title: A retrospective analysis of incidence and its associated risk factors of upper urinary tract recurrence following radical cystectomy for bladder cancer with transitional cell carcinoma: the significance of local pelvic recurrence and positive lymph node.
abstract: OBJECTIVE
  The aim of this study is to examine the incidence and risk factors of upper urinary tract recurrence (UUTR) following radical cystectomy (RC) in bladder cancer and to evaluate its relationship with neobladder (Neo) or ileal conduit (IC).
  
  
  METHODS
  All clinicopathologic parameters and perioperative parameters of 311 patients who underwent RC with either Neo or IC by a single surgeon from 1999 to 2012 were retrospectively included in this study. Patients with a history of renal surgery, concomitant UUTR, or a histopathology of non-transitional cell carcinoma were excluded. For statistical analyses of predictive risk factors of UUTR, a multivariate analysis was performed with known risk factors of UUTR, including type of urinary diversion with significance defined as P < 0.05.
  
  
  RESULTS
  During the median follow-up period of 53 months, 143 (46.0%) IC and 168 (54.0%) Neo were performed, resulting in 11 (3.5%) cases of UUTR (Neo 7 and IC 4) after RC and all patients then underwent nephroureterectomy. No significant differences in incidence and overall survival in UUTR were observed according different types of urinary diversion (p = 483), and the prognosis for survival of Neo was insignificantly better than that of IC (5-year overall survival 78% vs 74%, respectively, p>0.05). Higher number of positive lymph nodes (HR 9.03) and the presence of pelvic local recurrence (HR 7286.08) were significant predictive factors of UUTR (p<0.05).
  
  
  CONCLUSIONS
  This study reports a UUTR rate of 3.5%, and positive lymph nodes and presence of local recurrence at the pelvis as important risk factors. No significant differences in incidence and survival were observed between Neo and IC.
authors.affiliation: Department of Urology, National Cancer Center, Goyang, Gyanggi, Korea.
authors.forename: Sung Han
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Epidemiology and Statistics and Cancer Policy Branch of the National Cancer Control Research Institute, National Cancer Center, Goyang, Gyanggi, Korea.
authors.forename: Hyung-Kook
authors.initials: HK
authors.lastname: Yang
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Seoul, Korea.
authors.forename: Jung Hoon
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Seoul, Korea.
authors.forename: Eun-Sik
authors.initials: ES
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000601:surgery; D015653:Cystectomy; D005260:Female; D006801:Humans; D015994:Incidence; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010386:Pelvic Neoplasms / Q000556:secondary*; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery; D014571:Urologic Neoplasms / Q000556:secondary*