Clinicopathological characteristics, surgical treatments, and oncological outcomes of localized primary unifocal urothelial carcinoma involving the ureterovesical junction

• Published in: International urology and nephrology Vol. 56; no. 3; pp. 941 - 955
• Main Authors: Zhai, Hongyun, Wang, Yanghai, Chen, Zhenghao, Wang, Zhiwen, Xing, Jiyu, Zhu, Xi, Hao, Gangyue
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.03.2024; Springer Nature B.V
• Subjects: Cancer; Carcinoma, Transitional Cell - pathology; Humans; Male; Medicine; Medicine & Public Health; Nephrectomy; Nephrology; Pain; Patients; Prognosis; Retrospective Studies; Statistical analysis; Survival; Tumors; Ureter; Ureter - pathology; Ureter - surgery; Ureteral Neoplasms - pathology; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Urinary tract; Urological cancer; Urology; Urology - Original Paper; Urothelial carcinoma; Cancer-specific survival; Recurrence-free survival; Urothelial carcinoma; Surgical treatment; Ureterovesical junction
• ISSN: 1573-2584; 0301-1623; 1573-2584
• DOI: 10.1007/s11255-023-03838-0

Objective To investigate clinicopathological characteristics, surgical treatments, and oncological outcomes of patients with localized primary unifocal urothelial carcinoma involving the ureterovesical junction (UC-UVJ). Patients and methods Localized primary unifocal UC-UVJ cases in patients admitted to our hospital from March 2013 to August 2021 were reviewed. Clinicopathological parameters, perioperative data, and oncological outcomes were compared between patients grouped by tumor location and surgical treatment. Results A total of 130 patients with localized primary unifocal UC-UVJ were enrolled in this study. These included 72 cases of bladder cancer (BC) involving the ureteral orifice, and 58 cases of upper urinary tract urothelial carcinoma (UTUC) involving the intramural ureter. The proportion of male patients, hydronephrosis, flank pain/abdominal pain, and tumor size differed significantly between the BC and UTUC groups (all P  < 0.05). During the median follow-up period of 32.9 months, 49 cases (37.7%) recurred and 29 (22.3%) died from urothelial carcinoma (UC), though no statistical difference in recurrence ( P  = 0.436) or cancer-specific mortality ( P  = 0.653) was observed between the BC and UTUC groups. Cox proportional hazards regression analysis identified age, tumor grade, and lymphovascular invasion (LVI) as independent predictors of cancer-specific survival (CSS), and sex, T stage, tumor grade, and LVI as independent predictors of recurrence-free survival (RFS). Conclusion Owing to positional properties, patients with localized primary unifocal UC-UVJ exhibited significant heterogeneity, leading to varied treatment strategies. No statistically significant differences in CSS or RFS were observed between the BC and UTUC groups. Furthermore, age, sex, T stage, tumor grade, and LVI should be carefully considered in clinical practice because of their associations with CSS and RFS.