title: Upper urinary tract recurrence after radical cystectomy for bladder cancer--who is at risk?
abstract: OBJECTIVE
  Patients who underwent radical cystectomy for bladder cancer are at risk for upper urinary tract recurrence. We identified subgroups of patients at increased risk for upper urinary tract recurrence.
  
  
  METHODS
  All 1,420 patients who underwent radical cystectomy for bladder cancer at our center between January 1986 and October 2008 were included in the study. Negative frozen sections of the ureteral margins were obtained from all patients. Data analysis included preoperative tumor history, pathological findings of the cystectomy specimen and complete followup. Survival was calculated using the Kaplan-Meier method.
  
  
  RESULTS
  Until October 2008, 25 cases of upper urinary tract recurrence were observed. The overall rate of upper urinary tract recurrence at 5, 10 and 15 years was 2.4%, 3.9% and 4.9%, respectively. Of the patients 3 had superficial tumors of the renal pelvis and 22 had invasive upper tract transitional cell carcinoma. Upper urinary tract recurrence did not develop in any patients with nontransitional cell carcinoma. Four risk factors for upper urinary tract recurrence were identified including history of carcinoma in situ (RR 2.3), history of recurrent bladder cancer (RR 2.6), cystectomy for nonmuscle invasive bladder cancer (RR 3.8) and tumor involvement of the distal ureter in the cystectomy specimen (RR 2.7). Patients with transitional cell carcinoma who had none of these risk factors had an upper urinary tract recurrence rate of only 0.8% at 15 years. This rate increased with the number of positive risk factors, ie 8.4% in patients with 1 to 2 risk factors and 13.5% in those with 3 to 4 risk factors.
  
  
  CONCLUSIONS
  Patients who underwent cystectomy for transitional cell carcinoma and with at least 1 risk factor for upper urinary tract recurrence should have closer followup regimens than those with nontransitional cell carcinoma or without any of these risk factors.
authors.affiliation: Department of Urology, University of Ulm, Ulm, Germany. bjoern.volkmer@klinikum-kassel.de
authors.forename: Bjoern G
authors.initials: BG
authors.lastname: Volkmer
authors.forename: Thomas
authors.initials: T
authors.lastname: Schnoeller
authors.forename: Rainer
authors.initials: R
authors.lastname: Kuefer
authors.forename: Kilian
authors.initials: K
authors.lastname: Gust
authors.forename: Florian
authors.initials: F
authors.lastname: Finter
authors.forename: Richard E
authors.initials: RE
authors.lastname: Hautmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology*; D007682:Kidney Pelvis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D012307:Risk Factors; D014516:Ureteral Neoplasms / Q000453:epidemiology*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D055815:Young Adult