Pattern and risk factors of local recurrence and intravesical recurrence after segmental ureterectomy for upper tract urothelial carcinoma.

Objective: To investigate the pattern and risk factors of local recurrence and intravesical recurrence of ureteral upper tract urothelial carcinoma (UTUC) following segmental ureterectomy (SU).

Methods: From February 2012 to August 2021, a retrospective analysis was conducted on patients following SU. Univariate and multivariate Cox regression analysis were used to evaluate the risk factors. Kaplan-Meier curves were employed to illustrate survival outcomes.

Results: Among 88 patients, 50 (57%) were male, with a median age of 71 (IQR: 62-77) years. The procedures of ureteral reconstruction included ureteral reimplantation in 77 (88%) cases, ureteroureteral anastomosis in 9 (10 %) cases, Boari flap ureteroplasty with psoas hitch in 1 (1%) case, and cutaneous ureterostomy in 1 (1%) case. The median follow-up time was 44.5 months. The 3-year rate of local recurrence, lymph node metastasis, ipsilateral upper urinary tract recurrence and intravesical recurrence was 31.6%, 19.0%, 22.2% and 35.7%, respectively. G3 (HR = 3.355, 95% CI 1.375-8.184, P = 0.008), and lymphatic vascular infiltration (HR = 3.127, 95% CI 1.043-9.373, P = 0.042) were independent risk factors for local recurrence. G3 (HR = 3.782, 95% CI 1.036-13.812, P = 0.044) was an independent risk factor for lymph node metastasis. Sarcomatoid differentiation (HR = 3.943, 95% CI 1.087-14.308, P = 0.037) was an independent risk factor for ipsilateral upper urinary tract recurrence. Previous or concurrent bladder cancer (HR = 3.280, 95% CI 1.667-6.453, P = 0.001) and sarcomatoid differentiation (HR = 4.442, 95% CI 1.317-14.989, P = 0.016) were independent risk factor for intravesical recurrence. The most common regions for bladder recurrence were posterior wall (21%), same lateral wall (16%) and trigon (16%).

Conclusion: SU is a feasible treatment for selected UTUC patients, yet it is associated with a considerable risk of local and intravesical recurrence. Careful monitoring and active adjuvant therapy are essential to minimize the recurrence rate for patients with risk factors.