Impact of Tumor Location on Local Recurrence After Nephroureterectomy for Upper Tract Urothelial Carcinoma: Implications for Adjuvant Radiotherapy.

Purpose: To evaluate the impact of tumor location on local recurrence in upper tract urothelial carcinoma (UTUC). Patients and

Methods: Among UTUC patients who underwent radical nephroureterectomy, 192 with renal pelvic tumors and 161 with ureteral tumors were included. Local recurrence was divided into regional lymph node recurrence (rLNR) and surgical bed recurrence (SBR).

Results: During a mean follow-up of 73 months, local recurrence occurred in 33 patients (9.3%). The postoperative 5-year local recurrence-free survival (80.5% vs. 94.2%; P = .002), rLNR-free survival (89.8% vs. 96.5%; P = .046), and SBR-free survival (88.3% vs. 97.6%; P = .005) were poorer in ureteral tumor than renal pelvic tumor. Ureteral tumor (hazard ratio [HR], 2.552; P = .017), high-grade tumor (HR, 3.064; P = .016), and advanced tumor stage (T3 or greater) (HR, 3.236; P = .002) were associated with local recurrence. Ureteral tumor (HR, 3.516; P = .033) and advanced tumor stage (HR, 2.907; P = .039) were risk factors for SBR. Although tumor location was not associated with rLNR, lymphovascular invasion (HR, 5.451; P < .001) and high-grade tumor (HR, 4.191; P = .012) were related to rLNR.

Conclusion: Ureteral tumors are associated with local recurrence in the form of SBR. Adjuvant radiotherapy or surgical techniques aimed at reducing the risk of SBR should be considered in patients with ureteral tumors.