Predictors of Bladder Tumor Recurrence after Curative Surgery for Upper Urinary Tract Transitional Cell Carcinoma

Abstract

Purpose:We investigated the predictors for developing intravesical recurrence following curative surgery for primary upper tract transitional cell carcinoma (UTTCC). Materials and Methods:The data of 207 patients without a prior history of bladder tumor or distant metastasis were analyzed. We evaluated the influence of multiple clinicopathologic parameters, such as age, sex, T stage, N stage, grade, carcinoma-in-situ, anatomical location, multifocality, lymphovascular invasion (LVI), preoperative urine cytology, and operative methods, on intravesical recurrence. Considering the possibility of bias from the effect of adjuvant treatment, the same analyses were performed in 184 patients excluding those who underwent adjuvant therapy. Mean follow-up was 59.7 months. Results: Of 207 patients, 91 (44%) experienced intravesical recurrence at a mean interval of 13.2 months. Among them, 66% (60/91) experienced intravesical recurrence within 12 months postoperatively. Eighty-nine percent of the recurred bladder tumors were superficial tumors and 64% were grade 1 or 2. Among the multiple parameters analyzed, LVI was the only significant predictor for intravesical recurrence in univariate and multivariate analysis (p=0.008; HR=1.911), whereas preoperative urine cytology was marginally significant. Similar results were obtained in the analysis for 184 patients without adjuvant therapy. Ten patients (11%) underwent muscle-invasive bladder tumor recurrence. Muscle-invasive bladder tumor recurrence was significantly associated with the presence of LVI compared with superficial bladder tumor recurrence (70% vs. 30%; p=0.005). Conclusions: LVI in primary UTTCC was a significant predictor of intravesical recurrence after curative surgery, whereas preoperative urine cytology was a possible predictor. Therefore, we recommend more rigorous cystoscopic follow-up in patients with these risk factors.

Predictors of Intravesical Recurrence After Radical Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma: An Inflammation-Based Prognostic Score

“…However, this remains a matter of debate. In our results, the previously considered prognostic factors of DURS [ 17 ], tumor stage, grade, size [ 23 ], LVI [ 24 ], location [ 4 , 5 , 13 ], adjuvant chemotherapy [ 14 ], and synchronous bladder cancer [ 16 ] were not associated significantly with bladder recurrence. However, the presence of DM, cortical thinning, GPS, and performance status were suggested to be independent prognostic parameters for bladder recurrence.…”

“…In the current study, tumor size was only associated with shorter overall survival in the univariate analysis. In a previous study, LVI was the significant predictor for intravesical recurrence [ 24 ]. However, our results were not in accord with previous reports.…”

“…To date, several studies have identified possible risk factors for subsequent intravesical recurrence in patients treated surgically for UTUC [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Proposed risk factors include tumor configuration, tumor multifocality, tumor stage and grade, tumor location, tumor size, lymphovascular invasion (LVI), patient gender, adjuvant chemotherapy, preoperative urine cytology, synchronous bladder cancer, diagnostic ureteroscopy (DURS), hydronephrosis, and diabetes mellitus (DM).…”