Üst üriner trakt ürotelyal tümörlerinde radikal nefroüretrektomi sonrası intravezikal nüks için risk faktörleri: retrospektif tek merkezli çalışma

Abstract

Amaç: Üst üriner sistem karsinomu (UTUC) nedeniyle radikal nefroüreterektomi (RNU) uygulanan hasta serimizde mesane kanserinin metakron nüksünü öngören faktörleri inceledik.
Gereç ve Yöntemler: Merkezimizde Eylül 2009 ile Mart 2020 tarihleri ​​arasında UTUC kaynaklı RNU olan hastalar çalışmaya dahil edildi. Hastalar intravezikal nüks (IVR) olan ve olmayan olarak sınıflandırıldı ve nüksü öngören faktörler değerlendirildi.
Bulgular: Çalışmaya toplam 50 hasta dahil edildi. Toplam 50 hastanın 19›unda (%38) IVR gelişmiştir ve ortalama takip süresi 39,5 ± 25,3 aydır. Demografik özellikler, başvuru hemoglobini, glomerüler filtrasyon hızı ve hidronefroz derecesi, preoperatif üreterorenoskopi ve sitoloji pozitiflik öyküsü açısından iki grup arasında anlamlı fark yoktu (p>0.05). IVR (+) grubunda anlamlı olarak daha fazla mesane kanseri öyküsü vardı (sırasıyla %35,5’e karşı %52,6, p=0.019). Üreter tümörü olan hasta sayısı IVR (-) grubunda 10 (%32,3) iken IVR (+) grubunda 9 (%47,4) idi ve anlamlı olarak daha yüksekti (p=0,04). Tüm hasta grubunda 28 (%56) T2-T4 patolojisi olan hasta vardı ve oran IVR (+) grubunda anlamlı olarak daha fazlaydı (sırasıyla %63,2 ve %51,6, p=0.038).
Sonuç: Daha önce mesane kanseri öyküsü olan hastalarda, özellikle üreteral ve yüksek patolojik T evreli UTUC’larda mesane kanserinin metakron nüksü için dikkatli olunmalıdır.

Keywords

• Üst üriner sistem ürotelyal karsinomu
• intravezikal nüks
• risk faktörü
• nefroüreterektomi

Risk factors for intravesical recurrence after radical nephrourethrectomy in upper urinary tract urothelial tumors: retrospective single-center study

Abstract

Objective: We examined factors predicting metachronous recurrence of bladder cancer in our series of patients who underwent radical nephroureterectomy (RNU) for upper system urothelial carcinoma (UTUC).
Material and Methods: Patients with UTUC-induced RNU in our center from September 2009 to March 2020 were included in the study. Patients were classified as having and not having an intravesical recurrence (IVR), and the factors predicting recurrence were evaluated.
Results: A total of 50 patients were included in the study. IVR was developed in 19 (38%) of 50 patients, with a mean follow-up of 39.5 ± 25.3 months. There was no significant difference between the two groups in demographic characteristics, admission hemoglobin, glomerular filtration rate, and degree of hydronephrosis in preoperative ureterorenoscopy and cytology positivity history (p>0.05). The IVR (+) group had significantly more previous history of bladder cancer (35.5% vs. 52.6%, p=0.019, respectively). While the number of patients with ureteral tumors was 10 (32.3%) in the IVR (-) group, it was 9 (47.4%) in the IVR (+) group, and it was significantly higher. There are 28 (56%) patients with T2-T4 pathology in the entire patient group, and the rate is significantly greater in the IVR (+) group (63.2% vs. 51.6%, p=0.038, respectively).
Conclusion: Caution should be exercised for metachronous bladder cancer recurrence in patients with a previous history of bladder cancer, especially in ureteral and high pathological T-stage UTUCs. 

Keywords

• Upper urinary tract urothelial carcinoma
• intravesical recurrence
• risk factor
• nephroureterectomy

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