Impact of dialysis on intravesical recurrence and survival outcomes in upper tract urothelial cancer patients undergoing radical nephroureterectomy.

Background: Upper tract urothelial carcinoma (UTUC) presents a significant recurrence risk following radical nephroureterectomy (RNU). Patients on dialysis may experience unique clinical trajectories due to uremic states and altered immune responses.

Objective: To evaluate the impact of dialysis on intravesical recurrence and survival outcomes in patients with UTUC undergoing RNU, and to identify predictive factors influencing prognosis.

Methods: A retrospective cohort study analyzed 402 patients with non-metastatic UTUC treated with RNU between 2001 and 2014. Patients were stratified into dialysis (n = 66) and non-dialysis (n = 336) groups. Survival and recurrence outcomes were assessed using Kaplan-Meier and Cox regression analyses.

Results: Dialysis patients were predominantly female, younger, and exhibited less advanced pathological tumor stages. Dialysis was associated with higher intravesical recurrence rates (p = 0.009), which were largely attributable to a history of bladder cancer (42.4% vs. 26.5%; p = 0.009). After adjustment for bladder cancer history, dialysis was not an independent predictor of bladder recurrence-free survival (BRFS). Advanced pT stages (HR: 3.9, p = 0.012) and prior bladder cancer were the primary factors influencing BRFS.

Conclusions: Dialysis does not independently worsen surgical outcomes or BRFS in UTUC patients post-RNU when accounting for prior bladder cancer. Prognostic models should integrate these findings to enhance individualized surveillance and treatment strategies.