title: Prevention of Recurrent Bladder Tumors after Nephroureterectomy for Primary Upper Urinary Tract Urothelial Carcinoma: An Individualized Selection Strategy Based on Patient Risk Stratification Is Needed.
abstract: OBJECTIVE
  To evaluate the efficacies of different chemotherapy regimens in different risk sub-groups for the prevention of bladder recurrence after radical nephroureterectomy (RNU).
  
  
  METHODS
  Between 2004 and 2012, we recruited 685 patients who underwent RNU for upper tract urothelial carcinoma at 4 Chinese institutions. We assessed whether the type of intravesical chemotherapy regimen affected the bladder recurrence rate in patients with different risk levels after RNU.
  
  
  RESULTS
  For all patients, the bladder recurrence rate was lower with intravesical chemotherapy than without, but no significant differences were found between the 2 intravesical chemotherapy regimens (single dose or relatively long-term therapy). We used multivariate analysis to define the risk factors for bladder recurrence and stratified patients into low-, intermediate-, and high-risk sub-groups accordingly. The bladder recurrence rate in the low-risk patients was not significantly different between patients with or without intravesical chemotherapy. However, in the intermediate-risk and high-risk patients, the rate was greater in patients without intravesical chemotherapy than in patients with. Furthermore, the rate was not significantly different between the 2 intravesical chemotherapy regimens in the intermediate-risk patients, while the efficacy of the relatively long-term regimen in high-risk patients remains unclear.
  
  
  CONCLUSIONS
  Our study showed that an individualized strategy based on patient risk stratification is needed.
authors.affiliation: Department of Urology, Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Xingbo
authors.initials: X
authors.lastname: Long
authors.forename: Lin
authors.initials: L
authors.lastname: Qi
authors.forename: Xiongbing
authors.initials: X
authors.lastname: Zu
authors.forename: Yuan
authors.initials: Y
authors.lastname: Li
authors.forename: Wei
authors.initials: W
authors.lastname: He
authors.forename: Shuohuang
authors.initials: S
authors.lastname: Pi
authors.forename: Xiang
authors.initials: X
authors.lastname: Chen
authors.forename: Kebing
authors.initials: K
authors.lastname: Zhou
authors.forename: Xiheng
authors.initials: X
authors.lastname: Hu
authors.forename: Minfeng
authors.initials: M
authors.lastname: Chen
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000601:surgery*; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery; D002681:China; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control* / Q000601:surgery*; D012306:Risk; D014513:Ureter / Q000601:surgery; D014516:Ureteral Neoplasms / Q000473:pathology / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014571:Urologic Neoplasms / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D019459:Urothelium / Q000473:pathology