Impact of dialysis on intravesical recurrence and survival outcomes in upper tract urothelial cancer patients undergoing radical nephroureterectomy

Upper tract urothelial carcinoma (UTUC) presents a significant recurrence risk following radical nephroureterectomy (RNU). Patients on dialysis may experience unique clinical trajectories due to uremic states and altered immune responses. To evaluate the impact of dialysis on intravesical recurrence and survival outcomes in patients with UTUC undergoing RNU, and to identify predictive factors influencing prognosis. A retrospective cohort study analyzed 402 patients with non-metastatic UTUC treated with RNU between 2001 and 2014. Patients were stratified into dialysis (<i>n</i> = 66) and non-dialysis (<i>n</i> = 336) groups. Survival and recurrence outcomes were assessed using Kaplan–Meier and Cox regression analyses. Dialysis patients were predominantly female, younger, and exhibited less advanced pathological tumor stages. Dialysis was associated with higher intravesical recurrence rates (<i>p</i> = 0.009), which were largely attributable to a history of bladder cancer (42.4% vs. 26.5%; <i>p</i> = 0.009). After adjustment for bladder cancer history, dialysis was not an independent predictor of bladder recurrence-free survival (BRFS). Advanced pT stages (HR: 3.9, <i>p</i> = 0.012) and prior bladder cancer were the primary factors influencing BRFS. Dialysis does not independently worsen surgical outcomes or BRFS in UTUC patients post-RNU when accounting for prior bladder cancer. Prognostic models should integrate these findings to enhance individualized surveillance and treatment strategies.

上尿路尿路上皮癌（upper tract urothelial carcinoma, UTUC）在接受根治性肾输尿管切除术（radical nephroureterectomy, RNU）后存在显著复发风险。接受透析的患者因处于尿毒症状态且免疫应答发生改变，可能呈现独特的临床病程。本研究旨在评估透析对接受RNU治疗的UTUC患者膀胱内复发及生存结局的影响，并识别影响预后的预测因素。本回顾性队列研究分析了2001年至2014年间402例接受RNU治疗的非转移性UTUC患者，将其分为透析组（n=66）与非透析组（n=336）。采用Kaplan-Meier法与Cox回归分析评估患者的生存与复发结局。结果显示，透析组患者以女性占比更高、年龄更轻，且病理肿瘤分期相对偏早。透析与更高的膀胱内复发率相关（p=0.009），这一关联主要可归因于既往膀胱癌病史（透析组42.4% vs 非透析组26.5%；p=0.009）。在校正膀胱癌病史因素后，透析并非膀胱无复发生存（bladder recurrence-free survival, BRFS）的独立预测因素。高级别pT分期（风险比HR=3.9，p=0.012）与既往膀胱癌史是影响BRFS的主要因素。研究表明，在考虑既往膀胱癌病史的前提下，透析并不会独立恶化UTUC患者RNU术后的手术结局或BRFS。预后模型应整合上述研究发现，以优化个体化监测与治疗策略。