title: Bladder tumour development after urothelial carcinoma of the upper urinary tract is related to primary tumour location.
abstract: OBJECTIVE
  To better define the predictors of bladder tumour development in patients operated for upper urinary tract urothelial cancer (UT-UC).
  
  
  METHODS
  Surgical specimens from 191 consecutive patients with no history of bladder cancer and operated for UT-UC were chosen for analysis. Bladder tumour development was assessed in relation to UT-UC location, tumour multiplicity, stage and grade, margin status, mode of operation, age and gender.
  
  
  RESULTS
  Overall, 51 of 191 (27%) patients developed subsequent bladder tumours, including 25 of 123 (20%) with pelvic, 19 of 47 (40%) with ureteric and seven of 21 (33%) with multifocal tumours (P = 0.04 for all subgroups; P = 0.01 for pelvic vs ureteric). There was no influence of the other variables. The median (mean, range) time to recurrence was 12 (18, 3-64) months. In a multivariate analysis, ureteric tumour location was an independent predictor (P = 0.02; risk ratio, RR, 2.0, 95% confidence interval, CI, 1.1-3.7). After excluding 68 patients with systemic disease progression, bladder tumour development was noted in 39 of 123 (32%), including 18 of 76 (24%) with pelvic, 16 of 34 (47%) with ureteric and five of 13 with multifocal tumours (P = 0.06 for all subgroups; P = 0.02 for pelvic vs ureteric). In a multivariate analysis, ureteric location (P = 0.03; RR 2.1, 95% CI 1.1-4.2) and high tumour grade (P = 0.04; RR 2.2, 95% CI 1.03-4.7) were independent predictors of subsequent bladder tumour development.
  
  
  CONCLUSIONS
  The risk of developing a bladder tumour after surgery for UT-UC is significantly related to ureteric tumour location and high tumour grade. Clinical trials to evaluate a possible reduction of bladder cancer risk by intraoperative ureteric ligation and/or peri-operative topical intravesical chemotherapy instillation are justified.
authors.affiliation: Department of Surgery, Research Unit for Biomedical Engineering & Computing, Medical University Graz, Auenbruggerplatz 25, A-8036 Graz, Austria.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Zigeuner
authors.forename: Georg
authors.initials: G
authors.lastname: Hutterer
authors.forename: Thomas
authors.initials: T
authors.lastname: Chromecki
authors.forename: Peter
authors.initials: P
authors.lastname: Rehak
authors.forename: Cord
authors.initials: C
authors.lastname: Langner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D007682:Kidney Pelvis / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014516:Ureteral Neoplasms / Q000473:pathology* / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000209:etiology*; D019459:Urothelium / Q000473:pathology