title: Risk factors for intravesical recurrence after nephroureterectomy in patients with upper urinary tract urothelial carcinoma.
abstract: OBJECTIVE
  To determine major risk factors for bladder cancer (BC) recurrence after nephroureterectomy (Nux) by focusing on the pathologic appearances of tumors in upper urinary tract urothelial carcinomas (UUTUCs).
  
  
  METHODS
  We performed 147 Nux procedures between November 2002 and September 2015. Forty-eight patients were excluded because of a history of BC (28 patients), previous or concurrent radical cystectomy (9 patients), neoadjuvant chemotherapy (5 patients), and other reasons (6 patients). We classified UUTUCs into three types: renal pelvic, short-length ureteral, and long-length ureteral cancer; the cutoff for categorizing short- versus long-length ureteral cancer was the median tumor length. Univariate and multivariate analyses with Cox regression methods were performed to calculate hazard ratios (HRs) for BC recurrence using nine clinical covariates, including our new pathologic classification.
  
  
  RESULTS
  The median follow-up period for the survivors was 60 months (range 1-157 months). Of 99 patients, 36 (36%) had BC recurrence; of these 36 patients, 30 (85%) experienced recurrence within 2 years and 17 (47%) had invasive BC (≥pT1). Statistical analyses demonstrated that pathologic tumor type was the major significant risk factor for BC recurrence. Long-length (>5 cm) ureteral cancer had the highest risk of BC recurrence compared to other tumor types (multivariate HR 2.1; 95% confidence interval 1.03-4.2).
  
  
  CONCLUSIONS
  Our simple classification system based on the tumor's pathologic appearance is useful for predicting BC recurrence. Patients with long-length ureteral cancer have a high risk of BC recurrence.
authors.affiliation: Division of Urology, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi, Suntougun, Shizuoka, 411-8777, Japan. r.yamashita@scchr.jp.
authors.forename: Ryo
authors.initials: R
authors.lastname: Yamashita
authors.affiliation: Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Reiko
authors.initials: R
authors.lastname: Watanabe
authors.affiliation: Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Ito
authors.affiliation: Division of Urology, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi, Suntougun, Shizuoka, 411-8777, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Shinsaka
authors.affiliation: Division of Urology, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi, Suntougun, Shizuoka, 411-8777, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Division of Urology, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi, Suntougun, Shizuoka, 411-8777, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Matsuzaki
authors.affiliation: Division of Urology, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi, Suntougun, Shizuoka, 411-8777, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Niwakawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D007682:Kidney Pelvis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000473:pathology; D009392:Nephrectomy; D012307:Risk Factors; D047368:Tumor Burden; D014513:Ureter / Q000601:surgery; D014516:Ureteral Neoplasms / Q000473:pathology* / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000209:etiology* / Q000473:pathology
keywords: Bladder cancer recurrence; Nephroureterectomy; Tumor classification; Upper urinary tract; Urothelial carcinoma