title: Prognostic value of prior history of urothelial carcinoma of the bladder in patients with upper urinary tract urothelial carcinoma: results from a retrospective multicenter study.
abstract: BACKGROUND
  Patients with urothelial carcinoma (UC) often develop multifocal metachronous tumors throughout the genitourinary tract. In the present study, we evaluated the prognostic value of prior history of UC of the bladder (UCB) in patients with upper tract urothelial carcinoma (UTUC) in an international multi-institutional cohort.
  
  
  METHODS
  Data from 785 patients who underwent radical nephroureterectomy (RNU) with ipsilateral bladder cuff resection at nine academic institutions in Europe and the USA between 1987 and 2008 were reviewed. Log-rank tests and Cox proportional hazards regression models were used for univariable and multivariable analyses.
  
  
  RESULTS
  The median follow-up of the whole cohort was 34 months (interquartile range 15-66 months). Five hundred and fifty-eight (72 %) patients had no UCB before the diagnosis of UTUC; a prior history of non-muscle-invasive and muscle-invasive UCB before the UTUC was found in 179 (23 %) and 36 (5 %), respectively. History of UCB before RNU was an independent predictor of both recurrence-free survival (p = 0.012; no UCB vs. non-muscle-invasive UCB: hazard ratio (HR) 1.4, p = 0.082; no UCB vs. muscle-invasive UCB: HR 2.1, p = 0.007) and cancer-specific survival (p = 0.008; no UCB vs. non-muscle-invasive UCB: HR 1.2, p = 0.279; no UCB vs. muscle-invasive UCB: HR 2.3, p = 0.008) on multivariable Cox regression analyses that included age, gender, surgical type, stage, grade, presence of concomitant carcinoma in situ, presence of lymphovascular invasion, and lymph node status.
  
  
  CONCLUSIONS
  Prior history of muscle-invasive UCB was significantly associated with an increased risk of disease recurrence and cancer-specific death in patients with UTUC.
authors.affiliation: Department of Urology, Ludwig-Maximilians-Universität, Marchioninistr. 15, Klinikum Grosshadern, 81377, Munich, Germany, nuhn.philipp@gmail.com.
authors.forename: Philipp
authors.initials: P
authors.lastname: Nuhn
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: Christian
authors.initials: C
authors.lastname: Seitz
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walton
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
authors.forename: Stefan
authors.initials: S
authors.lastname: Tritschler
authors.forename: Juan I
authors.initials: JI
authors.lastname: Martínez-Salamanca
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Guido
authors.initials: G
authors.lastname: Mazzoleni
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bastian
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D019459:Urothelium