Elsevier

Urology

Volume 71, Issue 1, January 2008, Pages 123-127
Urology

Oncology
Risk Factors for Intravesical Recurrence After Surgical Management of Transitional Cell Carcinoma of the Upper Urinary Tract

https://doi.org/10.1016/j.urology.2007.08.054Get rights and content

Objectives

To identify risk factors for developing subsequent bladder cancer in patients undergoing surgical management of transitional cell carcinoma (TCC) of the upper urinary tract.

Methods

This study included 177 patients who were diagnosed as having clinically localized upper urinary tract TCC and thereafter underwent nephroureterectomy after exclusion of those with a previous and/or concurrent history of bladder cancer. Univariate and multivariate analyses using both the logistic regression model and the Cox proportional hazards model were carried out in these 177 patients to determine the risk factors for intravesical recurrence after nephroureterectomy.

Results

Of the 177 patients, 63 (35.6%) developed recurrent bladder cancer after a median interval of 7.5 months. Intravesical recurrence-free survival rates for these 177 patients at 1, 3, and 5 years were 75.7%, 63.7%, and 54.1%, respectively. Univariate analyses showed that patients with low-stage tumors and those with multifocal tumors were likely to undergo subsequent intravesical recurrence; however, there was no significant impact of other factors on subsequent intravesical recurrence, including age, tumor side, tumor location, surgical modality, operation time, management of the distal ureter, tumor grade, lymph node metastasis, microvascular invasion, lymphatic invasion, and margin status. Furthermore, pathologic stage and tumor multifocality were identified as independent predictors for the development of recurrent bladder cancer by multivariate analyses.

Conclusions

The incidence of intravesical recurrence after nephroureterectomy for upper urinary tract TCC is comparatively high. It could be important to perform careful follow-up targeting intravesical recurrence for such patients after nephroureterectomy, particularly those with low-stage tumors and/or multifocal tumors.

Section snippets

Material and Methods

A total of 240 patients who were diagnosed as having clinically localized TCC of the upper urinary tract without any suspicious lesions suggesting the presence of metastatic diseases underwent nephroureterectomy at Kobe University Hospital or related hospitals between January 2000 and December 2005. After the exclusion of 63 patients with a history of previous bladder cancer and/or with concurrent bladder cancer, the remaining 177 were included in this study. Of these 177, 111 and 66 underwent

Results

Of the 177 patients included in this study 63 (35.6%) developed recurrent bladder cancer, and the median time to intravesical recurrence after surgery was 7.5 months (range, 2.0 to 51.0 months). Table 1 presents the comparison of clinicopathologic characteristics between patients with and without subsequent intravesical recurrence. The incidence of tumors extending to multiple sites in patients with intravesical recurrence was significantly greater than that in those without intravesical

Comment

The incidence of subsequent bladder cancer after surgical management for upper urinary tract cancer has been shown to be approximately 15% to 50%.1, 2, 3, 4, 5 To date, several studies have identified possible risk factors for subsequent intravesical recurrence after nephrourterectomy2, 3, 4, 5, 6, 7, 8; however, the previously reported risk factors include numerous variables, such as patient age,2 tumor multifocality,2, 5, 7 tumor size,2, 4 pathologic stage,7, 4 tumor grade,3, 8 tumor location,

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