Independent predictors for bladder outcomes after treatment of intravesical recurrence following radical nephroureterectomy in patients with primary upper tract urothelial carcinoma

Nobuyuki Tanaka, Eiji Kikuchi, Kent Kanao, Kazuhiro Matsumoto, Suguru Shirotake, Hiroaki Kobayashi, Yasumasa Miyazaki, Hiroki Ide, Jun Obata, Katsura Hoshino, Nozomi Hayakawa, Masayuki Hagiwara, Takeo Kosaka, Masafumi Oyama, Akira Miyajima, Tetsuo Momma, Ken Nakagawa, Masahiro Jinzaki, Shintaro Hasegawa, Yosuke NakajimaMototsugu Oya

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)

Abstract

Background. Few studies have described the clinical courses and outcomes in the bladder after treatment of intravesical recurrence after radical nephroureterectomy (RNU) in patients with primary upper tract urothelial carcinoma (UTUC). We investigated the indicators for predicting subsequent bladder outcomes after treatment of intravesical recurrence after RNU. Methods. A total of 241 patients with primary UTUC (pTa-4N0M0) who experienced intravesical recurrence after RNU were included. Of these patients, 101 (41.9 %) underwent Bacillus Calmette-Guérin treatments, whereas 49 (20.3 %) underwent intravesical chemotherapy. The median follow-up period after initial transurethral resection of the bladder tumor was 33 months. Relationships with bladder outcomes were analyzed by using multivariable analysis. Results. Ninety-six patients experienced intravesical recurrence, and bladder progression was observed in 13. Cumulative incidence rates of intravesical recurrence at 1 and 5 years after treatment of the first intravesical recurrence were 31.0 and 48.4 %, whereas those of bladder progression at 1 and 5 years thereafter were 2.4 and 8.0 %. Multivariate analysis showed that the number of recurrent tumors and pT1 tumors at the time of the first intravesical relapse were independent risk factors for subsequent intravesical recurrence. With respect to bladder progression, multivariate analysis showed that pT1 tumors, the appearance of concomitant carcinoma-in situ at the time of the first intravesical relapse, and the absence of the Bacillus Calmette-Guérin treatment were independent risk factors. Conclusions. This retrospective study presents a detailed picture of further bladder outcomes after intravesical recurrence after RNU in primary UTUC patients. The results may assist physicians to develop a more rational protocol in bladder surveillance.

Original languageEnglish
Pages (from-to)3151-3158
Number of pages8
JournalAnnals of Surgical Oncology
Volume21
Issue number9
DOIs
Publication statusPublished - 2014 Sep

ASJC Scopus subject areas

  • Surgery
  • Oncology

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