Frontiers in oncology · 2026
Single versus maintenance intravesical instillation of chemotherapy for intravesical recurrence after radical nephroureterectomy in distal ureteral upper tract urothelial carcinoma: a multicenter retrospective study from China.
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Dai Shengnian, Shi Xinyu, Liu Jianzhou, Ma Zhenkun, Zhu Guodong, Fan Junjie, Yang Tao, Pei Xinqi
Аннотация
INTRODUCTION: Intravesical recurrence (IVR) is a common event after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Distal ureteral tumors are of particular clinical interest because they are associated with a relatively high risk of IVR. To reduce heterogeneity related to tumor location and pathological stage, this study focused specifically on patients with pathologically confirmed pT2 distal ureteral tumors. However, whether maintenance intravesical chemotherapy (MIC) provides additional benefit over single intravesical chemotherapy (SIC) in this subgroup remains uncertain.
METHODS: We retrospectively analyzed patients with pathologically confirmed pT2 distal ureteral UTUC who underwent RNU at multiple centers between 2018 and 2023. Patients were classified into the SIC and MIC groups according to their postoperative intravesical instillation strategy. Intravesical recurrence-free survival (IVRFS) was the primary endpoint. Inverse probability of treatment weighting (IPTW), Kaplan-Meier analysis, and Cox regression were used to evaluate the association between instillation strategy and IVR.
RESULTS: Among 532 patients (183 SIC, 349 MIC), IPTW achieved good baseline balance. MIC was associated with longer IVRFS than SIC on IPTW-weighted Kaplan-Meier analysis. In IPTW-weighted Cox model, MIC was associated with a lower risk of IVR (HR 0.71, 95% CI 0.501-0.989, P = 0.043). Tumor size, multifocality, preoperative ureteroscopy, and lymphovascular invasion were independent predictors of IVR.
CONCLUSIONS: In this multicenter retrospective study of patients with pT2 distal ureteral UTUC, MIC was associated with a lower risk of IVR compared with SIC. However, because of the retrospective and non-randomized study design, potential residual confounding, and heterogeneity in maintenance regimens across centers, these findings should be interpreted as hypothesis-generating rather than definitive evidence of treatment superiority. Further prospective randomized studies are warranted to validate these results.
METHODS: We retrospectively analyzed patients with pathologically confirmed pT2 distal ureteral UTUC who underwent RNU at multiple centers between 2018 and 2023. Patients were classified into the SIC and MIC groups according to their postoperative intravesical instillation strategy. Intravesical recurrence-free survival (IVRFS) was the primary endpoint. Inverse probability of treatment weighting (IPTW), Kaplan-Meier analysis, and Cox regression were used to evaluate the association between instillation strategy and IVR.
RESULTS: Among 532 patients (183 SIC, 349 MIC), IPTW achieved good baseline balance. MIC was associated with longer IVRFS than SIC on IPTW-weighted Kaplan-Meier analysis. In IPTW-weighted Cox model, MIC was associated with a lower risk of IVR (HR 0.71, 95% CI 0.501-0.989, P = 0.043). Tumor size, multifocality, preoperative ureteroscopy, and lymphovascular invasion were independent predictors of IVR.
CONCLUSIONS: In this multicenter retrospective study of patients with pT2 distal ureteral UTUC, MIC was associated with a lower risk of IVR compared with SIC. However, because of the retrospective and non-randomized study design, potential residual confounding, and heterogeneity in maintenance regimens across centers, these findings should be interpreted as hypothesis-generating rather than definitive evidence of treatment superiority. Further prospective randomized studies are warranted to validate these results.