title: Ureteral involvement and diabetes increase the risk of subsequent bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma.
abstract: OBJECTIVE
  To investigate the prognostic factors for bladder recurrence after radical nephroureterectomy (RNU) in patients with upper urinary tract urothelial carcinoma (UUT-UC).
  
  
  METHODS
  From 1994 to 2012, 695 patients with UUT-UC treated with RNU were enrolled in National Taiwan University Medical Center. Among them, 532 patients with no prior bladder UC history were recruited for analysis. We assessed the impact of potentially prognostic factors on bladder recurrence after RNU.
  
  
  RESULTS
  The median follow-up period was 47.8 months. In the Cox model, ureteral involvement and diabetes mellitus (DM) were significantly associated with a higher bladder recurrence rate in the multivariate analysis (hazard ratio [HR]: 1.838; P = 0.003 and HR: 1.821; P = 0.010, resp.). In the Kaplan-Meier analysis, DM patients with concomitant ureteral UC experienced about a threefold increased risk of bladder recurrence as compared to those without both factors (HR: 3.222; P < 0.001). Patients with either of the two risk factors experienced about a twofold increased risk as compared to those without both factors (with DM, HR: 2.184, P = 0.024; with ureteral involvement, HR: 2.006, P = 0.003).
  
  
  CONCLUSIONS
  Ureteral involvement and DM are significantly related to bladder recurrence after RNU in patients with UUT-UC.
authors: Department of Urology, National Taiwan University Hospital, Taipei 100, Taiwan.
authors: Che-Yuan
authors: CY
authors: Hu
authors: Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan.
authors: Yu-Chieh
authors: YC
authors: Tsai
authors: Department of Urology, National Taiwan University Hospital, Taipei 100, Taiwan.
authors: Shuo-Meng
authors: SM
authors: Wang
authors: Department of Urology, National Taiwan University Hospital, Taipei 100, Taiwan.
authors: Chao-Yuan
authors: CY
authors: Huang
authors: Department of Urology, National Taiwan University Hospital, Taipei 100, Taiwan.
authors: Huai-Ching
authors: HC
authors: Tai
authors: Department of Urology, National Taiwan University Hospital, Taipei 100, Taiwan.
authors: Chung-Hsin
authors: CH
authors: Chen
authors: Department of Urology, National Taiwan University Hospital, Taipei 100, Taiwan.
authors: Yeong-Shiau
authors: YS
authors: Pu
authors: Department of Pathology, National Taiwan University Hospital, Taipei 100, Taiwan.
authors: Wei-Chou
authors: 0000-0003-2857-3479
authors: WC
authors: Lin
authors: Department of Urology, National Taiwan University Hospital, Taipei 100, Taiwan.
authors: Kuo-How
authors: KH
authors: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009392:Nephrectomy; D012189:Retrospective Studies; D015996:Survival Rate; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D019459:Urothelium / Q000473:pathology / Q000601:surgery