The predictive value of positive urine cytology for outcomes following radical nephroureterectomy in patients with primary upper tract urothelial carcinoma

A multi-institutional study11This work was supported in part by Grants-in-Aid for Scientific Research (#24791671 to Tanaka N.) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan.

Nobuyuki Tanaka, Eiji Kikuchi, Kent Kanao, Kazuhiro Matsumoto, Suguru Shirotake, Hiroaki Kobayashi, Yasumasa Miyazaki, Hiroki Ide, Jun Obata, Katsura Hoshino, Nozomi Hayakawa, Takeo Kosaka, Masafumi Oyama, Akira Miyajima, Tetsuo Momma, Ken Nakagawa, Masahiro Jinzaki, Yosuke Nakajima, Mototsugu Oya

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Abstract

Background and 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). Materials and 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.

Original languageEnglish
JournalUrologic Oncology: Seminars and Original Investigations
Volume32
Issue number1
DOIs
Publication statusPublished - 2014 Jan

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Organized Financing
Sports
Cell Biology
Japan
Urine
Technology
Carcinoma
Education
Recurrence
Research
Confidence Intervals
Kaplan-Meier Estimate
Proportional Hazards Models
Multivariate Analysis
Survival Rate

Keywords

  • Intravesical recurrence
  • Nephroureterectomy
  • Upper urinary tract
  • Urine cytology
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

@article{2435f3fc7d7940bf836cd1154e1703f7,
title = "The predictive value of positive urine cytology for outcomes following radical nephroureterectomy in patients with primary upper tract urothelial carcinoma: A multi-institutional study11This work was supported in part by Grants-in-Aid for Scientific Research (#24791671 to Tanaka N.) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan.",
abstract = "Background and 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). Materials and 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.",
keywords = "Intravesical recurrence, Nephroureterectomy, Upper urinary tract, Urine cytology, Urothelial carcinoma",
author = "Nobuyuki Tanaka and Eiji Kikuchi and Kent Kanao and Kazuhiro Matsumoto and Suguru Shirotake and Hiroaki Kobayashi and Yasumasa Miyazaki and Hiroki Ide and Jun Obata and Katsura Hoshino and Nozomi Hayakawa and Takeo Kosaka and Masafumi Oyama and Akira Miyajima and Tetsuo Momma and Ken Nakagawa and Masahiro Jinzaki and Yosuke Nakajima and Mototsugu Oya",
year = "2014",
month = "1",
doi = "10.1016/j.urolonc.2013.07.003",
language = "English",
volume = "32",
journal = "Urologic Oncology",
issn = "1078-1439",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - The predictive value of positive urine cytology for outcomes following radical nephroureterectomy in patients with primary upper tract urothelial carcinoma

T2 - A multi-institutional study11This work was supported in part by Grants-in-Aid for Scientific Research (#24791671 to Tanaka N.) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan.

AU - Tanaka, Nobuyuki

AU - Kikuchi, Eiji

AU - Kanao, Kent

AU - Matsumoto, Kazuhiro

AU - Shirotake, Suguru

AU - Kobayashi, Hiroaki

AU - Miyazaki, Yasumasa

AU - Ide, Hiroki

AU - Obata, Jun

AU - Hoshino, Katsura

AU - Hayakawa, Nozomi

AU - Kosaka, Takeo

AU - Oyama, Masafumi

AU - Miyajima, Akira

AU - Momma, Tetsuo

AU - Nakagawa, Ken

AU - Jinzaki, Masahiro

AU - Nakajima, Yosuke

AU - Oya, Mototsugu

PY - 2014/1

Y1 - 2014/1

N2 - Background and 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). Materials and 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.

AB - Background and 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). Materials and 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.

KW - Intravesical recurrence

KW - Nephroureterectomy

KW - Upper urinary tract

KW - Urine cytology

KW - Urothelial carcinoma

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U2 - 10.1016/j.urolonc.2013.07.003

DO - 10.1016/j.urolonc.2013.07.003

M3 - Article

VL - 32

JO - Urologic Oncology

JF - Urologic Oncology

SN - 1078-1439

IS - 1

ER -