title: Muscle-invasive bladder cancer developing after nephroureterectomy for upper urinary tract urothelial carcinoma.
abstract: OBJECTIVE
  To evaluate the risk factors and prognosis of muscle-invasive bladder cancer (MIBC) developing after nephroureterectomy for upper urinary tract urothelial cell carcinoma (UUT-UC).
  
  
  METHODS
  We reviewed the medical records of 422 patients who underwent nephroureterectomy for UUT-UC between 1990 and 2010, and identified 173 (40.9%) with intravesical recurrence and 28 (6.6%) with MIBC. We evaluated the clinicopathologic features, risk factors, and cancer-specific survival (CSS) using the Kaplan-Meier method and the Cox proportional hazards regression models.
  
  
  RESULTS
  The median intervals from nephroureterectomy to intravesical recurrence and the development of MIBC were 8 and 17 months, respectively. On multivariate analysis, the pathologic stage (≥ pT3 vs. Ta/T1, HR 5.03, P = 0.001) and ureteral tumor location (HR 2.79, P = 0.011) were independent risk factors for the development of MIBC, whereas a history of previous or concomitant bladder tumor was the only significant risk factor for intravesical recurrence. The probability of developing MIBC 5 years after nephroureterectomy was 12.6% in patients with 1 risk factor and 20.6% in patients with both risk factors. Patients with MIBC had significantly worse CSS than those without MIBC (P = 0.004), whereas CSS rates were similar in patients with and without intravesical recurrence (P = 0.593). However, stratification analysis for matching pathology revealed that CSS rates were not significantly different in patients with pT2 or higher stage of UUT-UC.
  
  
  CONCLUSIONS
  Approximately 5% of the patients developed MIBC after nephroureterectomy with a median interval of 17 months. Patients with advanced pathologic stage (≥ pT3) and a ureteral tumor location are at increased risk of developing MIBC after nephroureterectomy.
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
authors.forename: Kwang Hyun
authors.initials: KH
authors.lastname: Kim
authors.forename: Dalsan
authors.initials: D
authors.lastname: You
authors.forename: In Gab
authors.initials: IG
authors.lastname: Jeong
authors.forename: Jun Hyuk
authors.initials: JH
authors.lastname: Hong
authors.forename: Hanjong
authors.initials: H
authors.lastname: Ahn
authors.forename: Choung-Soo
authors.initials: CS
authors.lastname: Kim
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009132:Muscles / Q000473:pathology; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods; 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 / Q000209:etiology / Q000473:pathology*; D014551:Urinary Tract / Q000473:pathology* / Q000601:surgery; D014571:Urologic Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery