Influence of preoperative hydronephrosis on the outcome of urothelial carcinoma of the upper urinary tract after nephroureterectomy: the results from a multi-institutional French cohort.
OBJECTIVE
Recent publications have assessed the prognostic significance of hydronephrosis in the outcome of upper tract urothelial carcinoma (UUT-UC). Our study sought to determine the prognostic impact of hydronephrosis on UUT-UC survival and its relationship to the clinicopathological features.


METHODS
A retrospective, multi-institutional French study was conducted on 401 patients who underwent radical nephroureterectomy for non-metastatic UUT-UC. Hydronephrotic status was determined using preoperative imaging reports. Univariate and multivariate analyses were conducted to identify factors associated with survival.


RESULTS
Preoperative hydronephrosis was present in 74 patients. Median follow-up was 26 months. Hydronephrosis was associated only with ureteral localisation (p < 0.001). No difference was observed in 5-year cancer-specific survival (CSS) between the hydronephrosis group (80.1 %) and the no hydronephrosis group (83.6 %) (p > 0.05). Only age (p = 0.02) and pT stage (p = 0.01) were independent predictors of CSS. Hydronephrosis was not a significant predictor of CSS in the univariate and multivariate analyses (p = 0.87 and p = 0.66). No significant difference was observed for 5-year metastasis-free survival (MFS) between the hydronephrosis group (69.8 % ± 6.6 %) and the no hydronephrosis group (80.5 % ± 3 %) (p = 0.052). Hydronephrosis was not a significant predictor of MFS in the univariate and multivariate analyses (p = 0.16 and p = 0.36). Multifocality (p = 0.02), pT stage (p < 0.001) and positive surgical margins (p = 0.02) were independent predictors of MFS. For the pelvic tumours subgroup, hydronephrosis was an independent predictor of MFS (p = 0.01) but not CSS (p = 0.86).


CONCLUSIONS
Preoperative hydronephrosis was not associated with survival. However, among tumours presenting with hydronephrosis, pelvicalyceal tumours appear to have a worse prognosis than ureteral tumours.
Academic Department of Urology, CHRU Lille, Lille Nord de France University, Lille, France. bozzini_gregory@yahoo.fr
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Bozzini
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Nison
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Colin
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Ouzzane
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Yates
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Audenet
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Pignot
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Arvin-Berod
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Merigot
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Guy
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Irani
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Saint
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Gardic
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Gres
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Rozet
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Neuzillet
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Ruffion
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Roupret
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000401:mortality* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology / Q000401:mortality*; D007680:Kidney Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery; D007682:Kidney Pelvis; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000150:complications / Q000401:mortality* / Q000601:surgery; D009392:Nephrectomy; D057234:Preoperative Period; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery