Oncological impact of different distal ureter managements during radical nephroureterectomy for primary upper urinary tract urothelial carcinoma

Table 1 Baseline characters of all patients treated with radical nephroureterectomy for upper urinary tract urothelial carcinoma

Variable	All patients (n = 248)	IVBC group (n = 99)	EVBC group (n = 96)	TVBC group (n = 53)	P value
Age
< 70 yr	128 (51.6)	51 (51.5)	56 (58.3)	21 (39.6)	0.09
≥ 70 yr	120 (48.4)	48 (48.5)	40 (41.7)	32 (60.4)
ASA
I	23 (9.3)	9 (9.1)	10 (10.4)	4 (7.5)	0.07
II	167 (67.3)	68 (68.7)	70 (72.9)	29 (54.7)
III	58 (23.4)	22 (22.2)	16 (16.7)	20 (37.7)
Gender
Male	122 (49.2)	52 (52.5)	46 (47.9)	24 (45.3)	0.66
Female	126 (50.8)	47 (47.5)	50 (52.1)	29 (54.7)
Smoke
No	204 (82.3)	79 (79.8)	83 (86.5)	42 (79.2)	0.39
Yes	44 (17.7)	20 (20.2)	13 (13.5)	11 (20.8)
Gross hematuria
No	79 (31.9)	31 (31.3)	28 (29.2)	20 (37.7)	0.56
Yes	169 (68.1)	68 (68.7)	68 (70.8)	33 (62.3)
Urinary cytology
Negative	77 (31.0)	28 (28.3)	34 (35.4)	15 (28.3)	0.50
Positive	171 (69.0)	71(71.7)	62 (64.6)	38 (71.7)
Tumor side
Left	134 (54.0)	50 (50.5)	52 (54.2)	32 (60.4)	0.51
Right	114 (46.0)	49 (49.5)	44 (45.8)	21 (39.6)
Tumor location
Renal pelvis	111 (44.8)	37 (37.4)	42 (43.8)	32 (60.4)	0.03
Upper and middle ureter	66 (26.6)	25 (25.3)	25 (26.0)	16 (30.2)
Lower ureter	49 (19.8)	26 (26.3)	20 (20.8)	3 (5.7)
Multiple	22 (8.9)	11 (11.1)	9 (9.4)	2 (3.8)
pT stage
pT0-pTa-pT1-pTis	69 (27.8)	27 (27.3)	23 (24.0)	19 (35.8)	0.17
pT2	69 (27.8)	31 (31.3)	22 (22.9)	16 (30.2)
pT3	107 (43.1)	39 (39.4)	51 (53.1)	17 (32.1)
pT4	3 (1.2)	2 (2.0)	0 (0.0)	1 (1.9)
LN status
LN-negative	238 (96.0)	94 (94.9)	93 (96.9)	51(96.2)	0.787
LN-positive	10 (4.0)	5 (5.1)	3 (3.1)	2 (3.8)
Tumor grade
Low	29 (11.7)	14 (14.1)	9 (9.4)	6 (11.3)	0.58
High	221 (88.3)	85 (85.9)	87 (90.6)	47 (88.7)
LVI
Negative	223 (89.9)	92 (92.9)	84 (87.5)	47 (88.7)	0.43
Positive	25 (10.1)	7 (7.1)	12 (12.5)	6 (11.3)
Intravesical chemotherapy
No	171 (69.0)	75 (75.8)	66 (68.8)	30 (56.6)	0.05
Yes	77 (31.0)	24 (24.2)	30 (31.2)	2 3 (43.4)
Adjuvant therapy
No	218 (87.9)	90 (90.9)	80 (83.3)	48 (90.6)	0.21
Yes	30 (12.1)	9 (9.1)	16 (16.7)	5 (9.4)

Data are shown as n (%). ASA: American society of anesthesiologists; EVBC: Extravesical incision of the bladder cuff; IVBC: Intrasvesical incision of the bladder cuff; TUBC: Transurethral incision of the bladder cuff; LN: Lymph node; LVI: Lymphovascular invasion; pT: Pathological tumor.

Table 2 Univariate and multivariate Cox regression analyses for predicting oncological outcomes in patients treated with radical nephroureterectomy for upper urinary tract urothelial carcinoma

Variable	IRFS						CSS						OS
	Univariate analysis			Multivariate analysis			Univariate analysis			Multivariate analysis			Univariate analysis			Multivariate analysis
	HR	95%CI	P value	HR	95%CI	P value	HR	95%CI	P value	HR	95%CI	P value	HR	95%CI	P value	HR	95%CI	P value
Age < 70 yr vs age ≥ 70 yr	0.799	0.412-1.550	0.507			-	0.968	0.398-2.353	0.943				1.340	0.656-2.737	0.421
Male vs female	0.535	0.273-1.047	0.068			-	0.820	0.339-1.986	0.661				0.644	0.315-1.319	0.229
BCE methods			0.987			-			0.826						0.503
IVBC	1	Reference	-			-	1	Reference	-				1	Reference	-
EVBC	1.032	0.474-2.246	0.937				0.707	0.235-2.128	0.537				0.587	0.223-1.542	0.280
TUBC	0.954	0.392-2.323	0.917				0.879	0.276-2.797	0.828				0.695	0.256-1.884	0.474
Tumor location			0.042			0.042			0.564						0.161
Lower ureter	1	Reference	-	1	Reference	-	1	Reference	-				1	Reference	-
Middle and upper ureter	0.421	0.177-1.002	0.051	0.421	0.177-1.002	0.051	0.930	0.295-2.933	0.901				1.148	0.451-2.920	0.772
Renal pelvis or calyx	0.339	0.153-0.750	0.008	0.339	0.153-0.750	0.008	0.505	0.160-1.598	0.245				0.466	0.176-1.230	0.123
Multiple	0.315	0.007-1.416	0.132	0.315	0.007-1.416	0.132	0.459	0.053-3.973	0.479				0.500	0.102-2.462	0.394
pT ≤ 2 vs pT > 2	0.567	0.273-1.178	0.128				9.156	2.673-31.358	0.000	8.439	2.424-29.377	0.001	2.970	1.417-6.225	0.004	2.891	1.364-6.128	0.006
LN (-/x) vs LN (+)	0.901	0.123-6.586	0.918				16.793	6.328-44.568	0.000	14.343	5.176-39.745	< 0.001	9.917	3.995-24.621	0.000	9.473	3.75-23.926	< 0.001
Tumor grade	0.988	0.383-2.547	0.980				25.367	0.083-7755.852	0.268				0.981	0.341-2.826	0.972
LV (-) vs LV (+)	0.611	0.146-2.552	0.499				2.933	0.969-8.881	0.057				2.385	0.907-6.273	0.078
Urinary cytology	0.993	0.478-2.064	0.986				1.474	0.492-4.419	0.488				1.446	0.592-3.532	0.418
Intravesical chemotherapy (yes vs no)	1.023	0.503-2.081	0.950				0.606	0.202-1.816	0.371				0.852	0.380-1.909	0.697

CSS: Cancer-specific survival; EVBC: Extravesical incision of the bladder cuff; IVBC: Intrasvesical incision of the bladder cuff; IRFS: Intravesical recurrence-free survival; OS: Overall survival; TUBC: Transurethral incision of the bladder cuff; LN: Lymph node; pT: Pathological tumor; LVI: Lymphovascular invasion; HR: Hazard ratio; CI: Confidence interval.