title: Clinical implications of intravesical recurrence after radical nephroureterectomy for upper urinary tract urothelial carcinoma.
abstract: To characterize the site and clinical implications of intravesical recurrence after radical nephroureterectomy for upper urinary tract urothelial carcinoma.
  
  
  
  Patients who underwent radical nephroureterectomy for upper urinary tract urothelial carcinoma between 2000 and 2011 at 12 institutions participating in the Tohoku Urological Evidence-Based Medicine Study Group were included in the present study. Those who underwent prior or simultaneous radical cystectomy were excluded. The site of intravesical recurrence was investigated, and the survival curves after radical nephroureterectomy were analyzed retrospectively using the Kaplan-Meier method. Multivariate analyses of factors predicting survival were carried out.
  
  
  
  A total of 534 patients were eligible for the present study. With a median follow up of 47 months, 205 patients (38.4%) had intravesical recurrence. The intravesical recurrence-free survival rates at 1, 2, and 5 years were 74.6%, 62.5% and 56.3%, respectively. In a subset of 137 patients with intravesical recurrence who did not have bladder cancer before or at the diagnosis of upper urinary tract urothelial carcinoma, the most frequent site of intravesical recurrence was around the cystotomy (52.6%), followed by at the posterior wall (39.4%) and at the bladder neck (35.8%). A total of 36 patients (17.6%) developed muscle-invasive bladder cancer after radical nephroureterectomy. On multivariate analyses for the subset of patients with non-muscle invasive (≤pT1) upper urinary tract urothelial carcinoma, intravesical recurrence was an independent predictor of cancer-specific survival (HR 4.27, P = 0.016) and overall survival (HR 3.00, P = 0.018).
  
  
  
  Most intravesical recurrences occur around the site of bladder mucosal injury within 1 year after radical nephroureterectomy, providing important insight into the mechanism of intravesical recurrence. Intravesical recurrence after radical nephroureterectomy had an impact on oncological outcomes of patients with non-muscle invasive upper urinary tract urothelial carcinoma.
authors.affiliation: Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan.|Tohoku Urological Evidence-Based Medicine Study Group, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yamashita
authors.affiliation: Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan.|Tohoku Urological Evidence-Based Medicine Study Group, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Ito
authors.affiliation: Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan.|Tohoku Urological Evidence-Based Medicine Study Group, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Mitsuzuka
authors.affiliation: Department of Urology, Miyagi Cancer Center, Natori, Japan.|Tohoku Urological Evidence-Based Medicine Study Group, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Tochigi
authors.affiliation: Department of Urology, Tohoku Rosai Hospital, Sendai, Japan.|Tohoku Urological Evidence-Based Medicine Study Group, Japan.
authors.forename: Takashige
authors.initials: T
authors.lastname: Namima
authors.affiliation: Department of Urology, Hachinohe City Hospital, Hachinohe, Japan.|Tohoku Urological Evidence-Based Medicine Study Group, Japan.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Soma
authors.affiliation: Department of Urology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan.|Tohoku Urological Evidence-Based Medicine Study Group, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Aizawa
authors.affiliation: Department of Urology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan.|Tohoku Urological Evidence-Based Medicine Study Group, Japan.
authors.forename: Naomasa
authors.initials: N
authors.lastname: Ioritani
authors.affiliation: Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan.|Tohoku Urological Evidence-Based Medicine Study Group, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kaiho
authors.affiliation: Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan.|Tohoku Urological Evidence-Based Medicine Study Group, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arai
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D006801:Humans; D009364:Neoplasm Recurrence, Local; D009392:Nephrectomy; D000074682:Nephroureterectomy; D012189:Retrospective Studies; D012307:Risk Factors; D014513:Ureter; D014516:Ureteral Neoplasms / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: intravesical recurrence; prognosis; radical nephroureterectomy; upper urinary tract; urothelial carcinoma