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

ObjectivesTo determine the independent risk factors of bladder recurrence in patients with upper urinary tract (UUT) urothelial carcinoma (UC).Materials and methodsA 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 nephroureterectomy was 37.5 months (range 1.0–174.0). The end-point of this study was defined as the initial intravesical recurrence of UC.ResultsOf 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.ConclusionsOur findings may be useful in patients with UUT-UC who may require more stringent follow-up by cystoscopy to detect bladder tumors.