Zhong W, et al. - Researchers attempted to inspect the effect of aristolochic acids (AA) exposure, including exposure duration and years since last exposure, on the oncologic outcomes of patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). A link was brought to light between AA exposure with worse cancer-specific survival, a higher rate of intravesical recurrence (IVR) and contralateral UTUC recurrence of UTUC treated with RNU. The correlation between AA exposure and IVR was possibly time-dependent. It was determined that the exposure cessation >5 years prior to RNU could not mitigate the effect of AA on the UTUC prognosis.

Methods

• The clinicopathologic and AA exposure variables were extracted for 942 UTUC patients treated with RNU between 1999 and 2014, in a high-volume center of China.
• During this study, AA exposure duration was categorized as (>3 vs ≤3 years) and time since last AA exposure to surgery as (>5 vs ≤5 years).

Results

• None or possible AA exposure was repoted in 856 patients (90.9%) and 86 patients (9.1%) had credible AA exposure history.
• The findings disclosed that 57 (66.3%) had AA exposure for ≤3 years and 29 (33.7%) had exposure for >3 years, amongst 86 patients.
• The median follow-up duration was discovered to be 60 months.
• The multivariate analysis illustrated that AA exposure history was prominently related to cancer specific survival (hazard ratio [HR]: 0.43, p=0.02), intravesical recurrence (IVR) (HR: 2.25, p < 0.001) and contralateral UTUC recurrence (HR: 2.71, p=0.001).
• The exposure duration served as an independent risk factor for subsequent IVR (exposure duration ≤3 years vs none/possible AA, HR: 1.87, p=0.009; exposure duration >3 years vs none/possible AA, HR: 3.07, p < 0.001), but not for cancer-specific survival (p=0.06), after being adjusted for the effects of standard clinicopathologic characteristics.
• It was observed that among those patients who had AA exposure, those with exposure within 5 years prior to RNU did not vary from patients having last exposure >5 years ago, in terms of cancer specific mortality (p=0.67) and IVR (p=0.54).