Independent predictors of metachronous bladder transitional cell carcinoma (TCC) after nephroureterectomy for TCC of the upper urinary tract

• Published in: BJU international Vol. 101; no. 11; pp. 1368 - 1374
• Main Authors: Novara, Giacomo, De Marco, Vincenzo, Dalpiaz, Orietta, Gottardo, Fedra, Bouygues, Vianney, Galfano, Antonio, Martignoni, Guido, Patard, Jean Jacques, Artibani, Walter, Ficarra, Vincenzo
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-06-2008; Blackwell; Wiley
• Subjects: Aged; Biological and medical sciences; bladder cancer; Cancer; Carcinoma, Transitional Cell; Carcinoma, Transitional Cell - diagnosis; Carcinoma, Transitional Cell - surgery; Female; Follow-Up Studies; Human health and pathology; Humans; Life Sciences; Male; Medical sciences; Multivariate Analysis; Neoplasms, Second Primary; Neoplasms, Second Primary - diagnosis; Nephrectomy; Nephrectomy - methods; Nephrology. Urinary tract diseases; nephroureterectomy; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; transitional cell carcinoma; Tumors of the urinary system; upper urinary tract; ureterectomy; Urinary Bladder Neoplasms; Urinary Bladder Neoplasms - diagnosis; Urinary Bladder Neoplasms - surgery; Urinary tract. Prostate gland; Urologic Neoplasms; Human; Nephrology; Urinary system disease; Prognosis; Nephroureterectomy; Urinary tract disease; Malignant tumor; Transitional cell carcinoma; Upper urinary tract transitional cell carcinoma; upper urinary tract; Bladder cancer; Baldder transitional cell carcinoma; Urology; Ureterectomy; Cancerology; Treatment; Surgery; Bladder disease; Predictive factor; Cancer
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2008.07438.x

OBJECTIVE
To identify the prognostic factors predictive of metachronous bladder transitional cell carcinoma (TCC) in a multi‐institutional dataset of patients who had undergone nephroureterectomy (NU) for nonmetastatic upper urinary tract (UUT) TCC.
PATIENTS AND METHODS
The clinical and pathological data of 231 patients who had had NU for UUT‐TCC from 1989 to 2005 in three European centres were collected retrospectively, and analysed for clinical and pathological variables.
RESULTS
The median follow‐up was 38 months; during the follow‐up, bladder TCC was detected in 109 patients (47.2%), and was significantly more common in patients who had UUT‐TCC after previous bladder TCC (P < 0.001), in those with ureteric cancer (P = 0.022), and in those with pT2 UUT‐TCC (P = 0.017). On multivariate analysis, a previous history of bladder TCC was the only independent predictor of metachronous bladder TCC (hazard ratio 2.825; P < 0.001). The 5‐year probability of being free from metachronous bladder TCC was 45.5%. A history of bladder TCC (P < 0.001) and UUT tumour site (P = 0.01) were significantly associated with the probability of bladder recurrence‐free survival. On multivariate analyses, a previous history of bladder TCC (hazard ratio 2.226; P < 0.001) and the presence of ureteric TCC (1.562; P = 0.036) were independent predictors of the probabilities of being free from metachronous bladder TCC.
CONCLUSION
In this multi‐institutional study of patients who had had NU for UUT‐TCC, a history of bladder TCC was the only independent predictor of metachronous bladder TCC, while both a history of bladder TCC and the presence of ureteric tumours were predictive of the probabilities of being free from metachronous bladder TCC.