[PROGNOSIS OF NEPHROURETERECTOMY FOR UPPER URINARY TRACT UROTHELIAL CARCINOMA]

(Objective) We retrospectively assessed prognostic factors following total nephroureterectomy for renal pelvis and ureter cancer. (Subjects and methods) Of the 291 patients who underwent total nephroureterectomy for renal pelvis and ureter cancer without distant metastasis between May 2005 and March 2022, we excluded those who underwent simultaneous total cystectomy, received presurgical chemotherapy, or had pN-positive status. The prognosis was evaluated based on metastasis-free survival (MFS) and overall survival (OS). Clinicopathological factors affecting prognosis were analyzed. (Results) A total of 262 cases were analyzed. Of these, 130 (49.6%) had pT1 or less, 54 (20.6%) had pT2, and 78 (29.8%) had pT3 or higher. Lymphovascular invasion (LVI) was present in 89 cases (34%), while 173 cases (66%) did not have LVI.By the pT stage, the 5-year MFS rate was 78.2% for pT1 and below, 60.5% for pT2, and 43.7% for pT3 and above. The 5-year OS rate was 81.9% for pT1 and below, 72.0% for pT2, and 63.2% for pT3 and above. By LVI status, the 5-year MFS rate was 77.2% for LVI-negative (-) cases and 43.3% for LVI-positive (+) cases. The 5-year OS rate was 82.6% for LVI (-) cases and 61.0% for LVI (+) cases.In the multivariate analysis, LVI (+) is defined as an independent prognostic factor related to MFS and OS.When the prognosis was evaluated through the pT stage and stratified by the presence or absence of LVI, patients with pT2 or higher who had LVI exhibited significantly worse MFS and OS. (Conclusion) LVI is a significant prognostic factor following total nephroureterectomy for renal pelvis and ureteral cancer.