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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

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Acknowledgment

Members of the Keio Collaboration Study of Urothelial Carcinoma participated in this study: Keishiro Fukumoto, Keio University School of Medicine, Tokyo; So Nakamura, Saiseikai Central Hospital, Tokyo; Yujiro Ito, Takeshi Masuda, Saitama Municipal Hospital, Saitama; Kiichiro Kodaira, Munehisa Ueno, International Medical Center-Comprehensive Cancer Center, Saitama Medical University, Saitama; Atsushi Uchida, Kyosai Tachikawa Hospital, Tokyo; Kazuhiko Nagakura, Musashino Yowakai Hospital, Tokyo; Masakazu Ohashi, Ogikubo Hospital, Tokyo; Shoji Matsuzaki, Inagi Municipal Hospital, Tokyo; Kazutoyo Miyata, Irumagawa Hospital, Saitama; and Michio Kosugi, Seiichi Iinuma, Eiju Hospital, Tokyo, Japan. This work was supported in part by Grants-in-Aid for Scientific Research (#24791671 to N. Tanaka) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan. This work was also supported in part by a Keio University Grant-in-Aid for Encouragement of Young Medical Scientists (#02-002-0021 to N. Tanaka) from the Keio University School of Medicine.

Funding

The work had no specific funding or financial support.

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Authors and Affiliations

  1. Department of Urology, Keio University School of Medicine, Tokyo, Japan

    Nobuyuki Tanaka MD, Eiji Kikuchi MD, PhD, Kent Kanao MD, PhD, Kazuhiro Matsumoto MD, Suguru Shirotake MD, PhD, Hiroaki Kobayashi MD, Yasumasa Miyazaki MD, Jun Obata MD, Katsura Hoshino MD, Nozomi Hayakawa MD, Masayuki Hagiwara MD, Takeo Kosaka MD, PhD, Akira Miyajima MD, PhD, Ken Nakagawa MD, PhD & Mototsugu Oya MD, PhD

  2. Department of Urology, Musashino Yowakai Hospital, Tokyo, Japan

    Nobuyuki Tanaka MD

  3. Department of Urology, Saiseikai Central Hospital, Tokyo, Japan

    Kazuhiro Matsumoto MD & Nozomi Hayakawa MD

  4. Department of Urology, International Medical Center-Comprehensive Cancer Center, Saitama Medical University, Saitama, Japan

    Suguru Shirotake MD, PhD & Masafumi Oyama MD, PhD

  5. Department of Urology, Kyosai Tachikawa Hospital, Tokyo, Japan

    Hiroaki Kobayashi MD

  6. Department of Urology, Ogikubo Hospital, Tokyo, Japan

    Yasumasa Miyazaki MD

  7. Department of Urology, Saitama City Hospital, Saitama, Japan

    Hiroki Ide MD

  8. Department of Urology, Inagi City Hospital, Tokyo, Japan

    Hiroki Ide MD

  9. Department of Urology, National Hospital Organization Tochigi Hospital, Tochigi, Japan

    Jun Obata MD & Shintaro Hasegawa MD, PhD

  10. Department of Urology, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan

    Katsura Hoshino MD & Yosuke Nakajima MD, PhD

  11. Department of Urology, National Hospital Organization Saitama Hospital, Saitama, Japan

    Tetsuo Momma MD, PhD

  12. Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan

    Masahiro Jinzaki MD, PhD

Authors
  1. Nobuyuki Tanaka MD
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  2. Eiji Kikuchi MD, PhD
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  3. Kent Kanao MD, PhD
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  4. Kazuhiro Matsumoto MD
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  5. Suguru Shirotake MD, PhD
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  6. Hiroaki Kobayashi MD
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  7. Yasumasa Miyazaki MD
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  8. Hiroki Ide MD
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  9. Jun Obata MD
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  10. Katsura Hoshino MD
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  11. Nozomi Hayakawa MD
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  12. Masayuki Hagiwara MD
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  13. Takeo Kosaka MD, PhD
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  14. Masafumi Oyama MD, PhD
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  15. Akira Miyajima MD, PhD
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  16. Tetsuo Momma MD, PhD
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  17. Ken Nakagawa MD, PhD
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  18. Masahiro Jinzaki MD, PhD
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  19. Shintaro Hasegawa MD, PhD
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  20. Yosuke Nakajima MD, PhD
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  21. Mototsugu Oya MD, PhD
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Corresponding author

Correspondence to Eiji Kikuchi MD, PhD.

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Tanaka, N., Kikuchi, E., Kanao, K. et al. Independent Predictors for Bladder Outcomes after Treatment of Intravesical Recurrence following Radical Nephroureterectomy in Patients with Primary Upper Tract Urothelial Carcinoma. Ann Surg Oncol 21, 3151–3158 (2014). https://doi.org/10.1245/s10434-014-3657-y

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  • DOI: https://doi.org/10.1245/s10434-014-3657-y

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