title: Prognostic significance of non-muscle-invasive bladder tumor history in patients with upper urinary tract urothelial carcinoma.
abstract: OBJECTIVE
  To evaluate the prognostic factors for survival and disease recurrence in patients treated surgically for upper tract urothelial carcinoma (UTUC), focusing especially on the impact of history of non-muscle-invasive bladder cancer.
  
  
  METHODS
  A single-center series of 221 consecutive patients who were treated surgically for UTUC between January 1999 and December 2010 was evaluated. Patients who had a history of bladder tumor at a higher stage than the upper tract disease, preoperative chemotherapy, or previous contralateral UTUC were excluded. None of the patients included in this study had distant metastasis at diagnosis of UTUC. In total, 183 patients (mean age 66 years, range 36-88) were then available for evaluation. Tumor multifocality was defined as the synchronous presence of 2 or more pathologically confirmed tumors in any upper urinary tract location (renal pelvis or ureter). All patients were treated with either open radical nephroureterectomy (RNU) or open conservative surgery. Recurrence-free probabilities and cancer-specific survival were estimated using the Kaplan-Meier method and Cox regression analyses.
  
  
  RESULTS
  Fifty-one patients (28%) had previous carcinoma not invading bladder muscle. Previous history of non-muscle-invasive bladder cancer was significantly associated with tumor multifocality (P < 0.001), concomitant bladder cancer (P < 0.001), higher tumor stage (P = 0.020), and lymphovascular invasion (P = 0.026). Using univariate analyses, history of non-muscle-invasive bladder cancer was significantly associated with an increased risk of both any recurrence (HR = 2.17; P = 0.003) and bladder-only recurrence (HR = 3.17; P = 0.001). Previous carcinoma not invading bladder muscle (HR = 2.58; P = 0.042) was an independent predictor of bladder-only recurrence. Overall 5-year disease recurrence-free (any recurrence and bladder-only recurrence) survival rates were 66.7% and 77%, respectively. Previous history of non-muscle-invasive bladder cancer was not associated with cancer-specific survival. Our results are subject to the inherent biases associated with high-volume tertiary care centers.
  
  
  CONCLUSIONS
  Patients with previous history of non-muscle-invasive bladder cancer had a higher risk of having multifocal and UTUC with higher tumor stages (pT3 or greater). History of bladder tumor was an independent predictor of bladder cancer recurrence but had no effect on non-bladder recurrence, and cancer-specific survival in patients who underwent surgical treatment of UTUC.
authors.affiliation: Clinic of Urology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia. Electronic address: 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: Isidora
authors.initials: I
authors.lastname: Grozdic Milojevic
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Vuksanovic
authors.forename: Predrag
authors.initials: P
authors.lastname: Nikic
authors.forename: Ivan
authors.initials: I
authors.lastname: Vukovic
authors.forename: Dejan
authors.initials: D
authors.lastname: Djordjevic
authors.forename: Uros
authors.initials: U
authors.lastname: Bumbasirevic
authors.forename: Cane
authors.initials: C
authors.lastname: Tulic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009392:Nephrectomy; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D014513:Ureter / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery; D014551:Urinary Tract / Q000473:pathology* / Q000601:surgery; D014571:Urologic Neoplasms / Q000473:pathology* / Q000601:surgery