title: Patterns of Recurrence in Upper Tract Transitional Cell Carcinoma: Imaging Surveillance.
abstract: OBJECTIVE
  The objective of our study was to evaluate recurrence patterns of upper tract transitional cell carcinomas (UT-TCCs) after radical nephroureterectomy (RNU).
  
  
  METHODS
  Sixty-eight patients (mean age, 78 years; 34 men and 34 women) with UT-TCC after having undergone RNU from 2001 to 2008 were included in this study. Radiologic examinations and clinical notes were reviewed to record tumor location, tumor morphology, histologic T stages and grades, lymphovascular invasion (LVI) status, and surgical procedures. Five-year imaging and clinical follow-up (2001-2013) findings were noted at 3, 6, 12, 18, 24, 36, 48, 60, and more than 60 months after RNU for recurrence pattern and tumor-free survival. Kaplan-Meier survival curves and Cox regression models were used to assess tumor-free survival and to perform a multivariate analysis.
  
  
  RESULTS
  Forty-one postoperative recurrences were noted in 20 patients. The mean time to relapse was 16 months, and time to relapse ranged from 1 to 66 months. Tumor site (multifocal lesions involving both renal collecting system and ureter), tumor morphology (mass), T stage (muscle invasion [T2-T4]), histologic grade (grade 3), and the presence of LVI were identified as risk factors for postoperative recurrence in UT-TCC. T stage was the only independent risk factor.
  
  
  CONCLUSIONS
  Urinary tract, lymph node, liver, bone, and lung recurrences were common in patients with UT-TCC and were detected most frequently at 3-24 months. Tumor site, tumor morphology, T stage, grade, and LVI status were associated with recurrence after RNU. T stage was the only independent predictor of tumor-free survival. Close surveillance for extra-urinary tract recurrences in high-risk groups and a shorter-interval follow-up of the urinary tract in low-risk patients with adjuvant chemotherapy are recommended. Identifying recurrence patterns in UT-TCC can aid in planning an effective tailored imaging surveillance strategy.
authors.affiliation: 1 Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Mao
authors.affiliation: 2 Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114.
authors.forename: Aoife
authors.initials: A
authors.lastname: Kilcoyne
authors.affiliation: 2 Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Hedgire
authors.affiliation: 3 Department of Surgery, Division of Urology, Brigham and Women's Hospital, Boston, MA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Preston
authors.affiliation: 4 Department of Urology, Massachusetts General Hospital, Boston, MA.
authors.forename: Francis J
authors.initials: FJ
authors.lastname: McGovern
authors.affiliation: 4 Department of Urology, Massachusetts General Hospital, Boston, MA.
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Dahl
authors.affiliation: 2 Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114.
authors.forename: Mukesh
authors.initials: M
authors.lastname: Harisinghani
keywords: cell carcinoma; nephroureterectomy; recurrence; transitional cell carcinoma; upper tract; upper tract transitional