Influence of preoperative hydronephrosis on the outcome of urothelial carcinoma of the upper urinary tract after nephroureterectomy: The results from a multi-institutional French cohort

摘要

Objectives: Recent publications have assessed the prognostic significance of hydronephrosis in the outcome of upper tract urothelial carcinoma (UUT-UC). Our study sought to determine the prognostic impact of hydronephrosis on UUT-UC survival and its relationship to the clinicopathological features. Materials and methods: A retrospective, multi-institutional French study was conducted on 401 patients who underwent radical nephroureterectomy for non-metastatic UUT-UC. Hydronephrotic status was determined using preoperative imaging reports. Univariate and multivariate analyses were conducted to identify factors associated with survival. Results: Preoperative hydronephrosis was present in 74 patients. Median follow-up was 26 months. Hydronephrosis was associated only with ureteral localisation (p < 0. 001). No difference was observed in 5-year cancer-specific survival (CSS) between the hydronephrosis group (80. 1 %) and the no hydronephrosis group (83. 6 %) (p > 0. 05). Only age (p = 0. 02) and pT stage (p = 0. 01) were independent predictors of CSS. Hydronephrosis was not a significant predictor of CSS in the univariate and multivariate analyses (p = 0. 87 and p = 0. 66). No significant difference was observed for 5-year metastasis-free survival (MFS) between the hydronephrosis group (69. 8 % ?? 6. 6 %) and the no hydronephrosis group (80. 5 % ?? 3 %) (p = 0. 052). Hydronephrosis was not a significant predictor of MFS in the univariate and multivariate analyses (p = 0. 16 and p = 0. 36). Multifocality (p = 0. 02), pT stage (p < 0. 001) and positive surgical margins (p = 0. 02) were independent predictors of MFS. For the pelvic tumours subgroup, hydronephrosis was an independent predictor of MFS (p = 0. 01) but not CSS (p = 0. 86). Conclusion: Preoperative hydronephrosis was not associated with survival. However, among tumours presenting with hydronephrosis, pelvicalyceal tumours appear to have a worse prognosis than ureteral tumours. ? 2012 Springer-Verlag Berlin Heidelberg.