title: Tumour multifocality and grade predict intravesical recurrence after nephroureterectomy in patients with upper urinary tract urothelial carcinoma without a history of bladder cancer.
abstract: OBJECTIVE
  Patients with upper urinary tract urothelial carcinoma (UUT-UC) without a history of bladder cancer have a different natural history of intravesical recurrence after nephroureterectomy compared with those with a history of bladder cancer. The aim of this study was to identify predictive factors for post-operative intravesical recurrence in patients with non-metastatic upper urinary tract-localized urothelial carcinoma without a history of bladder cancer and who were not taking medication during the perioperative period.
  
  
  METHODS
  This retrospective study included 133 patients who were treated between 1995 and 2012. Univariate and multivariate analyses were used to evaluate the clinical and pathological factors associated with the cumulative incidence of bladder cancer.
  
  
  RESULTS
  Of the 133 patients, 51 (38.3%) developed intravesical recurrence during a median follow-up of 71 months (range, 0.8-210.8). In the multivariate analysis, multifocality (P = 0.03) and high tumour grade (P = 0.007) were significantly associated with the cumulative incidence of bladder cancer. We constructed a prediction classification model on the basis of the total number of risk factors. The 2-year cumulative incidence rates were 5.6, 34.8 and 50.0% in individuals with no, one and two risk factors, respectively. There was a significant difference between patients with no risk factors and those with two risk factors (P = 0.01).
  
  
  CONCLUSIONS
  Although this retrospective study had several limitations, tumour multifocality and tumour grade were found to be potential risk factors for intravesical recurrence in our cases.
authors: Urology Division, National Cancer Center Hospital, Tokyo.
authors: Tsukasa
authors: T
authors: Narukawa
authors: Urology Division, National Cancer Center Hospital, Tokyo tomohara-jua@umin.ac.jp.
authors: Tomohiko
authors: T
authors: Hara
authors: Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan.
authors: Eri
authors: E
authors: Arai
authors: Urology Division, National Cancer Center Hospital, Tokyo.
authors: Motokiyo
authors: M
authors: Komiyama
authors: Urology Division, National Cancer Center Hospital, Tokyo.
authors: Takashi
authors: T
authors: Kawahara
authors: Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan.
authors: Yae
authors: Y
authors: Kanai
authors: Urology Division, National Cancer Center Hospital, Tokyo.
authors: Hiroyuki
authors: H
authors: Fujimoto
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009392:Nephrectomy / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D014513:Ureter / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000473:pathology*; D014571:Urologic Neoplasms / Q000556:secondary* / Q000601:surgery*
keywords: intravesical recurrence; renal pelvic cancer; upper urinary tract urothelial carcinoma; ureteral cancer; urologic-med; urology