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Clinical, pathological, and prognostic features of invasive pyelocaliceal urothelial carcinoma with venous thrombus: A propensity score-matched retrospective cohort study

Year: 2025

Type: article

Abstract: Objective To elucidate the clinical, pathological, and prognostic characteristics of invasive pyelocaliceal urothelial carcinoma (pUC) with venous thrombus (VT). Methods The study included 23 pUC-VT patients and 88 pUC patients (without VT) from March 2016 to April 2022. The features of pUC-VT were detailed and were compared with those of pUC. Normally distributed continuous variables were presented as mean±standard deviation; non-normally distributed variables were expressed as median (interquartile range); categorical variables were described as n (%). Propensity scores were calculated by age-adjusted Charlson comorbidity index level and tumor stage. After matching, differences of variables were compared using the paired t -test, Wilcoxon signed-rank test, and McNemar test. Kaplan-Meier method and Gehan-Breslow test were used to compare overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) curves of pUC-VT and pUC patients. Univariate and multivariate Cox proportional hazards regression models were used to determine whether VT was an independent risk factor. The Landmark analysis was applied to explore the role of VT in different time periods. Results After matching, all 23 pUC-VT patients were paired with pUC patients, revealing significant differences only in open surgery rates (48% vs. 4.3%, p =0.004), median intraoperative blood loss (400.0 mL vs. 80.0 mL, p =0.009), median red blood cell transfusion volume (400.0 mL vs. 0.0 mL, p =0.001), and tumor diameter (7.5 cm vs. 5.0 cm, p <0.001). The median OS, CSS, and PFS for pUC-VT patients were 7 (95% confidential interval [CI] 3–20) months, 9 (95% CI 3–28) months, and 3 (95% CI 1–11) months, respectively. The pUC-VT patients had significantly higher risks for shorter OS (hazard ratio [HR] 2.120, p =0.008), CSS (HR 2.163, p =0.009), and PFS (HR 3.070, p <0.001) before 18 months. Conclusion Patients with pUC-VT face a higher risk of early death and recurrence, necessitating multimodal treatment strategies to improve prognosis.

Source: Asian journal of urology

DOI: 10.1016/j.ajur.2025.03.019