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Pattern and risk factors of local recurrence after nephroureterectomy for upper tract urothelial carcinoma

PURPOSE: This study aims to identify predictive local recurrence risk factors and site-specific local recurrence pattern of upper tract urothelial carcinoma (UTUC) with different primary tumor locations. METHODS: Three hundred and eighty-nine UTUC patients with radical nephroureterectomy were includ...

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Autores principales: Li, Xiaoying, Cui, Ming, Gu, Xiaobin, Fang, Dong, Li, Hongzhen, Qin, Shangbin, Yang, Kunlin, Zhu, Tianzhao, Li, Xuesong, Zhou, Liqun, Gao, Xian-Shu, Wang, Dian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261378/
https://www.ncbi.nlm.nih.gov/pubmed/32473636
http://dx.doi.org/10.1186/s12957-020-01877-w
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author Li, Xiaoying
Cui, Ming
Gu, Xiaobin
Fang, Dong
Li, Hongzhen
Qin, Shangbin
Yang, Kunlin
Zhu, Tianzhao
Li, Xuesong
Zhou, Liqun
Gao, Xian-Shu
Wang, Dian
author_facet Li, Xiaoying
Cui, Ming
Gu, Xiaobin
Fang, Dong
Li, Hongzhen
Qin, Shangbin
Yang, Kunlin
Zhu, Tianzhao
Li, Xuesong
Zhou, Liqun
Gao, Xian-Shu
Wang, Dian
author_sort Li, Xiaoying
collection PubMed
description PURPOSE: This study aims to identify predictive local recurrence risk factors and site-specific local recurrence pattern of upper tract urothelial carcinoma (UTUC) with different primary tumor locations. METHODS: Three hundred and eighty-nine UTUC patients with radical nephroureterectomy were included in this study. Univariate and multivariate Cox proportional hazards regressions were performed to measure the risk of local recurrence. We also mapped the position of local recurrence sites stratified by primary tumor locations. RESULTS: A total of 73 patients (18.7%) developed local recurrence within a median follow-up of 41 months (range, 3-80 months). For patients with local recurrence, the median interval of local recurrence was 9 months. Ureter tumor, multifocality, T stage, G grade, lymph node metastasis (LNM), lymph node dissection (LND), and lymph vascular invasion (LVI) were all significantly associated with increased local recurrence by univariable analyses (P < 0.05). Only multifocality, T3–4, G3, and LNM remained independent predictors of increased local recurrence by multivariable analyses. Adjuvant radiotherapy could reduce the local recurrence (HR = 0.177; 95% CI 0.064-0.493, P = 0.001). Patients with local recurrence had poorer cancer-specific survival (4-year cancer-specific survival rate 36 ± 7.5% vs 88.4 ± 2.2%, P = 0.000). We evaluated local recurrence pattern stratified by tumor locations. Para-aortic lymph node region was the most common recurrence area for all the patients. Left-sided UTUC had more than 70% recurrent lymph nodes in the left para-aortic region (LPA). For right-sided UTUC patients, recurrent para-aortic lymph nodes distributed in the LPA (33.3%), aortocaval (AC) (41.5%), and right paracaval (RPC) (25.2%) regions. Recurrence in the internal and external iliac regions was only found in the distal ureter group (P < 0.05). Renal pelvic fossa recurrence was only found in renal pelvic tumor (22.2%, P = 0.007). The ureter tumor bed recurrence rate was higher for ureter patients (P = 0.001). CONCLUSIONS: Multifocality, T3–4, G3, and LNM are predictors of higher local recurrence rate of UTUC. Adjuvant radiotherapy can reduce local recurrence rate. Local recurrence patterns are different according to primary tumor locations.
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spelling pubmed-72613782020-06-07 Pattern and risk factors of local recurrence after nephroureterectomy for upper tract urothelial carcinoma Li, Xiaoying Cui, Ming Gu, Xiaobin Fang, Dong Li, Hongzhen Qin, Shangbin Yang, Kunlin Zhu, Tianzhao Li, Xuesong Zhou, Liqun Gao, Xian-Shu Wang, Dian World J Surg Oncol Research PURPOSE: This study aims to identify predictive local recurrence risk factors and site-specific local recurrence pattern of upper tract urothelial carcinoma (UTUC) with different primary tumor locations. METHODS: Three hundred and eighty-nine UTUC patients with radical nephroureterectomy were included in this study. Univariate and multivariate Cox proportional hazards regressions were performed to measure the risk of local recurrence. We also mapped the position of local recurrence sites stratified by primary tumor locations. RESULTS: A total of 73 patients (18.7%) developed local recurrence within a median follow-up of 41 months (range, 3-80 months). For patients with local recurrence, the median interval of local recurrence was 9 months. Ureter tumor, multifocality, T stage, G grade, lymph node metastasis (LNM), lymph node dissection (LND), and lymph vascular invasion (LVI) were all significantly associated with increased local recurrence by univariable analyses (P < 0.05). Only multifocality, T3–4, G3, and LNM remained independent predictors of increased local recurrence by multivariable analyses. Adjuvant radiotherapy could reduce the local recurrence (HR = 0.177; 95% CI 0.064-0.493, P = 0.001). Patients with local recurrence had poorer cancer-specific survival (4-year cancer-specific survival rate 36 ± 7.5% vs 88.4 ± 2.2%, P = 0.000). We evaluated local recurrence pattern stratified by tumor locations. Para-aortic lymph node region was the most common recurrence area for all the patients. Left-sided UTUC had more than 70% recurrent lymph nodes in the left para-aortic region (LPA). For right-sided UTUC patients, recurrent para-aortic lymph nodes distributed in the LPA (33.3%), aortocaval (AC) (41.5%), and right paracaval (RPC) (25.2%) regions. Recurrence in the internal and external iliac regions was only found in the distal ureter group (P < 0.05). Renal pelvic fossa recurrence was only found in renal pelvic tumor (22.2%, P = 0.007). The ureter tumor bed recurrence rate was higher for ureter patients (P = 0.001). CONCLUSIONS: Multifocality, T3–4, G3, and LNM are predictors of higher local recurrence rate of UTUC. Adjuvant radiotherapy can reduce local recurrence rate. Local recurrence patterns are different according to primary tumor locations. BioMed Central 2020-05-30 /pmc/articles/PMC7261378/ /pubmed/32473636 http://dx.doi.org/10.1186/s12957-020-01877-w Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Li, Xiaoying
Cui, Ming
Gu, Xiaobin
Fang, Dong
Li, Hongzhen
Qin, Shangbin
Yang, Kunlin
Zhu, Tianzhao
Li, Xuesong
Zhou, Liqun
Gao, Xian-Shu
Wang, Dian
Pattern and risk factors of local recurrence after nephroureterectomy for upper tract urothelial carcinoma
title Pattern and risk factors of local recurrence after nephroureterectomy for upper tract urothelial carcinoma
title_full Pattern and risk factors of local recurrence after nephroureterectomy for upper tract urothelial carcinoma
title_fullStr Pattern and risk factors of local recurrence after nephroureterectomy for upper tract urothelial carcinoma
title_full_unstemmed Pattern and risk factors of local recurrence after nephroureterectomy for upper tract urothelial carcinoma
title_short Pattern and risk factors of local recurrence after nephroureterectomy for upper tract urothelial carcinoma
title_sort pattern and risk factors of local recurrence after nephroureterectomy for upper tract urothelial carcinoma
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261378/
https://www.ncbi.nlm.nih.gov/pubmed/32473636
http://dx.doi.org/10.1186/s12957-020-01877-w
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