Bup Wan Kim1, Yun-Sok Ha1, Jun Nyung Lee1, Hyun Tae Kim1, Tae-Hwan Kim1, Jung Keun Lee2, Seok-Soo Byun2, Young Deuk Choi3, Ho Won Kang4, Seok-Joong Yun4, Wun-Jae Kim4, Young Suk Kwon5, Tae Gyun Kwon1. 1. Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea. 2. Department of Urology, Seoul National University, Bundang Hospital, Seongnam, Korea. 3. Department of Urology and Urological Science Institute, College of Medicine, Yonsei University, Seoul, Korea. 4. Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Chungbuk, Korea. 5. Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Abstract
PURPOSE: To evaluate the effects of the presence of previous or synchronous non-muscle invasive bladder cancer (NMIBC) on the oncologic outcomes of radical nephroureterectomy in patients with upper tract urothelial carcinoma (UTUC). MATERIALS AND METHODS: In total, 505 patients with UTUC were enrolled from four different institutions. The clinicopathologic parameters of patients with and without previous or synchronous NMIBC were compared, and Kaplan-Meier estimates and multivariate Cox regression analyses were performed. RESULTS: The median follow-up period was 38.4 months. In all, 408 patients had primary UTUC, 45 (8.9%) had a history of NMIBC, 59 (11.7%) had concomitant bladder cancer, and seven (1.4%) had experienced both. Tumors in patients with associated NMIBC were more commonly multifocal (P = .001) and associated with surgical margin positivity (P = .001). Kaplan-Meier estimates revealed that previous or synchronous NMIBC was significantly associated with bladder recurrence (P < .001) and locoregional recurrence/distant metastasis (P = .008). A multivariate Cox regression model identified previous or synchronous NMIBC as an independent predictor of bladder recurrence (P < .001). However, the presence of previous or synchronous NMIBC was not a prognostic indicator of locoregional recurrence/distant metastasis. CONCLUSION: In patients with UTUC, previous or synchronous NMIBC was significantly associated with an increased risk of cancer recurrences in the bladder after radical nephroureterectomy. The present findings suggest that a close monitoring should be required for the patients with previous or concomitant NMIBC.
PURPOSE: To evaluate the effects of the presence of previous or synchronous non-muscle invasive bladder cancer (NMIBC) on the oncologic outcomes of radical nephroureterectomy in patients with upper tract urothelial carcinoma (UTUC). MATERIALS AND METHODS: In total, 505 patients with UTUC were enrolled from four different institutions. The clinicopathologic parameters of patients with and without previous or synchronous NMIBC were compared, and Kaplan-Meier estimates and multivariate Cox regression analyses were performed. RESULTS: The median follow-up period was 38.4 months. In all, 408 patients had primary UTUC, 45 (8.9%) had a history of NMIBC, 59 (11.7%) had concomitant bladder cancer, and seven (1.4%) had experienced both. Tumors in patients with associated NMIBC were more commonly multifocal (P = .001) and associated with surgical margin positivity (P = .001). Kaplan-Meier estimates revealed that previous or synchronous NMIBC was significantly associated with bladder recurrence (P < .001) and locoregional recurrence/distant metastasis (P = .008). A multivariate Cox regression model identified previous or synchronous NMIBC as an independent predictor of bladder recurrence (P < .001). However, the presence of previous or synchronous NMIBC was not a prognostic indicator of locoregional recurrence/distant metastasis. CONCLUSION: In patients with UTUC, previous or synchronous NMIBC was significantly associated with an increased risk of cancer recurrences in the bladder after radical nephroureterectomy. The present findings suggest that a close monitoring should be required for the patients with previous or concomitant NMIBC.