title: Preoperative pyuria predicts advanced pathologic tumor stage and worse survival in patients with urothelial carcinoma of the upper urinary tract treated by radical nephroureterectomy.
abstract: To investigate the association of preoperative pyuria with pathologic features and oncologic outcomes in patients with urothelial carcinoma of the upper urinary tract (UTUC) treated by radical nephroureterectomy (RNU).
  
  
  
  A cohort of 176 patients treated with RNU from January 2001 to December 2014 were retrospectively reviewed. Logistic regression and survival analysis methodology was used to investigate the association of preoperative pyuria with clinicopathologic outcomes.
  
  
  
  Among this cohort, 36 (20.5%) presented with preoperative pyuria. Logistic regression revealed that pyuria was significantly associated with advanced pT stage (P = 0.001). During a median follow-up of 41 months (interquartile range: 22-60), 65 (37%) patients died, including 54 (31%) from UTUC. Overall survival rates at 3 year and 5 years in patients with pyuria were significantly lower than those in patients without pyuria (62.3% and 36.1% vs. 78.4% and 65.3%, respectively; P = 0.004). Also, cancer-specific survival rates at 3 year and 5 years in patients with pyuria were significantly lower than in patients without pyuria (65.7% and 50% vs. 80% and 67.6%, respectively; P = 0.016). Furthermore, in the multivariate analysis, after incorporating only preoperative factors, pyuria was found to be an independent predictor of overall survival and cancer-specific survival (P = 0.005 and P = 0.028, respectively).
  
  
  
  Preoperative pyuria among UTUC patients underwent RNU was significantly associated with advanced pathologic tumor stage and worse survival. Our data suggested that pyuria as a prognostic predictor could be valuable in preoperative risk stratification and guiding better therapeutic approaches, but further validation in a larger population is needed.
authors.affiliation: Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Chengcai
authors.initials: C
authors.lastname: Liang
authors.affiliation: Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Jinliang
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Hailong
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Liqun
authors.initials: L
authors.lastname: Huang
authors.affiliation: Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Ding
authors.initials: D
authors.lastname: Xu
authors.affiliation: Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Subo
authors.initials: S
authors.lastname: Qian
authors.affiliation: Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Xiaoqiang
authors.initials: X
authors.lastname: Qian
authors.affiliation: Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. Electronic address: urologistqijun@163.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Qi
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy; D000074682:Nephroureterectomy; D057234:Preoperative Period; D011379:Prognosis; D011776:Pyuria / Q000473:pathology*; D012189:Retrospective Studies; D015996:Survival Rate; D014513:Ureter; D014571:Urologic Neoplasms / Q000175:diagnosis*; D019459:Urothelium / Q000473:pathology
keywords: Preoperative pyuria; Radical nephroureterectomy; Survival; Upper tract urothelial carcinoma