Top

Published in:

01-04-2012 | Original Article

Preoperative positive urine cytology is a risk factor for subsequent development of bladder cancer after nephroureterectomy in patients with upper urinary tract urothelial carcinoma

Authors: Yasuyuki Kobayashi, Takashi Saika, Yoshiyuki Miyaji, Michinao Saegusa, Ryoji Arata, Naoki Akebi, Tadasu Takenaka, Daisuke Manabe, Yasutomo Nasu, Hiromi Kumon

Published in: World Journal of Urology | Issue 2/2012

Abstract

Purpose

To determine the independent risk factors of bladder recurrence in patients with upper urinary tract urothelial carcinoma (UUT-UC).

Methods

A total of 364 patients underwent nephroureterectomy (NUx) for UUT-UC between January 2005 and April 2009 in Okayama University and 17 affiliated hospitals. Patients with concomitant bladder cancer were excluded from the analysis. The clinicopathologic data for the remaining 288 patients with UUT-UC were retrospectively reviewed. Median follow-up after NUx was 20.2 months. The following variables were evaluated for any association with bladder recurrence: sex, age, tumor stage, tumor grade, venous invasion, lymphatic invasion, tumor location, multifocality, surgical modalities, time of ligation of the ureter, and preoperative urine cytology. The significance of each variable was tested univariately using the log-rank test. The simultaneous effects of multiple risk factors were estimated by multiple regression analysis using the Cox proportional hazards model.

Results

Bladder recurrence occurred in 103 patients (35.8%). Median time to first bladder recurrence was 6.9 months. Significant risk factors for bladder recurrences on univariate analysis were tumor location (P = 0.046) and preoperative positive urine cytology (P < 0.001). Multivariate analysis revealed that preoperative urine cytology positive was significant for bladder recurrence (HR: 1.977; 95% CI: 1.310–2.983, P = 0.001).

Conclusion

Risk factor for subsequent development of bladder cancer after NUx was preoperative positive urine cytology.

Sakamoto N, Naito S, Kotoh S et al (1991) Recurrence of bladder tumors following surgery for transitional cell carcinoma of the upper urinary tract. Eur Urol 20:136–139PubMed

Batata MA, Whitmore WF, Hilaris BS, Tokita N, Grabstald H (1975) Primary carcinoma of the ureter: a prognostic study. Cancer 35:1626–1632PubMedCrossRef

Mufti GR, Gove JR, Badenoch DF et al (1989) Transitional cell carcinoma of the renal pelvis and ureter. Br J Urol 63:135–140PubMedCrossRef

Steffens J, Nagel R (1988) Tumours of the renal pelvis and ureter. Observations in 170 patients. Br J Urol 61:277–283PubMedCrossRef

Huben RP, Mounzer AM, Murphy GP (1988) Tumor grade and stage as prognostic variables in upper tract urothelial tumors. Cancer 62:2016–2020PubMedCrossRef

Miyake H, Hara I, Kamidono S, Eto H (2004) Multifocal transitional cell carcinoma of the bladder and upper urinary tract: molecular screening of clonal origin by characterizing CD44 alternative splicing patterns. J Urol 172:1127–1129PubMedCrossRef

Habuchi T, Takahashi R, Yamada H, Kakehi Y, Sugiyama T, Yoshida O (1993) Metachronous multifocal development of urothelial cancers by intraluminal seeding. Lancet 342:1087–1088PubMedCrossRef

Hafner C, Knuechel R, Stoehr R, Hartmann A (2002) Clonality of multifocal urothelial carcinomas: 10 years of molecular genetic studies. Int J Cancer 101:1–6PubMedCrossRef

Hafner C, Knuechel R, Zanardo L et al (2001) Evidence for oligoclonality and tumor spread by intraluminal seeding in multifocal urothelial carcinomas of the upper and lower urinary tract. Oncogene 20:4910–4915PubMedCrossRef

10.

Vriesema JL, Aben KK, Witjes JA, Kiemeney LA, Schalken JA (2001) Superficial and metachronous invasive bladder carcinomas are clonally related. Int J Cancer 93:699–702PubMedCrossRef

11.

Catto JW, Yates DR, Rehman I et al (2007) Behavior of urothelial carcinoma with respect to anatomical location. J Urol 177:1715–1720PubMedCrossRef

12.

Catto JW, Hartmann A, Stoehr R et al (2006) Multifocal urothelial cancers with the mutator phenotype are of monoclonal origin and require panurothelial treatment for tumor clearance. J Urol 175:2323–2330PubMedCrossRef

13.

Kirkali Z, Tuzel E (2003) Transitional cell carcinoma of the ureter and renal pelvis. Crit Rev Oncol Hematol 47:155–169PubMedCrossRef

14.

Palou J, Rodriguez-Rubio F, Huguet J et al (2005) Multivariate analysis of clinical parameters of synchronous primary superficial bladder cancer and upper urinary tract tumor. J Urol 174:859–861, discussion 61PubMedCrossRef

15.

Azemar MD, Comperat E, Richard F, Cussenot O, Roupret M (2009) Bladder recurrence after surgery for upper urinary tract urothelial cell carcinoma: frequency, risk factors, and surveillance. Urol Oncol 29:130–136

16.

Koda S, Mita K, Shigeta M, Usui T (2007) Risk factors for intravesical recurrence following urothelial carcinoma of the upper urinary tract: no relationship to the mode of surgery. Jpn J Clin Oncol 37:296–301PubMedCrossRef

17.

Mullerad M, Russo P, Golijanin D et al (2004) Bladder cancer as a prognostic factor for upper tract transitional cell carcinoma. J Urol 172:2177–2181PubMedCrossRef

18.

Matsui Y, Utsunomiya N, Ichioka K et al (2005) Risk factors for subsequent development of bladder cancer after primary transitional cell carcinoma of the upper urinary tract. Urology 65:279–283PubMedCrossRef

19.

Zigeuner RE, Hutterer G, Chromecki T, Rehak P, Langner C (2006) Bladder tumour development after urothelial carcinoma of the upper urinary tract is related to primary tumour location. BJU Int 98:1181–1186PubMedCrossRef

20.

Terakawa T, Miyake H, Muramaki M, Takenaka A, Hara I, Fujisawa M (2008) Risk factors for intravesical recurrence after surgical management of transitional cell carcinoma of the upper urinary tract. Urology 71:123–127PubMedCrossRef

21.

Raman JD, Messer J, Sielatycki JA, Hollenbeak CS (2011) Incidence and survival of patients with carcinoma of the ureter and renal pelvis in the USA, 1973–2005. BJU Int 107:1059–1064

22.

Wu WJ, Ke HL, Yang YH, Li CC, Chou YH, Huang CH (2010) Should patients with primary upper urinary tract cancer receive prophylactic intravesical chemotherapy after nephroureterectomy? J Urol 183:56–61

Title: Preoperative positive urine cytology is a risk factor for subsequent development of bladder cancer after nephroureterectomy in patients with upper urinary tract urothelial carcinoma
Authors: Yasuyuki Kobayashi
Takashi Saika
Yoshiyuki Miyaji
Michinao Saegusa
Ryoji Arata
Naoki Akebi
Tadasu Takenaka
Daisuke Manabe
Yasutomo Nasu
Hiromi Kumon
Publication date: 01-04-2012
Publisher: Springer-Verlag
Published in: World Journal of Urology / Issue 2/2012
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-011-0731-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Preoperative positive urine cytology is a risk factor for subsequent development of bladder cancer after nephroureterectomy in patients with upper urinary tract urothelial carcinoma

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2012

Prospective blinded comparison of real-time sonoelastography targeted versus randomised biopsy of the prostate in the primary and re-biopsy setting

The effects of warm ischaemia time on renal function after laparoscopic partial nephrectomy in patients with normal contralateral kidney

Biopsy and treatment decisions in the initial management of prostate cancer and the role of PCA3; a systematic analysis of expert opinion

Sequence variants of toll-like receptor 4 (TLR4) and the risk of prostate cancer in Korean men

Editorial for special issue on epidemiology and prevention of prostate cancer

Diet and prostate cancer prevention