title: Bladder cancer after managing upper urinary tract transitional cell carcinoma: risk factors and survival.
abstract: OBJECTIVE
  To identify independent risk factors for the development of bladder cancer after surgical management of upper urinary tract transitional cell carcinoma (UUT-TCC).
  
  
  METHODS
  Between January 1999 and December 2008, 154 patients were treated surgically for UUT-TCC at the Clinic of Urology, Clinical Center of Serbia. Patients with a previous history of bladder cancer and patients with concomitant bladder cancer were excluded from the study. In all, 92 patients were then available for evaluation. The median follow-up after surgery was 39.5 months. Univariate and multivariate analyses using the logistic regression model were performed. The intravesical disease-free rate and survival were calculated using the Kaplan-Meier method, and the log-rank test was used to determine statistical differences.
  
  
  CONCLUSIONS
  In this study, 21.7% patients treated for UUT-TCC developed subsequent bladder tumors. Tumor multifocality was the only independent predictor associated with the development of subsequent bladder cancer (P = 0.028, RR = 3.52). Intravesical recurrence-free survival rates for these 92 patients at 1, 3, 5, and 7 years were 85.8, 80, 79.3, and 78.3%, respectively. Patients with tumors extending to multiple sites were significantly more likely to present subsequent intravesical recurrence (P = 0.006). The development of bladder cancer had no significant effect on the survival of patients who underwent surgical treatment of UUT-TCC, compared to patients without bladder cancer development (P = 0.660). Neither did the type of surgery mode affect patient survival (P = 0.245). This study is limited by biases associated with its retrospective design.
  
  
  CONCLUSIONS
  The multiplicity of the UUT-TCC is an independent risk factor for the occurrence of bladder cancer.
authors.affiliation: Clinic of Urology, Clinical Center of Serbia, School of Medicine, Belgrade University, Belgrade, Serbia. em2bogomir@yahoo.com
authors.forename: Bogomir
authors.initials: B
authors.lastname: Milojevic
authors.forename: Milan
authors.initials: M
authors.lastname: Djokic
authors.forename: Sandra
authors.initials: S
authors.lastname: Sipetic-Grujicic
authors.forename: Dragica
authors.initials: D
authors.lastname: Milenkovic-Petronic
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Vuksanovic
authors.forename: Dejan
authors.initials: D
authors.lastname: Dragicevic
authors.forename: Uros
authors.initials: U
authors.lastname: Bumbasirevic
authors.forename: Cane
authors.initials: C
authors.lastname: Tulic
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D055771:Serbia; D014516:Ureteral Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis*
chemical_list: D000970:Antineoplastic Agents