title: Vesical vs. extra-vesical patterns of recurrence after the treatment of urothelial upper tract tumors.
abstract: OBJECTIVE
  The objective of this study was to define recurrence patterns after nephro-ureterectomy (NU) for urothelial upper tract tumor (UUTT), and to suggest guidelines for follow-up.
  
  
  METHODS
  The effects of age, gender, UUTT grade, stage, size, location in the urinary system, and the administration of adjuvant chemotherapy on disease-free survival were assessed retrospectively.
  
  
  RESULTS
  Fifty-three patients (mean age 62.7 years) underwent NU for UUTT and were followed with periodic cystoscopy, urinary cytology, and CT of the chest and abdomen. During a median follow-up period of 72 months, 26 patients (49%) developed tumor recurrence. Almost 95% of the recurrences occurred within the first 48 months following surgery. Two distinct patterns of recurrence were identified: vesical and extra-vesical recurrences. Vesical recurrence occurred in 19 patients (35.8%) and did not impair survival. The risk of vesical recurrence was independent of UUTT grade or stage. Patients who had Grades 1 or 2 UUTT developed only low-grade vesical recurrence, while patients with Grade 3 UUTT developed either high- or low-grade vesical recurrences. Extra-vesical recurrence occurred in 8 patients (15.1%); all had an initial Grade 3 UUTT, and were associated with short median survival.
  
  
  CONCLUSIONS
  Patients presenting with Grades 1 or 2 UUTT are at risk of developing low-grade bladder tumors. Therefore, cystoscopic surveillance is recommended. Patients presenting with Grade 3 UUTT are at risk of developing both high- and low-grade bladder tumors as well as extra-vesical recurrence. An aggressive multimodality program including cystoscopy, urinary cytology, and CT of the chest and abdomen is advisable.
authors.affiliation: Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Sergey
authors.initials: S
authors.lastname: Shikanov
authors.forename: Amos
authors.initials: A
authors.lastname: Shapiro
authors.forename: Lea
authors.initials: L
authors.lastname: Baer
authors.forename: Ezekiel H
authors.initials: EH
authors.lastname: Landau
authors.forename: Ran
authors.initials: R
authors.lastname: Katz
authors.forename: Ofer N
authors.initials: ON
authors.lastname: Gofrit
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D014523:Urethral Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology*