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Risk factors for intravesical recurrence after nephroureterectomy in patients with upper urinary tract urothelial carcinoma

  • Urology - Original Paper
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Abstract

Purpose

To determine major risk factors for bladder cancer (BC) recurrence after nephroureterectomy (Nux) by focusing on the pathologic appearances of tumors in upper urinary tract urothelial carcinomas (UUTUCs).

Methods

We performed 147 Nux procedures between November 2002 and September 2015. Forty-eight patients were excluded because of a history of BC (28 patients), previous or concurrent radical cystectomy (9 patients), neoadjuvant chemotherapy (5 patients), and other reasons (6 patients). We classified UUTUCs into three types: renal pelvic, short-length ureteral, and long-length ureteral cancer; the cutoff for categorizing short- versus long-length ureteral cancer was the median tumor length. Univariate and multivariate analyses with Cox regression methods were performed to calculate hazard ratios (HRs) for BC recurrence using nine clinical covariates, including our new pathologic classification.

Results

The median follow-up period for the survivors was 60 months (range 1–157 months). Of 99 patients, 36 (36%) had BC recurrence; of these 36 patients, 30 (85%) experienced recurrence within 2 years and 17 (47%) had invasive BC (≥pT1). Statistical analyses demonstrated that pathologic tumor type was the major significant risk factor for BC recurrence. Long-length (>5 cm) ureteral cancer had the highest risk of BC recurrence compared to other tumor types (multivariate HR 2.1; 95% confidence interval 1.03–4.2).

Conclusions

Our simple classification system based on the tumor’s pathologic appearance is useful for predicting BC recurrence. Patients with long-length ureteral cancer have a high risk of BC recurrence.

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Acknowledgements

The authors thank Katsuhiro Omae for his assistance with statistical analysis.

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Authors and Affiliations

  1. Division of Urology, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi, Suntougun, Shizuoka, 411-8777, Japan

    Ryo Yamashita, Hideo Shinsaka, Masafumi Nakamura, Masato Matsuzaki & Masashi Niwakawa

  2. Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan

    Reiko Watanabe & Ichiro Ito

Authors
  1. Ryo Yamashita
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  2. Reiko Watanabe
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  3. Ichiro Ito
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  4. Hideo Shinsaka
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  5. Masafumi Nakamura
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  6. Masato Matsuzaki
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  7. Masashi Niwakawa
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Correspondence to Ryo Yamashita.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The requirement for informed consent was waived owing to the retrospective nature of this study.

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Yamashita, R., Watanabe, R., Ito, I. et al. Risk factors for intravesical recurrence after nephroureterectomy in patients with upper urinary tract urothelial carcinoma. Int Urol Nephrol 49, 425–430 (2017). https://doi.org/10.1007/s11255-017-1510-5

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  • DOI: https://doi.org/10.1007/s11255-017-1510-5

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