Influencing factors of postoperative extra-urinary tract recurrence and risk stratification analysis in patients with UTUC
GUO Xuetao1, SHAO Hongjiang1, ZHANG Qiang1, WANG Xin1, ZHANG Fei1, HUO Richa1, ZHANG Xiaochun2, MAO Quanzong3
1Department of Urology, Baotou Central Hospital, Baotou 014040, China; 2Department of Urology, First Hospital of Peking University; 3Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
Abstract：Objective： To investigate the influencing factors of postoperative extra-urinary tract recurrence and risk stratification in patients with upper tract urothelial carcinoma （UTUC）. Methods： Clinical data of 135 patients with UTUC were retrospectively chosen in the period from January 2010 to December 2014. Univariate and multifactorial methods were used to analyze the influencing factors of postoperative extra-urinary tract recurrence, and the local recurrence-free survival （IRFS） rate and distant metastasis-free survival （dMFS） rate were compared according to risk stratification. Results： ① The IRFS rate in patients with non-pedicle tumor, multiple lesions, ureteral cancer, lymphatic vascular invasion, pathological stage ≥ T3, eGFR < 60 mL•min-1•1.73 m-2） and Fib ≥ 3.2 g/L was significantly lower than other patients （P < 0.05）. The dMFS in patients with tumor grade for G3, non-pedicle tumor, lymphatic vascular invasion, moderate and severe hydronephrosis, and neutro-lymphocyte ratio > 2.0 was significantly lower than other patients （P < 0.05）. ② The multivariate analysis indicated that ureteral cancer, lymphatic vascular invasion, pathological stage ≥ T3 and Fib ≥ 3.2 g/L were all independent risk factors for IRFS rate （P < 0.05）. The non-pedicle tumor, lymphatic vascular invasion and neutro-lymphocyte ratio > 2.0 were all independent risk factors for dMFS rate （P < 0.05）. ③ The 1-, 3- and 5-year IRFS rate during the follow-up period in the low-risk group was significantly higher than that in medium-risk group and high-risk group （P < 0.05）. The 1-, 3- and 5-year dMFS rate during the follow-up period in low-risk group was significantly higher than that in medium-risk group and high-risk group （P < 0.05）. Conclusion： Ureteral cancer, lymphatic vascular invasion, pathological stage ≥ T3 and Fib ≥ 3.2 g/L were closely related to postoperative local recurrence of patients with UTUC and the non-pedicle tumor, lymphatic vascular invasion and neutro-lymphocyte ratio > 2.0 increased the risk of postoperative distant metastasis. Risk stratification based on relevant independent risk factors can effectively predict the clinical prognosis of patients.
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