Preoperative hydronephrosis predicts adverse pathological features and postoperative survival in patients with high-grade upper tract urothelial carcinoma

ABSTRACT Purpose: Epidemiological studies reported conflicting results about preoperative hydronephrosis in upper tract urothelial carcinoma (UTUC). This study aimed to investigate the association between preoperative hydronephrosis and pathologic features and oncologic outcomes in patients with UTUC treated by radical nephroureterectomy (RNU). Materials and Methods: This was a retrospective, single-center cohort study of 377 patients treated by RNU without perioperative chemotherapy between January 2001 and December 2014. Logistic regression, Cox regression, and survival analyses were performed. Results: Among the 226 patients with high-grade UTUC, 132 (58%) had preoperative hydronephrosis. Multivariable logistic regression revealed that hydronephrosis was independently associated with advanced pT stage (P=0.017) and lymph node or lymphovascular invasion (P=0.002). Median follow-up was 36 months (interquartile range: 20-48 months). The 3- and 5-year overall survival (OS) rates in patients with hydronephrosis were significantly lower than in those without hydronephrosis (both P

摘要
目的：既往流行病学研究对上尿路尿路上皮癌（upper tract urothelial carcinoma, UTUC）患者术前肾积水的报道结果存在分歧。本研究旨在探讨接受根治性肾输尿管切除术（radical nephroureterectomy, RNU）治疗的UTUC患者术前肾积水与病理特征及肿瘤学预后的关联。
材料与方法：本研究为一项回顾性单中心队列研究，纳入2001年1月至2014年12月间接受RNU治疗且未接受围手术期化疗的377例患者。研究采用logistic回归、Cox回归及生存分析方法。
结果：在226例高级别UTUC患者中，132例（58%）存在术前肾积水。多因素logistic回归分析显示，肾积水与进展性pT分期（P=0.017）及淋巴结或脉管癌栓（P=0.002）独立相关。中位随访时间为36个月（四分位间距：20~48个月）。肾积水患者的3年及5年总生存期（overall survival, OS）率显著低于无肾积水患者（两组比较P值均为