The Patterns and Risk Factors for Subsequent Bladder Recurrence in Patients with Transitional Cell Carcinoma of the Upper Urinary Tract: A Long-Term Follow-Up Study

Hyun Min Choi; Kang Su Cho; Sung Yong Cho; Young Deuk Choi; Byung Ha Chung; Sung Joon Hong

doi:10.4111/kju.2008.49.4.294

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Choi, Cho, Cho, Choi, Chung, and Hong: The Patterns and Risk Factors for Subsequent Bladder Recurrence in Patients with Transitional Cell Carcinoma of the Upper Urinary Tract: A Long-Term Follow-Up Study

Original Article

Korean J Urol 2008;49(4):294-299.

Published online: 19 January 2008

DOI: https://doi.org/10.4111/kju.2008.49.4.294

The Patterns and Risk Factors for Subsequent Bladder Recurrence in Patients with Transitional Cell Carcinoma of the Upper Urinary Tract: A Long-Term Follow-Up Study

Hyun Min Choi, Kang Su Cho, Sung Yong Cho¹, Young Deuk Choi, Byung Ha Chung, Sung Joon Hong

From the Department of Urology, Urological Science Institute, Yonsei University, Inje College of Medicine, Seoul, University, Gimhae, Korea

¹Department of Urology, College of Medicine, Inje College of Medicine, Seoul, University, Gimhae, Korea

Received 10 December 2007 Accepted 19 February 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We wanted to evaluate the patterns and risk factors for subsequent bladder recurrence after surgical management for upper urinary tract transitional cell carcinoma (TCC).

Materials and Methods

Between 1986 and 2004, the medical records of the patients who were diagnosed and surgically treated for upper urinary tract TCC were retrospectively analyzed. A total of 215 patients were enrolled in this study, and the median follow-up duration was 53 months (range: 12-240). The bladder recurrence-free survival curve was generated by the Kaplan-Meier method. To investigate the risk factors for subsequent bladder recurrence among the various clinicopathological features, the log rank test and Cox's proportional hazard model were used.

Results

Recurrence developed in 81 patients (37.7%). Of them, 70 patients (86.4%) had recurred within 24 months, and 76 patients (93.8%) had superficial bladder cancer. Muscle-invasive bladder cancer developed in only 8 patients (9.9%) during follow-up. On univariate analysis, the T stage, age and urine cytology had an influence on bladder recurrence with statistical (borderline) significance. Multivariate analysis revealed that urine cytology was the only independent risk factor for bladder recurrence (p=0.020).

Conclusions

Subsequent bladder recurrence after treatment for upper urinary tract transitional cell cancer usually occurred within two years after surgery, and positive urine cytology is an independent prognostic factor for subsequent bladder recurrence.

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Keywords: Transitional cell carcinoma, Urinary tract, Bladder, Recurrence, Risk factors

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Fig. 1.

Bladder recurrence-free survival probability.

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Table 1.

Clinical and pathological characteristics of the patients

		No. of patients (%)
Sex	Male	152 (70.7)
Sex	Female	63 (29.3)
Age	＜63 years*	94 (43.7)
Age	≥63 years*	121 (56.3)
Location	Renal pelvis	52 (24.2)
	Upper ureter	23 (10.7)
	Mid ureter	24 (11.2)
	Lower ureter	116 (54.0)
T stage	Ta, 1	76 (35.3)
	T2	44 (20.5)
	T3	89 (41.4)
	T4	6 (2.8)
Tumor grade	Low	54 (25.1)
Tumor grade	High	161 (74.9)
Tumor size	＜3cm	106 (49.3)
Tumor size	≥3cm	109 (50.7)
Multiplicity	Single	174 (80.9)
Multiplicity	Multiple	41 (19.1)
Previous bladder tumor	Presense	6 (2.8)
Previous bladder tumor	Absense	209 (97.2)
Concomitant bladder tumor	Presense	33 (15.3)
Concomitant bladder tumor	Absense	182 (84.7)
RGP or URS	Performed	125 (58.1)
RGP or URS	Not performed	90 (41.9)
Operation	Nephroureterectomy	203 (94.4)
Operation	Renal sparing surgery	12 (5.6)
Urine cytology	Positive	28 (13.0)
	Negative	170 (79.1)
	Not available	17 (7.9)
Total		215 (100)

^* : median age, RGP: retrograde pyelography, URS: ureterorenoscopy

Table 2.

Univariate analysis of the risk factors for bladder recurrence after surgery for upper urinary tract transitional cell carcinoma

		Five-year BRFS (%)	p-value
Age	＜63 years*	64.0	0.071
Age	≥63 years*	53.7
Location	Renal pelvis	58.2	0.959
	Upper ureter	69.1
	Mid ureter	61.2
	Lower ureter	56.5
T stage	Ta, 1	61.8	0.057
T stage	T2-4	56.5
Tumor grade	Low	56.9	0.652
Tumor grade	High	58.5
Tumor size	＜3cm	65.0	0.312
Tumor size	^≥3cm	61.9
Multiplicity	Single	59.3	0.663
Multiplicity	Multiple	53.1
Previous bladder tumor	Presense	33.3	0.156
Previous bladder tumor	Absense	58.9
Concomitant bladder tumor	Presense	55.7	0.389
Concomitant bladder tumor	Absense	58.8
RGP or URS	Performed	64.2	0.547
RGP or URS	Not performed	60.6
Operation	Nephroureterectomy	74.7	0.813
Operation	Renal sparing surgery	57.1
Urine cytology	Positive	46.5	0.046
Urine cytology	Negative	60.2

BRFS: bladder recurrence-free survival, BT: bladder tumor, *: median age, RGP: retrograde pyelography, URS: ureterorenoscopy, p-value: by log-rank test

Table 3.

Univariate analysis of the risk factors for bladder recurrence after surgery for upper urinary tract transitional cell carcinoma

	Hazard ratio	95% confidence interval	p-value
Age	1.49	0.94-2.36	0.087
Urine cytology	1.90	1.05-3.41	0.031
T stage	1.20	0.75-1.92	0.431

p-value: by multivariate Cox proportional hazard model

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