title: Independent predictors of metachronous bladder transitional cell carcinoma (TCC) after nephroureterectomy for TCC of the upper urinary tract.
abstract: OBJECTIVE
  To identify the prognostic factors predictive of metachronous bladder transitional cell carcinoma (TCC) in a multi-institutional dataset of patients who had undergone nephroureterectomy (NU) for nonmetastatic upper urinary tract (UUT) TCC.
  
  
  METHODS
  The clinical and pathological data of 231 patients who had had NU for UUT-TCC from 1989 to 2005 in three European centres were collected retrospectively, and analysed for clinical and pathological variables.
  
  
  RESULTS
  The median follow-up was 38 months; during the follow-up, bladder TCC was detected in 109 patients (47.2%), and was significantly more common in patients who had UUT-TCC after previous bladder TCC (P < 0.001), in those with ureteric cancer (P = 0.022), and in those with pT2 UUT-TCC (P = 0.017). On multivariate analysis, a previous history of bladder TCC was the only independent predictor of metachronous bladder TCC (hazard ratio 2.825; P < 0.001). The 5-year probability of being free from metachronous bladder TCC was 45.5%. A history of bladder TCC (P < 0.001) and UUT tumour site (P = 0.01) were significantly associated with the probability of bladder recurrence-free survival. On multivariate analyses, a previous history of bladder TCC (hazard ratio 2.226; P < 0.001) and the presence of ureteric TCC (1.562; P = 0.036) were independent predictors of the probabilities of being free from metachronous bladder TCC.
  
  
  CONCLUSIONS
  In this multi-institutional study of patients who had had NU for UUT-TCC, a history of bladder TCC was the only independent predictor of metachronous bladder TCC, while both a history of bladder TCC and the presence of ureteric tumours were predictive of the probabilities of being free from metachronous bladder TCC.
authors.affiliation: IRCCS Istituto Oncologico Veneto (IOV), Padua, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: Vincenzo
authors.initials: V
authors.lastname: De Marco
authors.forename: Orietta
authors.initials: O
authors.lastname: Dalpiaz
authors.forename: Fedra
authors.initials: F
authors.lastname: Gottardo
authors.forename: Vianney
authors.initials: V
authors.lastname: Bouygues
authors.forename: Antonio
authors.initials: A
authors.lastname: Galfano
authors.forename: Guido
authors.initials: G
authors.lastname: Martignoni
authors.forename: Jean Jacques
authors.initials: JJ
authors.lastname: Patard
authors.forename: Walter
authors.initials: W
authors.lastname: Artibani
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016609:Neoplasms, Second Primary / Q000175:diagnosis*; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000601:surgery; D014571:Urologic Neoplasms