Intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinomas: predictors and impact on subsequent oncological outcomes from a national multicenter study.
OBJECTIVE
To identify predictive factors and assess the impact on oncological outcomes of intravesical recurrence after radical nephroureterectomy (RNU) in upper tract urothelial carcinoma (UTUC).


METHODS
Using a national multicentric retrospective dataset, we identified all patients with UTUC who underwent a RNU between 1995 and 2010 (n = 482). Intravesical recurrence was tested as a prognostic factor for survival through univariable and multivariable Cox regression analysis.


RESULTS
Overall, intravesical recurrence occurred in 169 patients (35 %) with a median age of 69.2 years (IQR: 60-76) and after a median follow-up of 39.5 months (IQR: 25-60). Actuarial intravesical recurrence-free survival estimates at 2 and 5 years after RNU were 72 and 45 %, respectively. On univariable analyses, previous history of bladder tumor, tumor multifocality, laparoscopic approach, pathological T-stage, presence of concomitant CIS and lymphovascular invasion were all associated with intravesical recurrence. On multivariable analysis, previous history of bladder cancer, tumor multifocality and laparoscopic approach remained independent predictors of intravesical recurrence. Existence of intravesical recurrence was not correlated with worst oncological outcomes in terms of disease recurrence (p = 0.075) and cancer-specific mortality (p = 0.06).


CONCLUSIONS
In the current study, intravesical recurrence occurred in 35 % of patients with UTUC after RNU. Previous history of bladder cancer, tumor multifocality, concomitant CIS and laparoscopic approach were independent predictors of intravesical recurrence. These findings are in line with recent published data and should be considered carefully to provide a definitive surveillance protocol regarding management of urothelial carcinomas regardless of the location of urothelial carcinomas in the whole urinary tract.
Department of Urology and Pathology, Cochin Hospital, APHP, Paris Descartes University, Paris, France. evanguelosxylinas@hotmail.com
Evanguelos
E
Xylinas
Pierre
P
Colin
François
F
Audenet
Véronique
V
Phe
Luc
L
Cormier
Olivier
O
Cussenot
Alain
A
Houlgatte
Gilles
G
Karsenty
Franck
F
Bruyère
Thomas
T
Polguer
Alain
A
Ruffion
Antoine
A
Valeri
François
F
Rozet
Jean-Alexandre
JA
Long
Marc
M
Zerbib
Morgan
M
Rouprêt
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000556:secondary* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D007682:Kidney Pelvis; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000601:surgery; D009392:Nephrectomy / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D014513:Ureter / Q000601:surgery; D014516:Ureteral Neoplasms / Q000473:pathology* / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000556:secondary*