Bladder cancer after nephroureterectomy in patients with urothelial carcinoma of the upper urinary tract

Objectives: To determine the independent risk factors of bladder recurrence in patients with upper urinary tract (UUT) urothelial carcinoma (UC). Materials and methods: A total of 181 patients with UUT-UC were enrolled in this study. Their median age was 63 years (range 36-90), and median follow-up after total nephroureterecumny was 37.5 months (range 1.0-174.0). The end-point of this study was defined as the initial intravesical recurrence of UC. Results: Of the 181 patients, 64 (35.4%) developed subsequent bladder tumors at a median interval of 6.3 months (range 1.7-50.1) after initial treatment. By univariate analysis, a previous bladder tumor history (P = 0.046) and tumor necrosis (P < 0.001) were found to have a significant prognostic impact on bladder tumor-free survival in patients with superficial UUT-UC, whereas surgical margin status (P = 0.045) and the use of adjuvant chemotherapy (P = 0.003) were found to be prognostic factors for bladder tumor-free survival in those with invasive UUT-UC. However, by multivariate analysis, only tumor necrosis (P = 0.012, relative risk = 6.512) was found to have a significant impact on intravesical recurrence in patients with superficial UUT-UC. However, surgical margin status (P = 0.007, relative risk = 5.846) and the use of adjuvant chemotherapy (P = 0.001, relative risk = 0.223) were retained as independent predictors of bladder tumor survival in those with invasive UUT-UC. Conclusions: Our findings may be useful in patients with UUT-UC who may require more stringent follow-up by cystoscopy to detect bladder tumors. (C) 2011 Elsevier Inc. All rights reserved.