title: Upper urinary tract recurrence after radical cystectomy for bladder cancer: incidence and risk factors.
abstract: OBJECTIVE
  To examine the incidence of and the risk factors for upper urinary tract recurrence in patients undergoing a radical cystectomy for bladder cancer, and to examine the clinical course of patients harboring upper urinary tract recurrence.
  
  
  METHODS
  This retrospective study included 362 patients who underwent radical cystectomy for bladder cancer. Patients with a history of upper urinary tract recurrence and concomitant upper urinary tract recurrence at cystectomy were excluded.
  
  
  RESULTS
  After a median follow up of 48 months (range 0-214) after radical cystectomy, 11 patients (3.0%) developed upper urinary tract recurrence. The median time to upper urinary tract recurrence was 48.4 months (range 11.6-78.6). The overall probability of upper urinary tract recurrence was 3.3% at 5 years. The median overall survival period after upper urinary tract recurrence was 23.5 months (range 4.3-53.9), with a better overall survival for patients who received a radical operation than for those who did not (38.6 months vs 11.9 months, respectively; P=0.03). At multivariable analysis, the presence of carcinoma in situ (P < 0.01) and invasion of the urethra (P = 0.02) were independent risk factors for upper urinary tract recurrence. The 5-year upper urinary tract recurrence was significantly higher for patients positive for either of these risk factors than for those without risk factors (12.0% vs 0.9%, respectively; P < 0.001).
  
  
  CONCLUSIONS
  This study shows that the presence of carcinoma in situ and cancer invading the urethra are risk factors for upper urinary tract recurrence. Close follow up is needed for early detection of upper urinary tract recurrence in patients at higher risk.
authors: Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors: Akio
authors: A
authors: Takayanagi
authors: Naoya
authors: N
authors: Masumori
authors: Atsushi
authors: A
authors: Takahashi
authors: Yoshio
authors: Y
authors: Takagi
authors: Taiji
authors: T
authors: Tsukamoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000150:complications* / Q000601:surgery; D015653:Cystectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000209:etiology / Q000556:secondary* / Q000628:therapy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014516:Ureteral Neoplasms / Q000209:etiology / Q000556:secondary* / Q000628:therapy; D014521:Urethra / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*