in patients with upper tract urothelial carcinoma (UTUC). Methods: This 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. Results: The 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). Conclusions: Preoperative 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.

Original language	English (US)
Article number	872849
Journal	Frontiers in Oncology
Volume	12
DOIs	https://doi.org/10.3389/fonc.2022.872849
State	Published - Jun 2 2022
Externally published	Yes

Keywords

flank pain
hematuria
prognosis
radical nephroureterectomy (RNU)
symptomatic hydronephrosis
upper tract urothelial carcinoma (UTUC)

ASJC Scopus subject areas

Oncology
Cancer Research

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10.3389/fonc.2022.872849

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Yeh, H. C., Chang, C. H., Fang, J. K., Chen, I. H. A., Lin, J. T., Hong, J. H., Huang, C. Y., Wang, S. S., Chen, C. S., Lo, C. W., Yu, C. C., Tseng, J. S., Lin, W. R., Jou, Y. C., Cheong, I. S., Jiang, Y. H., Tsai, C. Y., Hsueh, T. Y., Chen, Y. T., ... Wu, W. J. (2022). The Value of Preoperative Local Symptoms in Prognosis of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy: A Retrospective, Multicenter Cohort Study. Frontiers in Oncology, 12, Article 872849. https://doi.org/10.3389/fonc.2022.872849

Yeh, HC, Chang, CH, Fang, JK, Chen, IHA, Lin, JT, Hong, JH, Huang, CY, Wang, SS, Chen, CS, Lo, CW, Yu, CC, Tseng, JS, Lin, WR, Jou, YC, Cheong, IS, Jiang, YH, Tsai, CY, Hsueh, TY, Chen, YT, Huang, HC, Tsai, YC, Lin, WY, Wu, CC, Lin, PH, Lin, TW & Wu, WJ 2022, 'The Value of Preoperative Local Symptoms in Prognosis of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy: A Retrospective, Multicenter Cohort Study', Frontiers in Oncology, vol. 12, 872849. https://doi.org/10.3389/fonc.2022.872849

@article{d182d3bc87944367a7e051860b6cc9e0,

title = "The Value of Preoperative Local Symptoms in Prognosis of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy: A Retrospective, Multicenter Cohort Study",

abstract = "Purpose: We aimed to evaluate the impact of preoperative local symptoms on prognosis after radical nephroureterectomy in patients with upper tract urothelial carcinoma (UTUC). Methods: This 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. Results: The 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). Conclusions: Preoperative 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 = "flank pain, hematuria, prognosis, radical nephroureterectomy (RNU), symptomatic hydronephrosis, upper tract urothelial carcinoma (UTUC)",

author = "Yeh, {Hsin Chih} and Chang, {Chao Hsiang} and Fang, {Jen Kai} and Chen, {I. Hsuan Alan} and Lin, {Jen Tai} and Hong, {Jian Hua} and Huang, {Chao Yuan} and Wang, {Shian Shiang} and Chen, {Chuan Shu} and Lo, {Chi Wen} and Yu, {Chih Chin} and Tseng, {Jen Shu} and Lin, {Wun Rong} and Jou, {Yeong Chin} and Cheong, {Ian Seng} and Jiang, {Yuan Hong} and Tsai, {Chung You} and Hsueh, {Thomas Y.} and Chen, {Yung Tai} and Huang, {Hsu Che} and Tsai, {Yao Chou} and Lin, {Wei Yu} and Wu, {Chia Chang} and Lin, {Po Hung} and Lin, {Te Wei} and Wu, {Wen Jeng}",

note = "Publisher Copyright: Copyright {\textcopyright} 2022 Yeh, Chang, Fang, Chen, Lin, Hong, Huang, Wang, Chen, Lo, Yu, Tseng, Lin, Jou, Cheong, Jiang, Tsai, Hsueh, Chen, Huang, Tsai, Lin, Wu, Lin, Lin and Wu.",

year = "2022",

month = jun,

day = "2",

doi = "10.3389/fonc.2022.872849",

language = "English (US)",

volume = "12",

journal = "Frontiers in Oncology",

issn = "2234-943X",

publisher = "Frontiers Media S. A.",

}

TY - JOUR

T1 - The Value of Preoperative Local Symptoms in Prognosis of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy

T2 - A Retrospective, Multicenter Cohort Study

AU - Yeh, Hsin Chih

AU - Chang, Chao Hsiang

AU - Fang, Jen Kai

AU - Chen, I. Hsuan Alan

AU - Lin, Jen Tai

AU - Hong, Jian Hua

AU - Huang, Chao Yuan

AU - Wang, Shian Shiang

AU - Chen, Chuan Shu

AU - Lo, Chi Wen

AU - Yu, Chih Chin

AU - Tseng, Jen Shu

AU - Lin, Wun Rong

AU - Jou, Yeong Chin

AU - Cheong, Ian Seng

AU - Jiang, Yuan Hong

AU - Tsai, Chung You

AU - Hsueh, Thomas Y.

AU - Chen, Yung Tai

AU - Huang, Hsu Che

AU - Tsai, Yao Chou

AU - Lin, Wei Yu

AU - Wu, Chia Chang

AU - Lin, Po Hung

AU - Lin, Te Wei

AU - Wu, Wen Jeng

PY - 2022/6/2

Y1 - 2022/6/2

N2 - Purpose: We aimed to evaluate the impact of preoperative local symptoms on prognosis after radical nephroureterectomy in patients with upper tract urothelial carcinoma (UTUC). Methods: This 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. Results: The 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). Conclusions: Preoperative 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.

AB - Purpose: We aimed to evaluate the impact of preoperative local symptoms on prognosis after radical nephroureterectomy in patients with upper tract urothelial carcinoma (UTUC). Methods: This 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. Results: The 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). Conclusions: Preoperative 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.

KW - flank pain

KW - hematuria

KW - prognosis

KW - radical nephroureterectomy (RNU)

KW - symptomatic hydronephrosis

KW - upper tract urothelial carcinoma (UTUC)

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U2 - 10.3389/fonc.2022.872849

DO - 10.3389/fonc.2022.872849

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C2 - 35719933

AN - SCOPUS:85132824529

SN - 2234-943X

VL - 12

JO - Frontiers in Oncology

JF - Frontiers in Oncology

M1 - 872849

ER -

The Value of Preoperative Local Symptoms in Prognosis of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy: A Retrospective, Multicenter Cohort Study

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