title: Independent prognostic factors for initial intravesical recurrence after laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma.
abstract: OBJECTIVE
  To elucidate clinicopathologic independent prognostic factors for intravesical recurrence after laparoscopic nephroureterectomy for primary upper urinary tract urothelial carcinoma (UUT-UC).
  
  
  METHODS
  This study included 212 consecutive patients clinically diagnosed as localized UUT-UC and treated by retroperitoneal laparoscopic nephroureterectomy between January 2002 and October 2010, after exclusion of those with a previous or concurrent history of bladder cancer. The clinicopathologic features, risk factors, and intravesical recurrence-free survival were analyzed using the Kaplan-Meier method. Univariate and multivariate analyses by Cox proportional hazards regression model was used to identify independent risk factors for intravesical tumor recurrence.
  
  
  RESULTS
  Of the patients, 64/212 (30.2%) developed subsequent intravesical recurrence during a median follow-up period of 39 months (range 7-78 months). Among them, 56/64 (87.5%) developed recurrent bladder cancer within 2 years after the surgery for UUT-UC, and the median interval between surgery and intravesical recurrence was 14 months (range 7-51 months). Multifocal tumors, renal insufficiency, and immunosuppression were determined as risk factors for intravesical recurrence by univariate analysis. However, by multivariate analyses, multifocality (hazard ratio = 2.060, P = 0.006) and immunosuppression (hazard ratio = 1.915, P = 0.037) were identified as independent predictors for the development of recurrent bladder cancer.
  
  
  CONCLUSIONS
  The incidence of intravesical recurrence after laparoscopic nephroureterectomy for UUT-UC is high, and most subsequent bladder cancers recur within 2 years after surgery. Tumor multifocality and immunosuppression are significant independent risk factors in developing initial intravesical recurrence after laparoscopic surgery for primary UUT-UC.
authors.affiliation: Urology Department, Peking University Third hospital, Haidian District, Beijing, China.
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Urology Department, Peking University Third hospital, Haidian District, Beijing, China. Electronic address: Quickmind365@yahoo.com.cn.
authors.forename: Jian
authors.initials: J
authors.lastname: Lu
authors.affiliation: Urology Department, Peking University Third hospital, Haidian District, Beijing, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Hong
authors.affiliation: Urology Department, Peking University Third hospital, Haidian District, Beijing, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Urology Department, Peking University Third hospital, Haidian District, Beijing, China.
authors.forename: Lulin
authors.initials: L
authors.lastname: Ma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009392:Nephrectomy / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D014513:Ureter / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Bladder cancer; Immunosuppression; Laparoscopic surgery; Recurrence; Transitional cell carcinoma