Preoperative pyuria predicts advanced pathologic tumor stage and worse survival in patients with urothelial carcinoma of the upper urinary tract treated by radical nephroureterectomy

- The first study to report that preoperative pyuria predicts advanced pathologic tumor stage and worse survival in UTUC patients after RNU.
- Pyuria could be valuable in preoperative risk stratification and guiding better therapeutic approaches.
- We are expecting a further validation in a larger population.

ObjectivesTo investigate the association of preoperative pyuria with pathologic features and oncologic outcomes in patients with urothelial carcinoma of the upper urinary tract (UTUC) treated by radical nephroureterectomy (RNU).Material and methodsA cohort of 176 patients treated with RNU from January 2001 to December 2014 were retrospectively reviewed. Logistic regression and survival analysis methodology was used to investigate the association of preoperative pyuria with clinicopathologic outcomes.ResultsAmong this cohort, 36 (20.5%) presented with preoperative pyuria. Logistic regression revealed that pyuria was significantly associated with advanced pT stage (P = 0.001). During a median follow-up of 41 months (interquartile range: 22-60), 65 (37%) patients died, including 54 (31%) from UTUC. Overall survival rates at 3 year and 5 years in patients with pyuria were significantly lower than those in patients without pyuria (62.3% and 36.1% vs. 78.4% and 65.3%, respectively; P = 0.004). Also, cancer-specific survival rates at 3 year and 5 years in patients with pyuria were significantly lower than in patients without pyuria (65.7% and 50% vs. 80% and 67.6%, respectively; P = 0.016). Furthermore, in the multivariate analysis, after incorporating only preoperative factors, pyuria was found to be an independent predictor of overall survival and cancer-specific survival (P = 0.005 and P = 0.028, respectively).ConclusionsPreoperative pyuria among UTUC patients underwent RNU was significantly associated with advanced pathologic tumor stage and worse survival. Our data suggested that pyuria as a prognostic predictor could be valuable in preoperative risk stratification and guiding better therapeutic approaches, but further validation in a larger population is needed.