title: Bladder recurrence after radical nephroureterectomy: predictors and impact on oncological outcomes.
abstract: OBJECTIVE
  To identify predictive factors of bladder recurrence after radical nephroureterectomy and to evaluate the impact of this event on oncological outcomes.
  
  
  METHODS
  We carried out a retrospective analysis of 237 patients treated with radical nephroureterectomy for urothelial carcinoma of the upper tract at our institution from 1998 to 2011. Univariable and multivariable models evaluated the prognostic factors of bladder recurrence, and its impact on recurrence-free survival and cancer-specific survival.
  
  
  RESULTS
  The median age was 69.3 years (interquartile range 60-76). With a median follow up of 44 months (interquartile range 24-79), bladder recurrence occurred in 85 patients (35.9%). A previous history of bladder cancer (P = 0.01) and the presence of concomitant carcinoma in situ (P = 0.005) remained independent predictors of bladder recurrence. The presence of bladder recurrence was not correlated with worse oncological outcomes in terms of disease recurrence (P = 0.075) and cancer-specific mortality (P = 0.06). However, the patients who experienced muscle-invasive bladder cancer recurrence had worse outcomes in terms of cancer-specific mortality (P = 0.01). Standard pathological features of aggressiveness, such as higher tumor stage (P = 0.05), higher grade (P = 0.01) and carcinoma in situ (P = 0.03), were independent predictors of muscle-invasive bladder cancer recurrence.
  
  
  CONCLUSIONS
  Previous history of bladder cancer, tumor location and concomitant carcinoma in situ are independent predictors of bladder recurrence in patients undergoing radical nephroureterectomy. Bladder recurrence overall does not impact the oncological outcomes, but a muscle-invasive bladder recurrence is associated with a worse cancer-specific mortality. Standard pathological features of urothelial carcinoma of the upper tract aggressiveness (pT-stage, grade) are independent predictors of muscle-invasive bladder cancer recurrence.
authors.affiliation: Department of Urology and Pathology, Cochin Hospital, APHP, Paris Descartes University, Paris, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Elalouf
authors.forename: Evanguelos
authors.initials: E
authors.lastname: Xylinas
authors.forename: Julia
authors.initials: J
authors.lastname: Klap
authors.forename: Géraldine
authors.initials: G
authors.lastname: Pignot
authors.forename: Nicolas Barry
authors.initials: NB
authors.lastname: Delongchamps
authors.forename: Djilali
authors.initials: D
authors.lastname: Saighi
authors.forename: Michael
authors.initials: M
authors.lastname: Peyromaure
authors.forename: Thierry
authors.initials: T
authors.lastname: Flam
authors.forename: Marc
authors.initials: M
authors.lastname: Zerbib
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000473:pathology*; D014571:Urologic Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery
keywords: bladder recurrence; radical nephroureterectomy; survival; upper tract urothelial carcinoma