Diagnostic ureteroscopy for upper tract urothelial carcinoma is independently associated with intravesical recurrence after radical nephroureterectomy

Blogger's Note: not specific to Lynch Syndrome; view abstract for stats

Abstract

Objective

To determine the effect of diagnostic ureteroscopy on intravesical recurrence in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU).

Methods

We conducted a retrospective analysis of 664 patients who were treated with RNU for UTUC from June 2000 to December 2011, excluding those who had concomitant/prior bladder tumors. Of the 664 patients, 81 underwent diagnostic ureteroscopy (URS). We analyzed the impact of diagnostic ureteroscopy on intravesical recurrence (IVR) using the Kaplan-Meier method. Univariate and multivariate analyses were used to determine the independent risk factors.

Results

The median follow-up time was 48 months: 31–77 months]. Patients who underwent ureteroscopy were more likely to have a small, early-staged, multifocality and ureteral tumor. IVR occurred in 223 patients during follow-up within a median of 17 months (IQR: 7–33). Patients without preoperative ureteroscopy have a statistically significant better 2-year and 5-year intravesical recurrence-free survival rates than patients who underwent ureteroscopy. In multivariate analysis, the diagnostic ureteroscopy, multiple tumors, tumor size <3 cm, low-grade and pN0 stage tumor were independent predictors of IVR.

Conclusions

Diagnostic ureteroscopy is independently associated with intravesical recurrence after radical nephroureterectomy.