title: Bladder cancer after nephroureterectomy in patients with urothelial carcinoma of the upper urinary tract.
abstract: OBJECTIVE
  To determine the independent risk factors of bladder recurrence in patients with upper urinary tract (UUT) urothelial carcinoma (UC).
  
  
  METHODS
  A total of 181 patients with UUT-UC were enrolled in this study. Their median age was 63 years (range 36-90), and median follow-up after total nephroureterectomy was 37.5 months (range 1.0-174.0). The end-point of this study was defined as the initial intravesical recurrence of UC.
  
  
  RESULTS
  Of the 181 patients, 64 (35.4%) developed subsequent bladder tumors at a median interval of 6.3 months (range 1.7-50.1) after initial treatment. By univariate analysis, a previous bladder tumor history (P = 0.046) and tumor necrosis (P < 0.001) were found to have a significant prognostic impact on bladder tumor-free survival in patients with superficial UUT-UC, whereas surgical margin status (P = 0.045) and the use of adjuvant chemotherapy (P = 0.003) were found to be prognostic factors for bladder tumor-free survival in those with invasive UUT-UC. However, by multivariate analysis, only tumor necrosis (P = 0.012, relative risk = 6.512) was found to have a significant impact on intravesical recurrence in patients with superficial UUT-UC. However, surgical margin status (P = 0.007, relative risk = 5.846) and the use of adjuvant chemotherapy (P = 0.001, relative risk = 0.223) were retained as independent predictors of bladder tumor survival in those with invasive UUT-UC.
  
  
  CONCLUSIONS
  Our findings may be useful in patients with UUT-UC who may require more stringent follow-up by cystoscopy to detect bladder tumors.
authors: Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
authors: Ja Hyeon
authors: JH
authors: Ku
authors: Woo Seok
authors: WS
authors: Choi
authors: Cheol
authors: C
authors: Kwak
authors: Hyeon Hoe
authors: HH
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data; D012307:Risk Factors; D013997:Time Factors; D014516:Ureteral Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000150:complications*; D014551:Urinary Tract / Q000187:drug effects / Q000473:pathology / Q000601:surgery