Effects of Previous or Synchronous Non-Muscle Invasive Bladder Cancer on Clinical Results after Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Multi-Institutional Study.
OBJECTIVE
To evaluate the effects of the presence of previous or synchronous non-muscle invasive bladder cancer (NMIBC) on the oncologic outcomes of radical nephroureterectomy in patients with upper tract urothelial carci­noma (UTUC).


METHODS
In total, 505 patients with UTUC were enrolled from four different institutions. The clinicopathologic parameters of patients with and without previous or synchronous NMIBC were compared, and Kaplan-Meier estimates and multivariate Cox regression analyses were performed.


RESULTS
The median follow-up period was 38.4 months. In all, 408 patients had primary UTUC, 45 (8.9%) had a history of NMIBC, 59 (11.7%) had concomitant bladder cancer, and seven (1.4%) had experienced both. Tumors in patients with associated NMIBC were more commonly multifocal (P = .001) and associ­ated with surgical margin positivity (P = .001). Kaplan-Meier estimates revealed that previous or synchro­nous NMIBC was significantly associated with bladder recurrence (P < .001) and locoregional recurrence/distant metastasis (P = .008). A multivariate Cox regression model identified previous or synchronous NMIBC as an independent predictor of bladder recurrence (P < .001). However, the presence of previ­ous or synchronous NMIBC was not a prognostic indicator of locoregional recurrence/distant metastasis.


CONCLUSIONS
In patients with UTUC, previous or synchronous NMIBC was significantly associated with an increased risk of cancer recurrences in the bladder after radical nephroureterectomy. The present find­ings suggest that a close monitoring should be required for the patients with previous or concomitant NMIBC.
Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.
Bup Wan
BW
Kim
Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.
Yun-Sok
YS
Ha
Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.
Jun Nyung
JN
Lee
Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.
Hyun Tae
HT
Kim
Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.
Tae-Hwan
TH
Kim
Department of Urology, Seoul National University, Bundang Hospital, Seongnam, Korea.
Jung Keun
JK
Lee
Department of Urology, Seoul National University, Bundang Hospital, Seongnam, Korea.
Seok-Soo
SS
Byun
Department of Urology and Urological Science Institute, College of Medicine, Yonsei University, Seoul, Korea.
Young Deuk
YD
Choi
Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Chungbuk, Korea.
Ho Won
HW
Kang
Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Chungbuk, Korea.
Seok-Joong
SJ
Yun
Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Chungbuk, Korea.
Wun-Jae
WJ
Kim
Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Young Suk
YS
Kwon
Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.
Tae Gyun
TG
Kwon
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000473:pathology / Q000601:surgery*; D001743:Urinary Bladder / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*