The Value of Preoperative Local Symptoms in Prognosis of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy: A Retrospective, Multicenter Cohort Study

Hsin Chih Yeh, Chao Hsiang Chang, Jen Kai Fang, I. Hsuan Alan Chen, Jen Tai Lin, Jian Hua Hong, Chao Yuan Huang, Shian Shiang Wang, Chuan Shu Chen, Chi Wen Lo, Chih Chin Yu, Jen Shu Tseng, Wun Rong Lin, Yeong Chin Jou, Ian Seng Cheong, Yuan Hong Jiang, Chung You Tsai, Thomas Y. Hsueh, Yung Tai Chen, Hsu Che HuangYao Chou Tsai, Wei Yu Lin, Chia Chang Wu, Po Hung Lin, Te Wei Lin, Wen Jeng Wu

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4 Citations (Scopus)


Purpose: We aimed to evaluate the impact of preoperative local symptoms on prognosis after radical nephroureterectomy in patients with upper tract urothelial carcinoma (UTUC). Methods: This retrospective study consisted of 2,662 UTUC patients treated at 15 institutions in Taiwan from 1988 to 2019. Clinicopathological data were retrospectively collected for analysis by the Taiwan UTUC Collaboration Group. The Kaplan-Meier method was used to calculate overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS). The prognostic value of preoperative local symptoms in OS, CSS, DFS, and BRFS was investigated using Cox proportional hazards models. Results: The median follow-up was 36.6 months. Among 2,662 patients, 2,130 (80.0%) presented with hematuria and 398 (15.0%) had symptomatic hydronephrosis at diagnosis. Hematuria was associated with less symptomatic hydronephrosis (p <0.001), more dialysis status (p = 0.027), renal pelvic tumors (p <0.001), and early pathological tumor stage (p = 0.001). Symptomatic hydronephrosis was associated with female patients (p <0.001), less dialysis status (p = 0.001), less bladder cancer history (p <0.001), ureteral tumors (p <0.001), open surgery (p = 0.006), advanced pathological tumor stage (p <0.001), and postoperative chemotherapy (p = 0.029). Kaplan-Meier analysis showed that patients with hematuria or without symptomatic hydronephrosis had significantly higher rates of OS, CSS, and DFS (all p <0.001). Multivariate analysis confirmed that presence of hematuria was independently associated with better OS (HR 0.789, 95% CI 0.661–0.942) and CSS (HR 0.772, 95% CI 0.607–0.980), while symptomatic hydronephrosis was a significant prognostic factor for poorer OS (HR 1.387, 95% CI 1.142–1.683), CSS (HR 1.587, 95% CI 1.229–2.050), and DFS (HR 1.378, 95% CI 1.122–1.693). Conclusions: Preoperative local symptoms were significantly associated with oncological outcomes, whereas symptomatic hydronephrosis and hematuria had opposite prognostic effects. Preoperative symptoms may provide additional information on risk stratification and perioperative treatment selection for patients with UTUC.

Original languageEnglish
Article number872849
JournalFrontiers in Oncology
Publication statusPublished - Jun 2022


  • flank pain
  • hematuria
  • prognosis
  • radical nephroureterectomy (RNU)
  • symptomatic hydronephrosis
  • upper tract urothelial carcinoma (UTUC)

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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