This study aims to identify predictive local recurrence risk factors and site-specific local recurrence pattern of upper tract urothelial carcinoma (UTUC) with different primary tumor locations. Three hundred and eighty-nine UTUC patients with radical nephroureterectomy were included in this study. Univariate and multivariate Cox proportional hazards regressions were performed to measure the risk of local recurrence. We also mapped the position of local recurrence sites stratified by primary tumor locations. A total of 73 patients (18.7%) developed local recurrence within a median follow-up of 41 months (range, 3-80 months). For patients with local recurrence, the median interval of local recurrence was 9 months. Ureter tumor, multifocality, T stage, G grade, lymph node metastasis (LNM), lymph node dissection (LND), and lymph vascular invasion (LVI) were all significantly associated with increased local recurrence by univariable analyses (P < 0.05). Only multifocality, T3–4, G3, and LNM remained independent predictors of increased local recurrence by multivariable analyses. Adjuvant radiotherapy could reduce the local recurrence (HR = 0.177; 95% CI 0.064-0.493, P = 0.001). Patients with local recurrence had poorer cancer-specific survival (4-year cancer-specific survival rate 36 ± 7.5% vs 88.4 ± 2.2%, P = 0.000). We evaluated local recurrence pattern stratified by tumor locations. Para-aortic lymph node region was the most common recurrence area for all the patients. Left-sided UTUC had more than 70% recurrent lymph nodes in the left para-aortic region (LPA). For right-sided UTUC patients, recurrent para-aortic lymph nodes distributed in the LPA (33.3%), aortocaval (AC) (41.5%), and right paracaval (RPC) (25.2%) regions. Recurrence in the internal and external iliac regions was only found in the distal ureter group (P < 0.05). Renal pelvic fossa recurrence was only found in renal pelvic tumor (22.2%, P = 0.007). The ureter tumor bed recurrence rate was higher for ureter patients (P = 0.001). Multifocality, T3–4, G3, and LNM are predictors of higher local recurrence rate of UTUC. Adjuvant radiotherapy can reduce local recurrence rate. Local recurrence patterns are different according to primary tumor locations.

中文翻译：

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上尿路尿路上皮癌肾切除术后局部复发的模式和危险因素。

本研究旨在确定具有不同原发灶位置的上尿路尿路上皮癌（UTUC）的预测性局部复发危险因素和部位特异性局部复发模式。这项研究包括了389例行根治性肾切除术的UTUC患者。进行单因素和多因素Cox比例风险回归以测量局部复发的风险。我们还绘制了按原发肿瘤位置分层的局部复发部位的位置。在中位随访41个月（范围3-80个月）内，共有73例患者（占18.7％）出现了局部复发。对于局部复发患者，局部复发的中位间隔为9个月。输尿管肿瘤，多灶性，T期，G级，淋巴结转移（LNM），淋巴结清扫（LND），单因素分析显示，淋巴管浸润和淋巴管浸润（LVI）均与局部复发增加显着相关（P <0.05）。通过多变量分析，只有多焦点，T3-4，G3和LNM仍然是局部复发增加的独立预测因子。辅助放疗可减少局部复发（HR = 0.177； 95％CI 0.064-0.493，P = 0.001）。局部复发患者的癌症特异性生存率较差（4年癌症特异性生存率36±7.5％对88.4±2.2％，P = 0.000）。我们评估了按肿瘤部位分层的局部复发模式。主动脉旁淋巴结区域是所有患者中最常见的复发区域。左侧UTUC在左主动脉旁区域（LPA）内有70％以上的复发淋巴结。对于右侧UTUC患者，主动脉旁淋巴结复发分布在LPA中（33.3％），主动脉腔（AC）（41.5％）和右腹腔（RPC）（25.2％）区域。仅在输尿管远端组发现内和internal外区域复发（P <0.05）。肾盂窝复发仅见于肾盂肿瘤（22.2％，P = 0.007）。输尿管患者的输尿管肿瘤床复发率较高（P = 0.001）。多灶性，T3-4，G3和LNM是UTUC局部复发率较高的预测因素。辅助放疗可降低局部复发率。根据原发肿瘤的位置，局部复发模式是不同的。输尿管患者的输尿管肿瘤床复发率较高（P = 0.001）。多灶性，T3-4，G3和LNM是UTUC局部复发率较高的预测因素。辅助放疗可降低局部复发率。根据原发肿瘤的位置，局部复发模式是不同的。输尿管患者的输尿管肿瘤床复发率较高（P = 0.001）。多灶性，T3-4，G3和LNM是UTUC局部复发率较高的预测因素。辅助放疗可降低局部复发率。根据原发肿瘤的位置，局部复发模式是不同的。