title: The characteristics of recurrent upper tract urothelial carcinoma after radical nephroureterectomy without bladder cuff excision.
abstract: OBJECTIVE
  To investigate oncological outcomes based on bladder cuff excision (BCE) during radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) and to provide clinical evidence of tumor recurrence in patients without BCE.
  
  
  METHODS
  We retrospectively collected data of 372 consecutive patients who underwent RNU at our institution from May 1989 through October 2010. After excluding some data, we reviewed 336 patients for the analysis.
  
  
  RESULTS
  Of the patients who underwent RNU with BCE (n=279, 83.0%) and without BCE (n=57, 17.0%), patients without BCE had poorer cancer-specific and overall survival rates. Among 57 patients without BCE, 35 (61.4%) experienced tumor recurrence. Recurrence at the remnant ureter resulted in poor oncological outcomes compared to those in patients with bladder recurrence, but better outcomes were observed compared to recurrence at other sites. No significant predictors for tumor recurrence at the remnant ureter were identified. In patients without BCE, pathological T stage [hazard ratio (HR), 5.73] and lymphovascular invasion (HR, 3.65) were independent predictors of cancer-specific survival, whereas age (HR, 1.04), pathological T stage (HR, 5.11), and positive tumor margin (HR, 6.50) were independent predictors of overall survival.
  
  
  CONCLUSIONS
  Patients without BCE had poorer overall and cancer-specific survival after RNU than those with BCE. Most of these patients experienced tumor recurrence at the remnant ureter and other sites. Patients with non-organ confined UTUC after RNU without BCE may be considered for adjuvant chemotherapy with careful follow-up.
authors: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors: Minyong
authors: M
authors: Kang
authors: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors: Chang Wook
authors: CW
authors: Jeong
authors: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors: Cheol
authors: C
authors: Kwak
authors: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors: Hyeon Hoe
authors: HH
authors: Kim
authors: Department of Urology, Seoul National University Hospital, Seoul, Korea. kuuro70@snu.ac.kr.
authors: Ja Hyeon
authors: JH
authors: Ku
mesh_terms: D000328:Adult; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000601:surgery*; D001743:Urinary Bladder / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000473:pathology*; D014571:Urologic Neoplasms / Q000473:pathology / Q000601:surgery*; D013520:Urologic Surgical Procedures; D019459:Urothelium / Q000473:pathology*
keywords: Upper urinary tract urothelial carcinoma; bladder cuff excision; oncological outcomes; radical nephroureterectomy; tumor recurrence