Factors Predicting Oncological Outcomes of Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma in Taiwan
BackgroundTaiwan is one of the endemic regions where upper tract urothelial carcinoma (UTUC) accounts for approximately a third of all urothelial tumors. Owing to its high prevalence, extensive experience has been accumulated in minimally invasive radical nephroureterectomy (RNU). Although a variety...
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Frontiers Media S.A.
2022-01-01
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| Series: | Frontiers in Oncology |
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| author | I-Hsuan Alan Chen I-Hsuan Alan Chen I-Hsuan Alan Chen Chao-Hsiang Chang Chao-Hsiang Chang Chi-Ping Huang Chi-Ping Huang Wen-Jeng Wu Wen-Jeng Wu Wen-Jeng Wu Ching-Chia Li Ching-Chia Li Ching-Chia Li Chung-Hsin Chen Chao-Yuan Huang Chi-Wen Lo Chih-Chin Yu Chih-Chin Yu Chung-You Tsai Chung-You Tsai Wei-Che Wu Wei-Che Wu Jen-Shu Tseng Jen-Shu Tseng Wun-Rong Lin Wun-Rong Lin Yuan-Hong Jiang Yu-Khun Lee Yeong-Chin Jou Yeong-Chin Jou Ian-Seng Cheong Thomas Y. Hsueh Thomas Y. Hsueh Allen W. Chiu Yung-Tai Chen Jih-Sheng Chen Bing-Juin Chiang Bing-Juin Chiang Bing-Juin Chiang Yao-Chou Tsai Yao-Chou Tsai Wei Yu Lin Wei Yu Lin Wei Yu Lin Chia-Chang Wu Chia-Chang Wu Chia-Chang Wu Jen-Tai Lin Chia-Cheng Yu |
| author_facet | I-Hsuan Alan Chen I-Hsuan Alan Chen I-Hsuan Alan Chen Chao-Hsiang Chang Chao-Hsiang Chang Chi-Ping Huang Chi-Ping Huang Wen-Jeng Wu Wen-Jeng Wu Wen-Jeng Wu Ching-Chia Li Ching-Chia Li Ching-Chia Li Chung-Hsin Chen Chao-Yuan Huang Chi-Wen Lo Chih-Chin Yu Chih-Chin Yu Chung-You Tsai Chung-You Tsai Wei-Che Wu Wei-Che Wu Jen-Shu Tseng Jen-Shu Tseng Wun-Rong Lin Wun-Rong Lin Yuan-Hong Jiang Yu-Khun Lee Yeong-Chin Jou Yeong-Chin Jou Ian-Seng Cheong Thomas Y. Hsueh Thomas Y. Hsueh Allen W. Chiu Yung-Tai Chen Jih-Sheng Chen Bing-Juin Chiang Bing-Juin Chiang Bing-Juin Chiang Yao-Chou Tsai Yao-Chou Tsai Wei Yu Lin Wei Yu Lin Wei Yu Lin Chia-Chang Wu Chia-Chang Wu Chia-Chang Wu Jen-Tai Lin Chia-Cheng Yu |
| author_sort | I-Hsuan Alan Chen |
| collection | DOAJ |
| description | BackgroundTaiwan is one of the endemic regions where upper tract urothelial carcinoma (UTUC) accounts for approximately a third of all urothelial tumors. Owing to its high prevalence, extensive experience has been accumulated in minimally invasive radical nephroureterectomy (RNU). Although a variety of predictive factors have been explored in numerous studies, most of them were on a single-center or limited institutional basis and data from a domestic cohort are lacking.ObjectiveThis study aims to identify significant predicting factors of oncological outcomes, including overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and intravesical recurrence-free survival (IVRFS), following RNU for UTUC in Taiwan.MethodsA multicenter registry database, Taiwan UTUC Collaboration Group, was utilized to analyze oncological outcomes of 3,333 patients undergoing RNU from 1988 to 2021 among various hospitals in Taiwan. Clinicopathological parameters were recorded according to the principles established by consensus meetings. The Kaplan-Meier estimator was utilized to estimate the survival rates, and the curves were compared using the stratified log-rank test. Univariate and multivariate analyses were performed with the Cox proportional hazard model to explore potential predicting factors.ResultsWith a median follow-up of 41.8 months in 1,808 patients with complete information, the 5-year IVRFS, DFS, CSS, and OS probabilities were 66%, 72%, 81%, and 70%, respectively. In total, 482 patients experienced intravesical recurrence, 307 died of UTUC, and 583 died of any cause. Gender predominance was female (57%). A total of 1,531 patients (84.7%) had high-grade tumors; preoperative hydronephrosis presented in 1,094 patients (60.5%). Synchronous bladder UC was identified in 292 patients (16.2%). Minimally invasive procedures accounted for 78.8% of all surgeries, including 768 hand-assisted laparoscopic (42.5%) and 494 laparoscopic (27.3%) approaches. Synchronous bladder UC was the dominant adverse predicting factor for all survival outcomes. Other independent predicting factors for OS, CSS, and DFS included age ≧70, presence of preoperative hydronephrosis, positive surgical margin, LVI, pathological T and N staging, and laparoscopic RNU.ConclusionSynchronous UC of the urinary bladder is an independent adverse prognostic factor for survival in UTUC. The presence of preoperative hydronephrosis was also corroborated as a disadvantageous prognostic factor. Our multivariate analysis suggested that laparoscopic RNU might provide better oncological control. |
| first_indexed | 2024-12-18T05:34:33Z |
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| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-18T05:34:33Z |
| publishDate | 2022-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-8a691406b034428cbd22ccbda5b77f982022-12-21T21:19:21ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-01-011110.3389/fonc.2021.766576766576Factors Predicting Oncological Outcomes of Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma in TaiwanI-Hsuan Alan Chen0I-Hsuan Alan Chen1I-Hsuan Alan Chen2Chao-Hsiang Chang3Chao-Hsiang Chang4Chi-Ping Huang5Chi-Ping Huang6Wen-Jeng Wu7Wen-Jeng Wu8Wen-Jeng Wu9Ching-Chia Li10Ching-Chia Li11Ching-Chia Li12Chung-Hsin Chen13Chao-Yuan Huang14Chi-Wen Lo15Chih-Chin Yu16Chih-Chin Yu17Chung-You Tsai18Chung-You Tsai19Wei-Che Wu20Wei-Che Wu21Jen-Shu Tseng22Jen-Shu Tseng23Wun-Rong Lin24Wun-Rong Lin25Yuan-Hong Jiang26Yu-Khun Lee27Yeong-Chin Jou28Yeong-Chin Jou29Ian-Seng Cheong30Thomas Y. Hsueh31Thomas Y. Hsueh32Allen W. Chiu33Yung-Tai Chen34Jih-Sheng Chen35Bing-Juin Chiang36Bing-Juin Chiang37Bing-Juin Chiang38Yao-Chou Tsai39Yao-Chou Tsai40Wei Yu Lin41Wei Yu Lin42Wei Yu Lin43Chia-Chang Wu44Chia-Chang Wu45Chia-Chang Wu46Jen-Tai Lin47Chia-Cheng Yu48Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, TaiwanInstitute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, TaiwanDivision of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDepartment of Urology, China Medical University and Hospital, Taichung, TaiwanSchool of Medicine, China Medical University, Taichung, TaiwanDepartment of Urology, China Medical University and Hospital, Taichung, TaiwanSchool of Medicine, China Medical University, Taichung, TaiwanDepartment of Urology, Kaohsiung Medical University Hospital, Kaohsiung, TaiwanDepartment of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanGraduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanDepartment of Urology, Kaohsiung Medical University Hospital, Kaohsiung, TaiwanDepartment of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanGraduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanDepartment of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, TaiwanDepartment of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan0Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan0Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan1School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan2Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan3Department of Healthcare Information and Management, Ming Chuan University, Taipei, Taiwan2Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan4Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan5Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan6Department of Medicine, Mackay Medical College, Taipei, Taiwan5Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan6Department of Medicine, Mackay Medical College, Taipei, Taiwan7Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan7Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan8Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan9Department of Health and Nutrition Biotechnology, Asian University, Taichung, Taiwan8Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan0Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan1Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan2College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan3Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan3Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan4College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan5Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan6Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan7Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan8Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan9Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan0Chang Gung University of Science and Technology, Chia-Yi, Taiwan1Department of Medicine, Chang Gung University, Taoyuan, Taiwan7Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan2Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan3TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, TaiwanDivision of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, TaiwanDivision of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, TaiwanBackgroundTaiwan is one of the endemic regions where upper tract urothelial carcinoma (UTUC) accounts for approximately a third of all urothelial tumors. Owing to its high prevalence, extensive experience has been accumulated in minimally invasive radical nephroureterectomy (RNU). Although a variety of predictive factors have been explored in numerous studies, most of them were on a single-center or limited institutional basis and data from a domestic cohort are lacking.ObjectiveThis study aims to identify significant predicting factors of oncological outcomes, including overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and intravesical recurrence-free survival (IVRFS), following RNU for UTUC in Taiwan.MethodsA multicenter registry database, Taiwan UTUC Collaboration Group, was utilized to analyze oncological outcomes of 3,333 patients undergoing RNU from 1988 to 2021 among various hospitals in Taiwan. Clinicopathological parameters were recorded according to the principles established by consensus meetings. The Kaplan-Meier estimator was utilized to estimate the survival rates, and the curves were compared using the stratified log-rank test. Univariate and multivariate analyses were performed with the Cox proportional hazard model to explore potential predicting factors.ResultsWith a median follow-up of 41.8 months in 1,808 patients with complete information, the 5-year IVRFS, DFS, CSS, and OS probabilities were 66%, 72%, 81%, and 70%, respectively. In total, 482 patients experienced intravesical recurrence, 307 died of UTUC, and 583 died of any cause. Gender predominance was female (57%). A total of 1,531 patients (84.7%) had high-grade tumors; preoperative hydronephrosis presented in 1,094 patients (60.5%). Synchronous bladder UC was identified in 292 patients (16.2%). Minimally invasive procedures accounted for 78.8% of all surgeries, including 768 hand-assisted laparoscopic (42.5%) and 494 laparoscopic (27.3%) approaches. Synchronous bladder UC was the dominant adverse predicting factor for all survival outcomes. Other independent predicting factors for OS, CSS, and DFS included age ≧70, presence of preoperative hydronephrosis, positive surgical margin, LVI, pathological T and N staging, and laparoscopic RNU.ConclusionSynchronous UC of the urinary bladder is an independent adverse prognostic factor for survival in UTUC. The presence of preoperative hydronephrosis was also corroborated as a disadvantageous prognostic factor. Our multivariate analysis suggested that laparoscopic RNU might provide better oncological control.https://www.frontiersin.org/articles/10.3389/fonc.2021.766576/fullkidney pelvisnephroureterectomyrisk factorssurvivalureterurinary bladder |
| spellingShingle | I-Hsuan Alan Chen I-Hsuan Alan Chen I-Hsuan Alan Chen Chao-Hsiang Chang Chao-Hsiang Chang Chi-Ping Huang Chi-Ping Huang Wen-Jeng Wu Wen-Jeng Wu Wen-Jeng Wu Ching-Chia Li Ching-Chia Li Ching-Chia Li Chung-Hsin Chen Chao-Yuan Huang Chi-Wen Lo Chih-Chin Yu Chih-Chin Yu Chung-You Tsai Chung-You Tsai Wei-Che Wu Wei-Che Wu Jen-Shu Tseng Jen-Shu Tseng Wun-Rong Lin Wun-Rong Lin Yuan-Hong Jiang Yu-Khun Lee Yeong-Chin Jou Yeong-Chin Jou Ian-Seng Cheong Thomas Y. Hsueh Thomas Y. Hsueh Allen W. Chiu Yung-Tai Chen Jih-Sheng Chen Bing-Juin Chiang Bing-Juin Chiang Bing-Juin Chiang Yao-Chou Tsai Yao-Chou Tsai Wei Yu Lin Wei Yu Lin Wei Yu Lin Chia-Chang Wu Chia-Chang Wu Chia-Chang Wu Jen-Tai Lin Chia-Cheng Yu Factors Predicting Oncological Outcomes of Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma in Taiwan Frontiers in Oncology kidney pelvis nephroureterectomy risk factors survival ureter urinary bladder |
| title | Factors Predicting Oncological Outcomes of Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma in Taiwan |
| title_full | Factors Predicting Oncological Outcomes of Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma in Taiwan |
| title_fullStr | Factors Predicting Oncological Outcomes of Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma in Taiwan |
| title_full_unstemmed | Factors Predicting Oncological Outcomes of Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma in Taiwan |
| title_short | Factors Predicting Oncological Outcomes of Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma in Taiwan |
| title_sort | factors predicting oncological outcomes of radical nephroureterectomy for upper tract urothelial carcinoma in taiwan |
| topic | kidney pelvis nephroureterectomy risk factors survival ureter urinary bladder |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2021.766576/full |
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