title: Preoperative positive urine cytology is a risk factor for subsequent development of bladder cancer after nephroureterectomy in patients with upper urinary tract urothelial carcinoma.
abstract: OBJECTIVE
  To determine the independent risk factors of bladder recurrence in patients with upper urinary tract urothelial carcinoma (UUT-UC).
  
  
  METHODS
  A total of 364 patients underwent nephroureterectomy (NUx) for UUT-UC between January 2005 and April 2009 in Okayama University and 17 affiliated hospitals. Patients with concomitant bladder cancer were excluded from the analysis. The clinicopathologic data for the remaining 288 patients with UUT-UC were retrospectively reviewed. Median follow-up after NUx was 20.2 months. The following variables were evaluated for any association with bladder recurrence: sex, age, tumor stage, tumor grade, venous invasion, lymphatic invasion, tumor location, multifocality, surgical modalities, time of ligation of the ureter, and preoperative urine cytology. The significance of each variable was tested univariately using the log-rank test. The simultaneous effects of multiple risk factors were estimated by multiple regression analysis using the Cox proportional hazards model.
  
  
  RESULTS
  Bladder recurrence occurred in 103 patients (35.8%). Median time to first bladder recurrence was 6.9 months. Significant risk factors for bladder recurrences on univariate analysis were tumor location (P = 0.046) and preoperative positive urine cytology (P < 0.001). Multivariate analysis revealed that preoperative urine cytology positive was significant for bladder recurrence (HR: 1.977; 95% CI: 1.310-2.983, P = 0.001).
  
  
  CONCLUSIONS
  Risk factor for subsequent development of bladder cancer after NUx was preoperative positive urine cytology.
authors.affiliation: Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan. kobayasu@md.okayma-u.ac.jp
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Saika
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Miyaji
authors.forename: Michinao
authors.initials: M
authors.lastname: Saegusa
authors.forename: Ryoji
authors.initials: R
authors.lastname: Arata
authors.forename: Naoki
authors.initials: N
authors.lastname: Akebi
authors.forename: Tadasu
authors.initials: T
authors.lastname: Takenaka
authors.forename: Daisuke
authors.initials: D
authors.lastname: Manabe
authors.forename: Yasutomo
authors.initials: Y
authors.lastname: Nasu
authors.forename: Hiromi
authors.initials: H
authors.lastname: Kumon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology / Q000601:surgery / Q000652:urine*; D003581:Cytodiagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery / Q000652:urine*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000652:urine*; D009392:Nephrectomy; D012189:Retrospective Studies; D012307:Risk Factors; D014513:Ureter / Q000473:pathology / Q000601:surgery; D014516:Ureteral Neoplasms / Q000473:pathology / Q000601:surgery / Q000652:urine*; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000652:urine*; D014556:Urine / Q000166:cytology*; D013520:Urologic Surgical Procedures; D019459:Urothelium / Q000473:pathology / Q000601:surgery