Upper urinary tract transitional cell carcinoma: is there a best?
BACKGROUND
This study aimed to determine the prognostic and risk factors for bladder and systemic recurrence after nephroureterectomy (NU) in patients with upper urinary tract (UUT) transitional cell carcinoma (TCC).


METHODS
Data from 101 patients with nonmetastatic UUT TCC who underwent NU between 1987 and 2009 were retrospectively evaluated. Kaplan-Meier curves for sex, age, anemia, smoking, stone disease, or history of bladder tumor, primary tumor localization, multiplicity, and disease stage and grade were constructed to predict 5-year recurrence-free survival (RFS). Multivariate Cox regression analysis was used to identify independent risk factors for recurrence.


RESULTS
Bladder, distant, and local recurrence rates at a mean of 56.19 ± 5.30 months after NU were 38.5%, 19.8%, and 7.9%, respectively. Univariate analysis showed that among the patients with bladder recurrence, female patients had significantly lower 5-year RFS than did male patients (34.7% ± 0.13% vs. 62.4% ± 0.06%, P = .038); however multivariate analysis showed that both female sex and a history of smoking were independent risk factors for bladder recurrence (odds ratio [OR], 4.22; 95% confidence interval [CI], 1.56-11.4; P = 0.005 and OR, 2.84; 95% CI, 1.1-7.4; P = .032, respectively). Univariate analysis showed that among the patients with local and distant recurrence, anemia, a positive history of bladder tumor, localization of the primary tumor, multiplicity, disease stage, and tumor grade significantly affected RFS, whereas primary tumor stage and grade were the only independent risk factors for 5-year RFS (OR, 4.48; 95% CI, 1.45-13.79; P = .009 and OR, 5.82; 95% CI, 2.08-16.26; P = .001, respectively).


CONCLUSIONS
Female sex and a history of smoking were independent risk factors for bladder recurrence after NU. Such patients should be monitored closely using cystoscopy and urine cytologic examination. Invasive and higher grade UUT TCC was associated with worse local or systemic RFS.
Mersin Ozel Sistem Cerrahi Tip Merkezi, Mersin, Turkey. mertgunay@yahoo.com
Levent Mert
LM
Gunay
Bulent
B
Akdogan
Artan
A
Koni
Kubilay
K
Inci
Cenk Yucel
CY
Bilen
Haluk
H
Ozen
D002295:Carcinoma, Transitional Cell / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000517:prevention & control*; D009392:Nephrectomy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D014513:Ureter / Q000601:surgery; D014571:Urologic Neoplasms / Q000209:etiology / Q000401:mortality / Q000628:therapy*