The purpose of this study was to identify the prognostic impact of intravesical recurrence (IVR) on oncologic outcomes and the clinicopathologic factors that predict IVR in patients who undergo radical nephroureterectomy (RNU) for upper tract urothelial carcinoma.
Patients and Methods
Between January 2000 and December 2015, 760 patients with upper tract urothelial carcinoma underwent RNU at 5 institutions in Korea, and patient data were retrospectively collected. Clinicopathologic factors were analyzed for intravesical recurrence-free survival, cancer-specific survival (CSS), and overall survival (OS). Univariate and multivariate Cox proportional hazards regression models were used to test the clinicopathologic factors on IVR.
Of the 760 patients, 231 (30.3%) patients experienced IVR within 10 months of the median interval between RNU and the first IVR. The overall estimated probabilities of 5-year CSS, intravesical recurrence-free survival, and OS were 84.2%, 63.8%, and 79.2%, respectively. No difference was noted in terms of CSS and OS between the patients who did or did not experience IVR. The multivariate Cox analysis showed an association between IVR and positive hydronephrosis, tumor size, positive preoperative urinary cytology, and ureterorenoscopy before RNU (all P < .05). However, a significantly decreased risk of IVR was associated with female gender, laparoscopic RNU, and receipt of adjuvant systemic chemotherapy (all P < .05).
The occurrence of IVR following RNU did not affect CSS and OS. Patients with larger tumor size, preoperative hydronephrosis, positive preoperative urinary cytology, and ureterorenoscopy before RNU had a higher risk of IVR following RNU.
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- Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration.Cancer. 2009; 115: 1224-1233
- Bladder tumour development after urothelial carcinoma of the upper urinary tract is related to primary tumour location.BJU Int. 2006; 98: 1181-1186
- Impact of distal ureter management on oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma.Eur Urol. 2014; 65: 210-217
- NCCN Clinical Practice Guidelines in Oncology: Bladder Cancer. Version 2. 2016.(Available at:)Accessed: December 23, 2016)
- European Association of Urology Guidelines on Upper Urinary Tract Urothelial Cell Carcinoma: 2015 Update.Eur Urol. 2015; 68: 868-879
- Prediction of intravesical recurrence after radical nephroureterectomy: development of a clinical decision-making tool.Eur Urol. 2014; 65: 650-658
- Risk stratification for bladder recurrence of upper urinary tract urothelial carcinoma after radical nephroureterectomy.BJU Int. 2015; 115: 705-712
- Risk factors for bladder cancer recurrence after nephroureterectomy for upper tract urothelial tumors: results from the Canadian Upper Tract Collaboration.Urol Oncol. 2014; 32: 839-845
- Impact of tumour size on prognosis of upper urinary tract urothelial carcinoma after radical nephroureterectomy: a multi-institutional analysis of 795 cases.BJU Int. 2016; 118: 902-910
- Metachronous multifocal development of urothelial cancers by intraluminal seeding.Lancet. 1993; 342: 1087-1088
- Molecular evidence supporting field effect in urothelial carcinogenesis.Clin Cancer Res. 2005; 11: 6512-6519
- Significant predictive factors for prognosis of primary upper urinary tract cancer after radical nephroureterectomy in Taiwanese patients.Eur Urol. 2008; 54: 1127-1134
- The predictive value of positive urine cytology for outcomes following radical nephroureterectomy in patients with primary upper tract urothelial carcinoma: a multi-institutional study.Urol Oncol. 2014; 32: e19-e26
- Risk factors for subsequent development of bladder cancer after primary transitional cell carcinoma of the upper urinary tract.Urology. 2005; 65: 279-283
- Concomitant carcinoma in situ and tumour size are prognostic factors for bladder recurrence after nephroureterectomy for upper tract transitional cell carcinoma.BJU Int. 2010; 106: 1319-1323
- Diagnostic ureteroscopy independently correlates with intravesical recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma.Ann Surg Oncol. 2013; 20: 3121-3126
- Impact of ureteroscopy before nephroureterectomy for upper tract urothelial carcinoma on oncologic outcomes.Urology. 2016; 94: 148-153
- Preoperative positive urine cytology is a risk factor for subsequent development of bladder cancer after nephroureterectomy in patients with upper urinary tract urothelial carcinoma.World J Urol. 2012; 30: 271-275
- Preoperative hydronephrosis, ureteroscopic biopsy grade and urinary cytology can improve prediction of advanced upper tract urothelial carcinoma.J Urol. 2010; 184: 69-73
- Multi-institutional validation of the ability of preoperative hydronephrosis to predict advanced pathologic tumor stage in upper-tract urothelial carcinoma.Urol Oncol. 2013; 31: 904-908
- Laparoscopic radical nephroureterectomy: a multicenter analysis in Japan.Eur Urol. 2009; 55: 1397-1407
- Bladder cancer after nephroureterectomy in patients with urothelial carcinoma of the upper urinary tract.Urol Oncol. 2011; 29: 383-387
- Adjuvant methotrexate, vinblastine, adriamycin, and cisplatin chemotherapy has potential to prevent recurrence of bladder tumors after surgical removal of upper urinary tract transitional cell carcinoma.Int J Urol. 2008; 15: 800-803
- Combining hand assisted laparoscopic nephroureterectomy with cystoscopic circumferential excision of the distal ureter without primary closure of the bladder cuff—is it safe?.J Urol. 2006; 175 (discussion: 67-8): 63-67
- Should patients with primary upper urinary tract cancer receive prophylactic intravesical chemotherapy after nephroureterectomy?.J Urol. 2010; 183: 56-61
- Prevention of bladder tumours after nephroureterectomy for primary upper urinary tract urothelial carcinoma: a prospective, multicentre, randomised clinical trial of a single postoperative intravesical dose of mitomycin C (the ODMIT-C Trial).Eur Urol. 2011; 60: 703-710
- Prospective randomized phase II trial of a single early intravesical instillation of pirarubicin (THP) in the prevention of bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma: the THP Monotherapy Study Group Trial.J Clin Oncol. 2013; 31: 1422-1427
Published online: July 21, 2017
Accepted: July 18, 2017
Received in revised form: July 6, 2017
Received: May 4, 2017
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