Mehmet Gurkan ARIKAN, İsmail Önder YILMAZ
Çukurova Anestezi ve Cerrahi Bilimler Dergisi - 2026;9(3):861-869
Aim: To evaluate clinicopathological factors and perioperative complications associated with intravesical recurrence-free survival (IVR-FS) and overall survival (OS) after radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC). Materials and Methods: We retrospectively analyzed 99 patients who underwent RNU for UTUC at Çukurova University between 2005 and 2024. Survival outcomes were evaluated using Kaplan-Meier and log-rank analyses, with exploratory multivariable Cox regression for OS. Results: The mean age was 64.6+/-10.3 years, and 80.8% of patients were male. During a mean follow-up of 54.8+/-49.5 months, intravesical recurrence occurred in 31 patients (31.3%), with a median time to recurrence of 11 months. Higher pathological T stage (p=0.047) and postoperative complications (p<0.001) were associated with worse IVR-FS. Overall, 64 patients (64.6%) died. In the exploratory multivariable analysis, pathological stage >=pT3 (HR: 2.18, p=0.009), positive surgical margins (HR: 2.41, p=0.020), and postoperative complications (HR: 1.89, p=0.031) were independently associated with worse OS. Conclusion: Intravesical recurrence affected approximately one-third of patients, typically within the first year after RNU. Advanced pathological stage, positive surgical margins, and postoperative complications were independently associated with worse OS in the exploratory model. IVR-FS findings remain univariable and require cautious interpretation because death is a substantial competing event, particularly in advanced disease. These findings support close cystoscopic surveillance and require prospective validation.
