title: Preoperative risk factors for extraurothelial recurrence in N0M0 patients with renal pelvic cancer treated by radical nephroureterectomy.
abstract: The prediction of extraurothelial recurrence (EUR) before radical nephroureterectomy (RNU) is difficult for patients with upper tract urothelial carcinoma. If EUR can be predicted preoperatively, it may be possible to determine the need for neoadjuvant chemotherapy or the surgical strategy. Our previous study identified preoperative risk factors for EUR in ureteral cancer, while the present study identified preoperative risk factors for EUR in renal pelvic cancer (RPC). The preoperative factors were reviewed in 71 N0M0 patients with RPC treated by RNU between 1999 and 2013. Preoperative clinical background data, laboratory test results, including inflammatory indices, lactate dehydrogenase (LDH), and estimated glomerular filtration rate, and radiological findings were subjected to multivariate analyses to identify independent predictive factors for EUR. The 3-year EUR-free survival (EURFS) rate was 81.9%, and univariate analysis showed that clinical T (cT) stage ≥3, white blood cell counts ≥7600/µl, neutrophil counts ≥4,500/µl, neutrophil-to-lymphocyte ratio ≥2.0, and LDH ≥210 IU/l were significantly associated with EURFS. Additionally, a cT stage ≥3 (P=0.0244) and LDH ≥210 IU/l (P=0.0322) were independent predictors for EUR. When patients were stratified into three groups according to the number of risk factors, the 3-year EURFS rates were 94.5, 76.3, and 33.3% for the low-, intermediate-, and high-risk patient groups, respectively. In conclusion, cT stage ≥3 and LDH ≥210 IU/l were preoperative predictive factors of EUR in patients with RPC. High-risk patients may be candidates for neoadjuvant chemotherapy and low-risk patients may be candidates for RNU without lymph node dissection.
authors.affiliation: Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ito
authors.affiliation: Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Asakuma
authors.affiliation: Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kuroda
authors.affiliation: Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Tachi
authors.affiliation: Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Sato
authors.affiliation: Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Horiguchi
authors.affiliation: Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Seguchi
authors.affiliation: Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Asano
keywords: extraurothelial recurrence; lactate dehydrogenase; nephroureterectomy; preoperative factor; renal pelvic cancer