title: Influence of previous or synchronous bladder cancer on oncologic outcomes after radical nephroureterectomy for upper urinary tract urothelial carcinoma.
abstract: OBJECTIVE
  The objective of the study was to evaluate the effect of a history of bladder cancer (BC) or synchronous BC on the prognosis and survival of patients who have undergone radical nephroureterectomy (RNU).
  
  
  METHODS
  Using a multi-institutional, retrospective database, we identified 662 patients with upper urinary tract urothelial carcinoma (UUT-UC) treated by radical nephroureterectomy, between 1995 and 2010. We analyzed clinicopathologic characteristics and outcomes according to the history of BC or concomitant BC or both, at the time of diagnosis. BC was evaluated as a prognostic factor for bladder recurrence and survival.
  
  
  RESULTS
  Overall, 83 (12.5%) patients had previous BC, 62 (9.4%) exhibited concomitant BC, and 75 (11.3%) presented with both previous and current BC. A history of BC was less seen in women and nonsmokers (P<0.0001 and P = 0.013, respectively). The patients with associated BC had more tumors located in the ureter (P<0.0001), as well as more multiple locations in the upper tract (P<0.0001). The tumors without concomitant BC were more likely to be associated with locally advanced stages (P = 0.024). At a median follow-up time of 37.3 months, 31.4% of patients experienced BC recurrence and 2.9% developed contralateral upper tract tumor. Using multivariate analyses, the previous or synchronous BC (P = 0.01) and positive surgical margins (P = 0.03) are independent prognostic factors for BC recurrence. The metastasis-free survival and cancer-specific survival rates did not significantly differ according to the associated BC status.
  
  
  CONCLUSIONS
  In patients without previous or concomitant BC, the upper tract tumors are more frequently localized in the renal pelvis and are associated with a more invasive status at the time of diagnosis. Nevertheless, the presence of UUT-UC without previous or synchronous BC did not significantly affect the survival rates after nephroureterectomy.
authors: Academic Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Paris Descartes University Paris V, Paris, France. Electronic address: geraldine.pignot@bct.aphp.fr.
authors: Géraldine
authors: G
authors: Pignot
authors: Academic Department of Urology, CHRU Lille, University Lille Nord de France, Lille, France.
authors: Pierre
authors: P
authors: Colin
authors: Academic Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Paris Descartes University Paris V, Paris, France.
authors: Marc
authors: M
authors: Zerbib
authors: Academic Department of Urology, La Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France.
authors: François
authors: F
authors: Audenet
authors: Academic Department of Urology, CHRU Toulouse, University of Toulouse, Toulouse, France.
authors: Michel
authors: M
authors: Soulié
authors: Academic Department of Urology, CHU Caen, University of Caen, Caen, France.
authors: Sophie
authors: S
authors: Hurel
authors: Academic Department of Urology, CHRU Brest, University of Brest, Brest, France.
authors: Francky
authors: F
authors: Delage
authors: Academic Department of Urology, CHRU Poitiers, University of Poitiers, Poitiers, France.
authors: Jacques
authors: J
authors: Irani
authors: Academic Department of Urology, CHRU Limoges, University of Limoges, Limoges, France.
authors: Aurélien
authors: A
authors: Descazeaud
authors: Academic Department of Urology, CHRU Nimes, University of Nimes, Nimes, France.
authors: Stéphane
authors: S
authors: Droupy
authors: Department of Urology, Institut Mutualiste Montsouris, Paris, France.
authors: François
authors: F
authors: Rozet
authors: Academic Department of Urology, Academic Hospital of Foch, Suresnes, France.
authors: Véronique
authors: V
authors: Phé
authors: Academic Department of Urology, CHRU Lyon Sud, Claude Bernard Lyon 1 University, Lyon, France.
authors: Alain
authors: A
authors: Ruffion
authors: Academic Department of Urology, CHRU Grenoble, University of Grenoble, Grenoble, France.
authors: Jean-Alexandre
authors: JA
authors: Long
authors: Academic Department of Urology, Edouard Herriot Hospital, Claude Bernard Lyon 1 University, Lyon, France.
authors: Sebastien
authors: S
authors: Crouzet
authors: Department of Urology, Val de Grace Military Hospital, Paris, France.
authors: Alain
authors: A
authors: Houlgatte
authors: Academic Department of Urology, CHRU Angers, University of Angers, Angers, France.
authors: Pierre
authors: P
authors: Bigot
authors: Academic Department of Urology, CHRU Clermont Ferrand, University of Clermont Ferrand, Clermont Ferrand, France.
authors: Laurent
authors: L
authors: Guy
authors: Academic Department of Urology, CHU Marseille, University of Marseille, Marseille, France.
authors: Pierre-Olivier
authors: PO
authors: Faïs
authors: Academic Department of Urology, La Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France.
authors: Morgan
authors: M
authors: Rouprêt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery; D009378:Neoplasms, Multiple Primary / Q000401:mortality / Q000601:surgery; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*; D014571:Urologic Neoplasms / Q000401:mortality / Q000601:surgery*; D019459:Urothelium / Q000601:surgery
keywords: Bladder cancer; Prognostic factor; Recurrence; Survival; Upper urinary tract; Urothelial carcinoma