title: Risk of Intravesical Recurrence After Ureteroscopic Biopsy for Upper Tract Urothelial Carcinoma: Does the Location Matter?
abstract: To investigate whether ureteroscopic biopsy (URS-Bx) for upper tract urothelial carcinoma (UTUC) before radical nephroureterectomy affects intravesical recurrence (IVR).
  
  
  
  Of the 515 patients receiving radical nephroureterectomy for UTUC between 1998 and 2012, 387 patients were included for the analysis. URS-Bx was performed in 69 patients (17.8%). Patients were stratified according to tumor location, and the impact of URS-Bx on IVR was evaluated after adjusting for other clinicopathologic variables.
  
  
  
  IVR occurred in 163 patients (42.1%). The postoperative 5-year IVR-free survival was not significantly different according to URS-Bx in the overall patient group (54.0% vs 39.3%, p = 0.056). In patients with renal pelvic tumor, IVR-free probability was lower in patients with URS-Bx than in patients without URS-Bx (39.6% vs 62.2%, p = 0.012), although IVR-free survival in patients with ureteral tumor was equivalent (36.7% vs 45.8%, p = 0.946). In multivariate analysis, previous bladder tumors (hazard ratio [HR], 1.65; p = 0.016) were a significant risk factor for IVR in all patients and ureteral tumor location (HR, 1.35; p = 0.071) was associated with IVR, although statistical significance was not achieved. In patients with renal pelvic tumor, URS-Bx HR, 1.98; p = 0.020 was the only risk factor for IVR. However, URS-Bx was not associated with IVR in patients with ureteral tumor, although previous bladder tumor HR, 1.74; p = 0.028 was a risk factor for IVR.
  
  
  
  URS-Bx is a significant risk factor for IVR in patients with renal pelvic tumor and should be performed after sufficient consideration in these patients if other examinations are uncertain.
authors: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea.
authors: Sangjun
authors: S
authors: Yoo
authors: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea.
authors: Dalsan
authors: D
authors: You
authors: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea.
authors: Cheryn
authors: C
authors: Song
authors: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea.
authors: Bumsik
authors: B
authors: Hong
authors: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea.
authors: Jun Hyuk
authors: JH
authors: Hong
authors: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea.
authors: Choung-Soo
authors: CS
authors: Kim
authors: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea.
authors: Hanjong
authors: H
authors: Ahn
authors: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea.
authors: In Gab
authors: IG
authors: Jeong
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000009:adverse effects*; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000601:surgery*; D007682:Kidney Pelvis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D009392:Nephrectomy / Q000379:methods*; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis; D014571:Urologic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D019459:Urothelium
keywords: biopsy; carcinoma; transitional cell; ureteroscopy; urinary bladder neoplasms