Clinical Research Papers:
Detecting asymptomatic recurrence after radical nephroureterectomy contributes to better prognosis in patients with upper urinary tract urothelial carcinoma
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Hirotaka Horiguchi1, Shingo Hatakeyama1, Go Anan1,2, Yuka Kubota1, Hirotake Kodama1, Masaki Momota1, Koichi Kido1, Hayato Yamamoto1, Yuki Tobisawa1, Tohru Yoneyama3, Takahiro Yoneyama1, Yasuhiro Hashimoto3, Takuya Koie1, Hiroyuki Ito4, Kazuaki Yoshikawa5, Toshiaki Kawaguchi6, Makoto Sato2 and Chikara Ohyama1,3
1Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
2Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
3Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
4Department of Urology, Aomori Rosai Hospital, Hachinohe, Japan
5Department of Urology, Mutsu General Hospital, Mutsu, Japan
6Department of Urology, Aomori Prefectural Central Hospital, Aomori, Japan
Shingo Hatakeyama, email: email@example.com
Keywords: radical nephroureterectomy; asymptomatic; symptomatic; recurrence; upper tract urothelial carcinoma
Received: July 17, 2017 Accepted: November 15, 2017 Published: January 04, 2018
Background: The prognostic benefit of regular follow-up to detect asymptomatic recurrence after radical nephroureterectomy (RNU) remains unclear. We aimed to assess whether regular follow-up to detect asymptomatic recurrence after RNU improves patient survival.
Materials and Methods: We retrospectively analysed 415 patients who underwent RNU for upper tract urothelial carcinoma at four hospitals between January 1995 and February 2017. All patients had regular follow-up examinations after RNU including urine cytology, blood biochemical tests, and computed tomography. We investigated the first site and date of tumor recurrence. Overall survivals of patients who developed recurrence, stratified by mode of recurrence (asymptomatic vs. symptomatic group), were estimated using the Kaplan–Meier method with the log–rank test. Cox proportional hazards regression analysis was performed using inverse probability of treatment weighting (IPTW) to evaluate the impact of the mode of recurrence on survival.
Results: Of the 415 patients, 108 (26%) experienced disease recurrences after RNU. Of these, 62 (57%) were asymptomatic and 46 (43%) were symptomatic at the time of diagnosis. The most common recurrence site and symptom were lymph nodes and pain, respectively. Overall survival after RNU and time from recurrence to death in the asymptomatic group were significantly longer than that in the symptomatic group. Multivariate Cox regression analysis showed that symptomatic recurrence was an independent risk factor for overall survival after RNU and survival from recurrence to death.
Conclusions: Routine oncological follow-up for detection of asymptomatic recurrence contributes to a better prognosis after RNU.
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