[PREOPERATIVE SEVERE HYDRONEPHROSIS IN RENAL PELVIC-URETERAL CANCER PREDICTS POSTOPERATIVE INTRAVESICAL RECURRENCE]

(Objective) We examined if the degree of preoperative hydronephrosis influences the occurrence of postoperative intravesical recurrence (IVR) in patients with upper tract urothelial cancer (UTUC). (Material and method) From January 2010 to March 2022, a total of 237 patients underwent total nephroureterectomy and partial cystectomy for UTUC at our hospital. For this study, 169 patients were selected after excluding 57 patients with a history of bladder cancer, 10 patients who received postoperative intravesical anticancer drug injection and 1 patient with inadequate data. Cases with Society for Fetal Urology (SFU) Grade 2 or higher (renal pelvis and several calyces observed) on preoperative computed tomography were considered to have hydronephrosis. Multivariate analysis was performed by selecting four known risk factors: tumor localization (ureter tumor), positive preoperative urine cytology, multiple upper tract ureteral carcinomas, and carcinoma in situ of UTUC. (Result) There were 120 male patients (71.0%) and 49 female patients (29.0%), with a median age of 71 years. The median observation period was 43 months. IVR was observed in 46 patients (27.2%) after surgery; 82 patients (49.1%) had SFU Grade 2 or higher (preoperative hydronephrosis) and 25 had SFU Grade 4 (dilatation of the renal pelvis and calyces and thinning of the renal parenchyma). There was a correlation between SFU Grade progression and an increase in IVR rate. Compared with patients without hydronephrosis, the presence of SFU Grade 4 hydronephrosis was found to be an independent associate factor after adjusting for known risk factors in multivariate analysis (p=0.02, hazard ratio 3.02, 95% confidence interval 1.18-7.75). (Conclusion) Patients with preoperative SFU Grade 4 hydronephrosis are more likely to have IVR. Postoperative intravesical anticancer drug injections and more frequent cystoscopies may be beneficial for these patients.