Predictive risk factors of bladder recurrence after radical nephroureterectomy for non-metastatic upper tract urothelial carcinoma

Background The aim of our study was to explore predictive factors for bladder recurrence and oncologic outcomes in patients with non-metastatic upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy with bladder cuff excision (RNUx). Methods The retrospective cohort study enrolled 169 patients after RNUx in Changhua Christian Hospital between January 2010 and October 2023. Patients were divided into two groups of either experience bladder recurrence (n = 44) or not (n = 125). Data on clinical parameters, pre-surgery ureteroscopy, pre-surgery hydronephrosis, pathologic features, comorbidities, smoking, adjuvant chemotherapy, and intravesical chemotherapy were collected from patients’ medical records. The log-rank test and multivariable Cox regression analysis were performed to identify variables associated with bladder recurrence-free survival (BRFS), distant metastasis-free survival (DMFS), and overall survival (OS). Results Our finding shows that the BRFS rate was 81.8% at 12 months and 69.6% at 36 months after RNUx. Cox regression models revealed that male (aHR: 0.41 for females, 95% CI: 0.21–0.78, p = 0.007), carcinoma in situ (aHR: 2.62, 95% CI: 1.07–6.41, p = 0.035) and hypertension (aHR:2.25, 95% CI: 1.13–4.49, p = 0.022) were risk factors of bladder recurrence. Furthermore, advanced stage and lymphovascular invasion were identified as risk factors of DMFS, and advanced T stage and hemodialysis were associated with poorer OS. Conclusion Our study identified several significant risk factors of bladder recurrence, distant metastasis, and all-cause death. These findings provide a reference of clinical care. A more frequent surveillance schedule may be helpful for these patients.