OBJECTIVE To evaluate the predictive value of preoperative hydronephrosis for pathological outcome and prognosis in patients with upper tract urothelial carcinoma treated with nephroureterectomy. METHODS 167 patients with UTUC treated with nephroureterectomy at our two institutions in Japan between 2002 and 2017 were retrospectively analyzed. Preoperative computed tomography scans were evaluated for the presence of ipsilateral hydronephrosis. Preoperative hydronephrosis's associations with pathological outcome and postnephroureterectomy survival were assessed. RESULTS Ipsilateral hydronephrosis was present in 102 patients (61.1%). Preoperative hydronephrosis was not associated with higher pathological T stage (T3 or greater). Patients with preoperative hydronephrosis compared with patients without preoperative hydronephrosis had significantly worse recurrence-free survival (RFS) (5-year survival, 61.9% and 77.6%, respectively; p = 0.033), disease-specific survival (DSS) (5-year survival, 66.9% and 88.1%, respectively; p = 0.026), and overall survival (OS) (5-year survival, 54.5% and 80.6%, respectively; p = 0.030). A multivariate Cox regression model identified preoperative hydronephrosis and higher clinical T stage (T3 or greater) as an independent predictor of shorter RFS (p = 0.015 and 0.0009, respectively). We segregated the patients into three risk groups based on the number of these two prognostic factors: 0, favorable risk; 1, intermediate risk; 2, poor risk. The favorable-risk group had significantly better RFS (p = 0.0003), DFS (p = 0.0001), and OS (p = 0.0007) than the poor and intermediate-risk groups (RFS (p = 0.0011), DFS (p = 0.0017), and OS (p = 0.0043)). CONCLUSION The presence of preoperative hydronephrosis was a significant risk factor affecting survival. Our risk classification based on preoperative hydronephrosis and clinical T stage may be helpful for patient counselling and decision-making before nephroureterectomy.

中文翻译：

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术前肾积水可预测上尿路尿路上皮癌患者行肾结膜切除术后生存：日本的一项两中心研究。

目的评价肾盂切除术治疗上尿路尿路上皮癌患者术前肾积水对病理结果和预后的预测价值。方法回顾性分析2002年至2017年间在日本两家机构进行的167例UTUC肾结直肠切除术治疗的患者。评估术前计算机断层扫描是否存在同侧肾积水。评估术前肾积水与病理结果和肾切除术后生存的关系。结果102例患者存在同侧肾积水（61.1％）。术前肾积水与较高的病理T期（T3或更高）无关。与无术前肾积水的患者相比，术前肾积水的患者的无复发生存期（RFS）显着更差（5年生存率，分别为61.9％和77.6％； p = 0.033），疾病特异性生存期（DSS）（5年）生存率分别为66.9％和88.1％； p = 0.026）和总生存期（OS）（5年生存率分别为54.5％和80.6％； p = 0.030）。多元Cox回归模型将术前肾积水和较高的临床T期（T3或更高）确定为较短RFS的独立预测因子（分别为p = 0.015和0.0009）。根据这两个预后因素的数目，我们将患者分为三个风险组：0，有利风险；1，中等风险；2，风险差。有利风险组的RFS（p = 0.0003），DFS（p = 0.0001）和OS（p = 0）明显更好。0007），而不是处于中等风险和低风险的人群（RFS（p = 0.0011），DFS（p = 0.0017）和OS（p = 0.0043））。结论术前肾积水的存在是影响生存的重要危险因素。我们基于术前肾积水和临床T期的风险分类可能对肾切除术前的患者咨询和决策有帮助。