Should patients with primary upper urinary tract cancer receive prophylactic intravesical chemotherapy after nephroureterectomy?
OBJECTIVE
We assessed the efficacy of prophylactic intravesical chemotherapy for primary upper urinary tract urothelial cancer after nephroureterectomy during long-term followup.


METHODS
From January 1985 to June 2007, 196 patients with primary upper urinary tract urothelial cancer were included in this study. Patients were divided into group 1-31 who received intravesical epirubicin instillation, group 2-27 who received intravesical mitomycin C instillation and group 3-138 who did not receive prophylactic instillation after nephroureterectomy. We compared the bladder tumor recurrence rate, number of recurrence episodes, time to first bladder tumor recurrence, tumor type, percent of patients with cystectomy and percent who died of urothelial cancer, and the recurrence-free survival rate.


RESULTS
Of the 196 patients 73 had subsequent bladder recurrence at a mean followup of 55.6 months. There were no significant differences in recurrence type, mean number of bladder tumor recurrences, percent of patients with cystectomy and the cancer specific survival rate. The bladder recurrence rate was lower in group 1 and 2 than in group 3. Mean time to first bladder tumor recurrence was longer in groups 1 and 2. Kaplan-Meier curves of recurrence-free survival rates were significantly increased in groups 1 and 2.


CONCLUSIONS
Intravesical instillation of epirubicin or mitomycin C appears to be well tolerated and effective for preventing bladder recurrence and prolonging time to first bladder recurrence. Patients should receive prophylactic intravesical chemotherapy after nephroureterectomy.
Wu
Wen-Jeng
WJ
Department of Urology, Kaohsiung Medical University, Kaohsiung, Taiwan.
Ke
Hung-Lung
HL
Yang
Yi-Hsin
YH
Li
Ching-Chia
CC
Chou
Yii-Her
YH
Huang
Chun-Hsiung
CH
D000283:Administration, Intravesical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D002295:Carcinoma, Transitional Cell / Q000517:prevention & control* / Q000601:surgery*; D003131:Combined Modality Therapy; D015251:Epirubicin / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000517:prevention & control* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009392:Nephrectomy; D011182:Postoperative Care; D012189:Retrospective Studies; D013997:Time Factors; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000517:prevention & control* / Q000601:surgery*; D055815:Young Adult
D000903:Antibiotics, Antineoplastic; D015251:Epirubicin; D016685:Mitomycin