The predictive value of positive urine cytology for outcomes following radical nephroureterectomy in patients with primary upper tract urothelial carcinoma: a multi-institutional study.
OBJECTIVE
Few studies have addressed the predictive value of positive urine cytology for prognosis in patients with upper tract urothelial carcinoma (UTUC). We investigated whether the status of preoperative urine cytology could provide additional prognostic information following radical nephroureterectomy (RNU).


METHODS
The study included 474 patients with primary nonmetastatic UTUC (pTa-4N0M0) from a retrospective multi-institutional cohort. The median follow-up period was 35 months. Associations between the status of urine cytologic evaluation and outcomes were analyzed using multivariate Cox regression models. Urine cytology was evaluated preoperatively using voided samples. Disease recurrence was defined as any relapse in nonbladder lesions and was coded separately from intravesical recurrence.


RESULTS
Positive urine cytology was detected in 184 patients (38.8%) preoperatively. Disease recurrence occurred in 127 patients, while intravesical recurrence occurred in 219 patients; 83 patients died of UTUC during follow-up. Kaplan-Meier analysis revealed that only the incidence of intravesical recurrence was significantly associated with the status of urine cytologic evaluation (P = 0.024); the intravesical recurrence-free survival rates at 1 and 3 years following RNU were 61.4% and 46.2% in patients with positive urine cytology and 71.1% and 51.6% in their counterparts, respectively. Multivariate analysis showed that gender (hazard ratio [HR] = 1.74, 95% confidence interval [CI]; 1.28-2.43), tumor multifocality in RNU specimens (HR = 1.64, 95% CI; 1.09-2.47), and positive urine cytology (HR = 1.41, 95% CI; 1.08-1.85) were independent risk factors for subsequent intravesical recurrence.


CONCLUSIONS
The results showed the prognostic value of positive urine cytology in patients with primary UTUC, and preoperative positive urine cytology may be associated with a significant increase in the prevalence of intravesical recurrence following RNU.
Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Musashino Yowakai Hospital, Tokyo, Japan.
Nobuyuki
N
Tanaka
Department of Urology, Keio University School of Medicine, Tokyo, Japan. Electronic address: eiji-k@kb3.so-net.ne.jp.
Eiji
E
Kikuchi
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Kent
K
Kanao
Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Saiseikai Central Hospital, Tokyo, Japan.
Kazuhiro
K
Matsumoto
Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, International Medical Center-Comprehensive Cancer Center, Saitama Medical University, Saitama, Japan.
Suguru
S
Shirotake
Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Kyosai Tachikawa Hospital, Tokyo, Japan.
Hiroaki
H
Kobayashi
Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Ogikubo Hospital, Tokyo, Japan.
Yasumasa
Y
Miyazaki
Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Saitama City Hospital, Saitama, Japan.
Hiroki
H
Ide
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Jun
J
Obata
Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan.
Katsura
K
Hoshino
Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Saiseikai Central Hospital, Tokyo, Japan.
Nozomi
N
Hayakawa
Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Irumagawa Hospital, Saitama, Japan.
Takeo
T
Kosaka
Department of Urology, International Medical Center-Comprehensive Cancer Center, Saitama Medical University, Saitama, Japan.
Masafumi
M
Oyama
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Akira
A
Miyajima
Department of Urology, National Hospital Organization, Saitama Hospital, Saitama, Japan.
Tetsuo
T
Momma
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Ken
K
Nakagawa
Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
Masahiro
M
Jinzaki
Department of Urology, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan.
Yosuke
Y
Nakajima
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Mototsugu
M
Oya
D000368:Aged; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009392:Nephrectomy / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*; D014556:Urine / Q000166:cytology*; D014571:Urologic Neoplasms / Q000175:diagnosis / Q000601:surgery* / Q000652:urine
Intravesical recurrence; Nephroureterectomy; Upper urinary tract; Urine cytology; Urothelial carcinoma