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Independent Predictors for Bladder Outcomes after Treatment of Intravesical Recurrence following Radical Nephroureterectomy in Patients with Primary Upper Tract Urothelial Carcinoma |
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| Authors: | Nobuyuki Tanaka MD Eiji Kikuchi MD PhD Kent Kanao MD PhD Kazuhiro Matsumoto MD Suguru Shirotake MD PhD Hiroaki Kobayashi MD Yasumasa Miyazaki MD Hiroki Ide MD Jun Obata MD Katsura Hoshino MD Nozomi Hayakawa MD Masayuki Hagiwara MD Takeo Kosaka MD PhD Masafumi Oyama MD PhD Akira Miyajima MD PhD Tetsuo Momma MD PhD Ken Nakagawa MD PhD Masahiro Jinzaki MD PhD Shintaro Hasegawa MD PhD Yosuke Nakajima MD PhD Mototsugu Oya MD PhD |
| Affiliation: | 1. Department of Urology, Keio University School of Medicine, Tokyo, Japan 2. Department of Urology, Musashino Yowakai Hospital, Tokyo, Japan 3. Department of Urology, Saiseikai Central Hospital, Tokyo, Japan 4. Department of Urology, International Medical Center-Comprehensive Cancer Center, Saitama Medical University, Saitama, Japan 5. Department of Urology, Kyosai Tachikawa Hospital, Tokyo, Japan 6. Department of Urology, Ogikubo Hospital, Tokyo, Japan 7. Department of Urology, Saitama City Hospital, Saitama, Japan 8. Department of Urology, Inagi City Hospital, Tokyo, Japan 9. Department of Urology, National Hospital Organization Tochigi Hospital, Tochigi, Japan 10. Department of Urology, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan 11. Department of Urology, National Hospital Organization Saitama Hospital, Saitama, Japan 12. Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan |
| Abstract: | BackgroundFew 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.MethodsA 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.ResultsNinety-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.ConclusionsThis 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. |
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