Concomitant CIS Is a Risk Factor for the Occurrence of High Risk Bladder Cancer after Radical Nephroureterectomy
Toyonori Tsuzuki, Tsuyoshi Majima, Naoto Sassa, Shohei Ishida, Ryohei Hattori, Momokazu Gotoh. Nagoya Daini Red Cross Hospital, Nagoya, Japan; Nagoya University Hospital, Nagoya, Japan; Chukyo Hospital, Nagoya, Japan; Nagoya Firsti Red Cross Hospital, Nagoya, Japan
Background: Twenty to 50% of patients who have radical nephroureterectomy for upper urinary tract urothelial cancer subsequently develop bladder recurrence. Some of them recurred as high risk bladder cancers, which are advanced or Bacille de Calmette et Guérin (BCG) resistant, and require radical cystectomy. This study investigates the factors contributing to the occurrence of high risk bladder cancer after radical nephroureterectomy for upper urinary tract urothelial cancer.
Design: A total of 214 patients who developed intravesical recurrence following radical nephroureterectomy for upper urinary tract urothelial cancer were retrospectively analysed. Univariate and multivariate Cox regression models addressed high risk bladder cancer recurrence-free survival.
Results: Among 214 patients, 45 (21%) developed high risk bladder cancer at a median of 13 months (range, 3–93 months) following radical nephroureterectomy. The 5-year high risk bladder cancer recurrence-free survival was 78%. Thirty patients of those had lesions at high risk of progression (7 points or higher on the EORTC risk table); 12 patients had a pT2-stage or higher lesion; 3 patients had carcinoma in situ lesion resistance to 2 cycles of intravesical BCG therapy. In univariate analysis, age (>70 years) and concomitant carcinoma in situ were significantly associated with the occurrence of high risk bladder cancer (HR 2.14, 95% CI 1.18–3.88, p = 0.011; and HR 8.06, 95% CI 2.48–26.13, p < 0.001). In multivariate analysis, only concomitant CIS had a significant impact on recurrence (HR 8.78, 95% CI 2.08–37.9, p = 0.004).
Conclusions: Concomitant carcinoma in situ is a risk factor for the occurrence of high risk bladder cancer after radical nephroureterectomy.
Category: Genitourinary (including renal tumors)
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 157, Wednesday Morning