Predictors of Bladder Tumor Recurrence after Curative Surgery for Upper Urinary Tract Transitional Cell Carcinoma

Seong-Heon Ha; Jinsung Park; Jun Hyuk Hong; Choung-Soo Kim; Hanjong Ahn

doi:10.4111/kju.2009.50.7.635

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Ha, Park, Hong, Kim, and Ahn: Predictors of Bladder Tumor Recurrence after Curative Surgery for Upper Urinary Tract Transitional Cell Carcinoma

Original Article

Urological Oncology

Korean Journal of Urology

Korean Journal of Urology 2009; 50(7): 635-641.

Published online: 20 July 2009

DOI: https://doi.org/10.4111/kju.2009.50.7.635

Predictors of Bladder Tumor Recurrence after Curative Surgery for Upper Urinary Tract Transitional Cell Carcinoma

Seong-Heon Ha, Jinsung Park¹, Jun Hyuk Hong, Choung-Soo Kim, Hanjong Ahn

Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

¹Department of Urology, Eulji University Hospital, Daejeon, Korea.

Correspondence to: Hanjong Ahn. Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap2-dong, Songpa-gu, Seoul 138-736, Korea. TEL: 02-3010-3733, FAX: 02-477-8928, hjahn@amc.seoul.kr

Received 4 February 2009 Accepted 3 June 2009

Abstract

Purpose

We investigated the predictors for developing intravesical recurrence following curative surgery for primary upper tract transitional cell carcinoma (UTTCC).

Materials and Methods

The data of 207 patients without a prior history of bladder tumor or distant metastasis were analyzed. We evaluated the influence of multiple clinicopathologic parameters, such as age, sex, T stage, N stage, grade, carcinoma-in-situ, anatomical location, multifocality, lymphovascular invasion (LVI), preoperative urine cytology, and operative methods, on intravesical recurrence. Considering the possibility of bias from the effect of adjuvant treatment, the same analyses were performed in 184 patients excluding those who underwent adjuvant therapy. Mean follow-up was 59.7 months.

Results

Of 207 patients, 91 (44%) experienced intravesical recurrence at a mean interval of 13.2 months. Among them, 66% (60/91) experienced intravesical recurrence within 12 months postoperatively. Eighty-nine percent of the recurred bladder tumors were superficial tumors and 64% were grade 1 or 2. Among the multiple parameters analyzed, LVI was the only significant predictor for intravesical recurrence in univariate and multivariate analysis (p=0.008; HR=1.911), whereas preoperative urine cytology was marginally significant. Similar results were obtained in the analysis for 184 patients without adjuvant therapy. Ten patients (11%) underwent muscle-invasive bladder tumor recurrence. Muscle-invasive bladder tumor recurrence was significantly associated with the presence of LVI compared with superficial bladder tumor recurrence (70% vs. 30%; p=0.005).

Conclusions

LVI in primary UTTCC was a significant predictor of intravesical recurrence after curative surgery, whereas preoperative urine cytology was a possible predictor. Therefore, we recommend more rigorous cystoscopic follow-up in patients with these risk factors.

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

Figures and Tables

Fig. 1

Bladder tumor recurrence-free survival of 207 patients who underwent curative surgery for upper urinary tract transitional cell carcinoma according to (A) lymphovascular invasion (LVI) status in primary tumor and (B) preoperative urine cytology. BT-RFS: bladder tumor recurrence-free survival, BTCC: bladder transitional cell carcinoma.

Table 1

Clinicopathologic characteristics of the patients with upper urinary tract transitional cell carcinoma

Table 2

Univariate analysis of predictors for developing bladder tumors after curative surgery for upper urinary tract transitional cell carcinoma

BT-RFS: bladder tumor recurrence-free survival, LVI: lymphovascular invasion, CIS: carcinoma-in-situ, ^a: same results were obtained in the analysis based on different grouping of T stage (≤T1 vs. T2 vs. T3 or higher)

Table 3

Multivariate analysis of multiple clinicopathologic parameters for bladder tumor recurrence

LVI: lymphovascular invasion, HR: hazard ratio, CI: confidence interval

Table 4

Relationship between lymphovascular invasion status in primary tumor and stage of recurred bladder tumor

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