Intravesical recurrence after surgical management of urothelial carcinoma of the upper urinary tract.
OBJECTIVE
To elucidate clinicopathological risk factors for intravesical recurrence (IVR) in patients undergoing nephroureterectomy for upper urinary tract urothelial carcinoma (UUT-UC).


METHODS
We identified a study population of 151 consecutive patients without previous or concurrent bladder cancer who underwent nephroureterectomy for UUT-UC. IVR was assessed in relation to tumor location, size, and multifocality, operation modality and time, stage, grade, lymphovascular invasion, regional lymph node metastasis, preoperative urinary cytology, and perioperative chemotherapy. The median follow-up time was 24 months.


RESULTS
Of 151 patients, 51 (34%) developed IVR after nephroureterectomy, and 50 (98%) of the patients presented with IVR within 2 years. Tumor multifocality and site (located in ureter) were determined as risk factors for IVR by univariate analysis. In a multivariate analysis, only tumor multifocality (relative risk: 4.024, p = 0.001) was an independent predictor of IVR. Ten-year cancer-specific survival rates for the patients with and without IVR were 68 and 52%, respectively (p = 0.06).


CONCLUSIONS
Tumor multifocality is a significant risk factor in developing IVR after surgery for UUT-UC. These results indicate that despite most IVR occurring within 2 years of treatment, it is necessary to follow such patients more closely using cystoscopy. However, IVR is unlikely to indicate a poorer prognosis.
Department of Urology, Nihon University School of Medicine, Tokyo, Japan. byd04561 @ nifty.com
Daisaku
D
Hirano
Yasuhiro
Y
Okada
Yusuke
Y
Nagane
Katsuhiko
K
Satoh
Junichi
J
Mochida
Yataroh
Y
Yamanaka
Hitoshi
H
Hirakata
Kenya
K
Yamaguchi
Nozomu
N
Kawata
Satoru
S
Takahashi
Akihiro
A
Henmi
D002277:Carcinoma / Q000556:secondary* / Q000601:surgery*; D016009:Chi-Square Distribution; D003558:Cystoscopy; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary; D009392:Nephrectomy / Q000009:adverse effects / Q000401:mortality; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000556:secondary*; D019459:Urothelium / Q000473:pathology / Q000601:surgery