Risk factors and prognosis of intravesical recurrence after surgical management of upper tract urothelial carcinoma: A 30-year single centre experience

Abstract

ObjectiveTo review the incidence, predictors and prognosis of bladder cancer recurrence after management of upper tract urothelial carcinoma (UTUC).Patients and methodsWe retrospectively reviewed patients who were surgically treated for UTUC from 1983 to 2013. The tumours were categorised according to the 1997 Tumour-Node-Metastasis (TNM) staging and the three-tiered World Health Organization grading systems. The primary endpoint was the occurrence of any intravesical recurrence after treatment. We studied the possible risk factors that may contribute to development of intravesical recurrence, as well as the prognosis of the patients who had recurrence.ResultsIn all, 297 patients were eligible for analysis. Recurrent bladder tumours occurred in 139 patients (46.8%). The mean (range) time to recurrence after surgery was 33 (6–300) months. Neither sex, past history of bladder tumours, concomitant bladder tumour, the side of the tumour, UTUC stage, grade, presence of carcinoma in situ or multicentricity at the time of diagnosis of UTUC, were significant predictors of intravesical tumour recurrence. Ureteric tumour was the only identified risk factor (P = 0.02). Post-treatment bladder recurrence was a significant predictor of later urethral recurrence (P = 0.002).ConclusionsIn our present series, bladder cancer recurrence of urothelial malignancy occurred in nearly half of the patients after surgical management of UTUC. Ureteric tumour was the only identifiable risk factor, thus patients with ureteric tumours may benefit from prophylactic intravesical chemoimmunotherapy. Bladder recurrence does not appear to affect the cancer-specific survival after surgical management of UTUC.

Developing a prediction model for disease‐free survival from upper urinary tract urothelial carcinoma in the Korean population

“…However, similar to our results, another study reported no significant association between sex and CSS (HR 1.050, 95% CI 0.841‐1.310, Table for OS) . Some studies have shown that CIS is a significant adverse prognostic factor, whereas others have not . As for the BMI, different version existed on the prognostic significance of survival in UTUC that obese UTUC patients had significantly worse CSS than the other three BMI groups ( P = 0.031).…”

“…2 Some studies have shown that CIS is a significant adverse prognostic factor, 3 whereas others have not. 27,28 As for the BMI, different version existed on the prognostic significance of survival in UTUC that obese UTUC patients had significantly worse CSS than the other three BMI groups (P = 0.031). The association between surgical technique, such as laparoscopic RNU, and survival outcome has been debated, and several meta-analyses have shown no significant differences in oncological outcome including IVRFS, CSS, OS, and metastasis rates based on surgical technique.…”

The complex relationship between upper urinary tract and bladder cancer: clinical and predictive issues

“…IVR usually develop in up to 50% of patients during surgical follow-up after RNU ( 12 ) with cumulative incidence rates at 1 and 5 years after treatment as high as 31.0% and 48.4%, respectively, in one series ( 24 ), the most frequent site being around the excised bladder cuff. Furthermore, post-surgical IVR may be a significant predictor of later urethral recurrence ( 25 ). In order to find parameters able to predict the outcome of such IVRs, Tanaka et al examined a series of 241 IVRs after RNU for UTUC; according to their analysis, multiplicity, pT1 stage, concomitant carcinoma in situ (CIS) and lack of BCG treatment were independent risk factors for subsequent IVR and/or progression ( 24 ).…”

Intravesical Recurrence After Nephroureterectomy in Patients with Upper Urinary Tract Urothelial Carcinoma

“…Çalışmamız, yaş ortalaması 62,6±11,4 yıl olan 16 erkek ve altı kadın hastadan oluşmakta idi. On üç hastanın tümörü sadece renal pelviste, altı hastanın tümörü üreterde bulunmaktaydı ve geri kalan üç hastada multifokal tümör mevcuttu.…”