title: Concomitant carcinoma in situ and tumour size are prognostic factors for bladder recurrence after nephroureterectomy for upper tract transitional cell carcinoma.
abstract: OBJECTIVE
  To identify prognostic risk factors for the development of subsequent bladder recurrence in patients undergoing nephroureterectomy (NU) for upper tract transitional cell carcinoma (TCC).
  
  
  METHODS
  The data of 79 patients who underwent NU for localized upper tract TCC were collected retrospectively, and analysed for clinical and pathological variables. Patients with previous invasive bladder tumours were excluded. Age, sex, tumour location, previous/synchronic bladder tumours, stage, grade, concomitant upper tract carcinoma in situ (CIS), and size were all analysed. Univariate and multivariate analyses were done using the Kaplan-Meier Method, with the log-rank test, and the Cox proportional hazards regression model, respectively.
  
  
  RESULTS
  The median follow-up was 71 months, during which bladder tumours were detected in 42 patients (54%). On univariate analyses, tumour stage ≥ pT2 (P = 0.015), concomitant upper tract CIS (P = 0.001), high-grade tumour G3 (P = 0.027) and tumour size > 4 cm (P = 0.011) were statistically significant predictors of intravesical recurrence. After multivariate analyses, concomitant CIS (P = 0.005, hazard ratio 2.9, 95% confidence interval 1.4-5.8) and tumour size > 4 cm (P = 0.042; 1.9, 1-3.7) were significantly related to bladder tumour recurrence.
  
  
  CONCLUSIONS
  There is a high bladder recurrence rate after NU for upper tract TCC. Patients with tumours of > 4 cm and concomitant upper tract CIS have a major risk of developing subsequent bladder recurrence. Therefore, closer surveillance of the bladder is needed in these patients and they may potentially benefit from prophylactic intravesical instillation therapy.
authors.affiliation: Department of Urology, Son Dureta University Hospital, Palma de Mallorca, Baleares Isles, Spain. 32477apa@comb.es
authors.forename: Enrique
authors.initials: E
authors.lastname: Pieras
authors.forename: Guillermo
authors.initials: G
authors.lastname: Frontera
authors.forename: Xavi
authors.initials: X
authors.lastname: Ruiz
authors.forename: Antoni
authors.initials: A
authors.lastname: Vicens
authors.forename: Mariano
authors.initials: M
authors.lastname: Ozonas
authors.forename: Pedro
authors.initials: P
authors.lastname: Pizá
mesh_terms: D000368:Aged; D002278:Carcinoma in Situ / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D016609:Neoplasms, Second Primary / Q000401:mortality* / Q000473:pathology; D009392:Nephrectomy / Q000379:methods; D011379:Prognosis; D047368:Tumor Burden; D014513:Ureter / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology; D014571:Urologic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery