Pattern and risk factors of intravesical recurrence after nephroureterectomy for upper tract urothelial carcinoma: a large Chinese center experience

Dong Fang; Geng-Yan Xiong; Xue-Song Li; Xiao-Peng Chen; Lei Zhang; Lin Yao; Zhi-Song He; Li-Qun Zhou

doi:10.1016/j.jfma.2013.11.004

Pattern and risk factors of intravesical recurrence after nephroureterectomy for upper tract urothelial carcinoma: a large Chinese center experience

J Formos Med Assoc. 2014 Nov;113(11):820-7. doi: 10.1016/j.jfma.2013.11.004. Epub 2013 Dec 19.

Authors

Dong Fang¹, Geng-Yan Xiong¹, Xue-Song Li², Xiao-Peng Chen¹, Lei Zhang¹, Lin Yao¹, Zhi-Song He¹, Li-Qun Zhou³

Affiliations

¹ Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
² Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China. Electronic address: pineneedle@sina.com.
³ Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China. Electronic address: zhouliqunmail@sina.com.

PMID: 24360737
DOI: 10.1016/j.jfma.2013.11.004

Abstract

Background/purpose: There is currently no consensus about the pattern and risk factors of bladder recurrence after nephroureterectomy, especially in the Chinese population. We evaluated the pattern and risk factors based on data from a large Chinese center.

Methods: The clinical and pathological data of 438 patients with upper tract urothelial carcinoma (UTUC), who underwent nephroureterectomy at Peking University First Hospital, Beijing, China between 2000 and 2010, was retrospectively analyzed. Univariate analysis by log-rank test and multivariate analysis by Cox proportional hazards regression model were used to determine the independent risk factors.

Results: A total of 135 patients (30.8%) developed intravesical recurrence within a median follow-up of 45 months (range: 12-144 months). The median interval of bladder recurrence was 15 months (range: 2.0-98.0 months), and the two peaks for recurrence were 4-6 months and 17-19 months. Lower tumor grade, tumor multifocality, concomitant carcinoma in situ (CIS) and tumors located in the lower ureter were significant risk factors by univariate and multivariate analysis. A risk-scoring system was developed and a significant difference was found between different risk evaluations. Patients with concomitant CIS tended to develop a late bladder recurrence. One hundred and eighteen patients (87.4%) received transurethral resection after bladder tumor recurrence.

Conclusion: Lower tumor grade, tumor multifocality, concomitant CIS and tumors located in the lower ureter tend to be predictive for bladder recurrence after nephroureterectomy, although the underlying mechanism is not fully elucidated, and the scoring system could help risk stratification. Most recurrent tumors could be treated by transurethral resection and there were two peaks for recurrence, which is probably related to the mechanisms and may be unique to the Chinese population.

Keywords: bladder tumor; nephroureterectomy; recurrence; risk factors; upper tract urothelial carcinoma (UTUC).

MeSH terms

Adult
Aged
Aged, 80 and over
Carcinoma, Transitional Cell / surgery*
China
Female
Humans
Male
Middle Aged
Multivariate Analysis
Neoplasm Recurrence, Local / pathology*
Nephrectomy / methods
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk Factors
Ureter / surgery*
Urinary Bladder Neoplasms / pathology*
Urinary Bladder Neoplasms / surgery*
Young Adult