title: Risk factors for bladder cancer recurrence after nephroureterectomy for upper tract urothelial tumors: results from the Canadian Upper Tract Collaboration.
abstract: OBJECTIVE
  To evaluate risk factors for bladder cancer recurrence in a cohort of patients treated with radical nephroureterectomy (RNU).
  
  
  METHODS
  At 10 Canadian University Centers, we retrospectively evaluated data, between 1990 and 2010, from 743 patients who were free from bladder cancer and were previously treated with RNU for upper tract urothelial cancer.
  
  
  RESULTS
  Of 743 patients, 167 (22.5%) developed bladder tumors after a median time of 17.2 months after RNU. Multivariable analysis detected age (hazard ratio [HR] = 1.028; 95% CI: 1.010-1.046; P = 0.0018), tumor location in both the renal pelvis and the ureter (HR = 2.205; 95% CI: 1.355-3.589; P = 0.0015), the use of adjuvant systemic chemotherapy (HR = 2.309; 95% CI: 1.439-3.705; P = 0.0005), and laparoscopic surgery (HR = 1.876; 95% CI: 1.226-2.87; P = 0.0037) as risk factors for bladder cancer recurrence. Open excision of a bladder cuff (HR = 0.661; 95% CI: 0.453-0.965; P = 0.0319) and transurethral resection of the intramural ureter (HR = 0.548; 95% CI: 0.306-0.981; P = 0.0429) on comparison with extravesical resection decreased the risk of bladder cancer recurrence significantly. Major limitations were the retrospective design and partially missing data, although the significance of variables did not change in the imputation analysis.
  
  
  CONCLUSIONS
  Older patients, those with tumor location in both the renal pelvis and the ureter, and those treated with adjuvant systemic chemotherapy were found at higher risk for intravesical recurrence, as were those having undergone extravesical ureterectomy or laparoscopic RNU.
authors.affiliation: Department of Surgery (Urology), Laval University, Quebec City, Quebec, Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: Fradet
authors.affiliation: Department of Surgery (Urology), Laval University, Quebec City, Quebec, Canada; Department of Urology, Hietzing Hospital, Vienna, Austria.
authors.forename: Julian
authors.initials: J
authors.lastname: Mauermann
authors.affiliation: Department of Surgery (Urology), McGill University, Montreal, Quebec, Canada.
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.affiliation: Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Rendon
authors.affiliation: Department of Surgery (Urology), University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Niels
authors.initials: N
authors.lastname: Jacobsen
authors.affiliation: Department of Surgery (Urology), University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Adrian
authors.initials: A
authors.lastname: Fairey
authors.affiliation: Division of Urologic Surgery, University of Western Ontario, London, Ontario, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Izawa
authors.affiliation: Division of Urology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Anil
authors.initials: A
authors.lastname: Kapoor
authors.affiliation: Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Black
authors.affiliation: Department of Surgery (Urology), McGill University, Montreal, Quebec, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Tanguay
authors.affiliation: Division of Urologic Surgery, University of Western Ontario, London, Ontario, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Chin
authors.affiliation: Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: So
authors.affiliation: Department of Surgery (Urology), University of Montreal, Montreal, Quebec, Canada.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Lattouf
authors.affiliation: Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Bell
authors.affiliation: Department of Surgery (Urology), University of Montreal, Montreal, Quebec, Canada.
authors.forename: Fred
authors.initials: F
authors.lastname: Saad
authors.affiliation: Division of Urology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Bobby
authors.initials: B
authors.lastname: Sheyegan
authors.affiliation: Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Darren
authors.initials: D
authors.lastname: Drachenberg
authors.affiliation: Division of Urology, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Ilias
authors.initials: I
authors.lastname: Cagiannos
authors.affiliation: Department of Surgery (Urology), Laval University, Quebec City, Quebec, Canada. Electronic address: louis.lacombe@crhdq.ulaval.ca.
authors.forename: Louis
authors.initials: L
authors.lastname: Lacombe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009392:Nephrectomy / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D014513:Ureter / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000473:pathology*; D014571:Urologic Neoplasms / Q000188:drug therapy / Q000601:surgery*; D019459:Urothelium / Q000187:drug effects / Q000473:pathology / Q000601:surgery*
keywords: Bladder cancer; Radical nephroureterectomy; Recurrence; Risk factors; Upper tract urothelial carcinoma