title: Independent predictors for bladder outcomes after treatment of intravesical recurrence following radical nephroureterectomy in patients with primary upper tract urothelial carcinoma.
abstract: BACKGROUND
  Few studies have described the clinical courses and outcomes in the bladder after treatment of intravesical recurrence after radical nephroureterectomy (RNU) in patients with primary upper tract urothelial carcinoma (UTUC). We investigated the indicators for predicting subsequent bladder outcomes after treatment of intravesical recurrence after RNU.
  
  
  METHODS
  A total of 241 patients with primary UTUC (pTa-4N0M0) who experienced intravesical recurrence after RNU were included. Of these patients, 101 (41.9 %) underwent Bacillus Calmette-Guérin treatments, whereas 49 (20.3 %) underwent intravesical chemotherapy. The median follow-up period after initial transurethral resection of the bladder tumor was 33 months. Relationships with bladder outcomes were analyzed by using multivariable analysis.
  
  
  RESULTS
  Ninety-six patients experienced intravesical recurrence, and bladder progression was observed in 13. Cumulative incidence rates of intravesical recurrence at 1 and 5 years after treatment of the first intravesical recurrence were 31.0 and 48.4 %, whereas those of bladder progression at 1 and 5 years thereafter were 2.4 and 8.0 %. Multivariate analysis showed that the number of recurrent tumors and pT1 tumors at the time of the first intravesical relapse were independent risk factors for subsequent intravesical recurrence. With respect to bladder progression, multivariate analysis showed that pT1 tumors, the appearance of concomitant carcinoma-in situ at the time of the first intravesical relapse, and the absence of the Bacillus Calmette-Guérin treatment were independent risk factors.
  
  
  CONCLUSIONS
  This retrospective study presents a detailed picture of further bladder outcomes after intravesical recurrence after RNU in primary UTUC patients. The results may assist physicians to develop a more rational protocol in bladder surveillance.
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Tanaka
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.forename: Kent
authors.initials: K
authors.lastname: Kanao
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Suguru
authors.initials: S
authors.lastname: Shirotake
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Miyazaki
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ide
authors.forename: Jun
authors.initials: J
authors.lastname: Obata
authors.forename: Katsura
authors.initials: K
authors.lastname: Hoshino
authors.forename: Nozomi
authors.initials: N
authors.lastname: Hayakawa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hagiwara
authors.forename: Takeo
authors.initials: T
authors.lastname: Kosaka
authors.forename: Masafumi
authors.initials: M
authors.lastname: Oyama
authors.forename: Akira
authors.initials: A
authors.lastname: Miyajima
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Momma
authors.forename: Ken
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Jinzaki
authors.forename: Shintaro
authors.initials: S
authors.lastname: Hasegawa
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Nakajima
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Oya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects / Q000401:mortality*; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*