Bladder mapping of tumour recurrence after radical nephroureterectomy for upper tract urothelial carcinoma and its influence on oncological outcomes.

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  • Additional Information
    • Source:
      Publisher: Blackwell Science Country of Publication: England NLM ID: 100886721 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1464-410X (Electronic) Linking ISSN: 14644096 NLM ISO Abbreviation: BJU Int Subsets: MEDLINE
    • Publication Information:
      Original Publication: Oxford, UK : Blackwell Science, c1999-
    • Subject Terms:
      Laparoscopy* ; Nephroureterectomy* ; Ureteroscopy*; Carcinoma, Transitional Cell/*pathology ; Neoplasm Recurrence, Local/*pathology ; Ureteral Neoplasms/*pathology; Aged ; Carcinoma, Transitional Cell/diagnostic imaging ; Carcinoma, Transitional Cell/surgery ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Treatment Outcome ; Ureteral Neoplasms/diagnostic imaging ; Ureteral Neoplasms/surgery
    • Abstract:
      Objectives: To assess the location of intravesical recurrence (IVR) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), to determine the main predictive factors for IVR in the bladder-cuff area (BCA), and to assess the effect of BCA recurrence (BCAR) on prognosis.
      Patients and Methods: This was a multicentre, retrospective study using the French collaborative database on UTUC, which includes data for all patients treated in 24 referral uro-oncology centres across the country. All patients who underwent RNU with bladder-cuff excision and who developed IVR between 1995 and 2010 were selected. Patients were divided into two groups: Group A: BCAR; and Group B: recurrence elsewhere in the bladder. The Kaplan-Meier method was used to estimate the probability of BCAR-free survival. Groups were compared using the log-rank test. Independent risk factors for BCAR were identified using a Cox proportional hazard regression model, with univariate and multivariate analyses.
      Results: Overall, 163 patients were included in the final analysis: Group A, 87 patients (53.4%) and Group B, 76 (46.6%). The clinicopathological characteristics were similar in the groups. The median (interquartile range [IQR]) follow-up was 36 (31.7-40.39) months. The median (IQR) time to IVR was 10.0 (8.6-13.39) months [Group A: 11.0 (8.8-13.2)  months vs Group B: 10.0 (8.5-11.5) months; P = 0.35]. The probability of BCAR at 1, 2, and 3 years was 45.5% (95% confidence interval [CI] 40.1-50.9), 17.9% (95% CI 13.7-22.1), and 10.8% (95% CI 7.4-14.2) respectively, whereas the probability of recurrence elsewhere in the bladder was 42.1% (95% CI 36.4-47.8), 14.7% (95% CI 10.6-18.8), and 4.4% (95% CI 1.9-6.9), respectively (P = 0.35). Pathological tumour stage (≥pT3) was significantly related to the risk of BCAR (P = 0.03).
      Conclusion: There were more BCARs after RNU in advanced UTUC. However, no preferred site for recurrence was detected.
      (© 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.)
    • Contributed Indexing:
      Keywords: #uroonc; #utuc; intravesical recurrence; radical nephroureterectomy; risk factors; upper tract urothelial carcinoma
    • Publication Date:
      Date Created: 20181215 Date Completed: 20191217 Latest Revision: 20191217
    • Publication Date:
      20231215
    • Accession Number:
      10.1111/bju.14647
    • Accession Number:
      30548115