Prognostic Factors for Contralateral Recurrence of Upper Tract Urothelial Carcinoma after Nephroureterectomy: A Large Multiregional Study.

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.

Cancers. 2021 Nov 25*** epublish ***

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

Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan., Departments of Urology and Oncology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA., Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan., Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan., Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan., Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.