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J Urol. 2019 Jun 28:101097JU0000000000000422. doi: 10.1097/JU.0000000000000422. [Epub ahead of print]

Impact of Previous, Simultaneous or Subsequent Bladder Cancer on Prognosis after Radical Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma.

Author information

1
Departments of Urology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan.
2
Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
3
University of Tsukuba, Ibaraki, Japan.
4
Faculty of Medicine, Kagawa University, Kagawa, Japan.
5
Niigata Cancer Center Hospital, Niigata, Japan.
6
Urology Division, National Cancer Center Hospital, Tokyo, Japan.
7
Nagoya University Graduate School of Medicine, Nagoya, Japan.
8
Sapporo Medical University School of Medicine, Sapporo, Japan.
9
Kyoto University, Kyoto, Japan.
10
Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
11
Harasanshin Hospital, Fukuoka, Japan.
12
Graduate School of Medicine, Yamaguchi University, Ube, Japan.
13
Graduate School of Medicine, Chiba University, Chiba, Japan.
14
Japan Clinical Oncology Group Data Center, Operations Office, National Cancer Center, Tokyo, Japan.

Abstract

PURPOSE:

We investigated the impact of previous, simultaneous or subsequent bladder cancer on the clinical outcomes of upper urinary tract urothelial carcinoma.

MATERIALS AND METHODS:

We retrospectively collected data on 2,668 patients who underwent radical nephroureterectomy of nonmetastatic upper urinary tract urothelial carcinoma in 1995 to 2009. We evaluated the impact of bladder cancer on overall mortality and the factors predictive of subsequent bladder cancer.

RESULTS:

A total of 631 patients (23.7%) had previous or simultaneous bladder cancer. Patients with previous or simultaneous bladder cancer had significantly shorter overall survival than patients without previous or simultaneous bladder cancer (HR 1.29, 95% CI 1.09-1.53, p=0.0026). Of the 2,037 patients without previous or simultaneous bladder cancer 683 (33.5%) subsequently had bladder cancer after radical nephroureterectomy. Of patients with pT0-2 disease those with subsequent bladder cancer had significantly shorter overall survival than patients without subsequent bladder cancer (HR 1.81, 95% CI 1.23-2.67, p=0.0025). In patients with pT3-4 disease subsequent bladder cancer was not associated with worse overall survival. On multivariable analyses independent predictors of subsequent bladder cancer were gender, preoperative urine cytology and clinical node status in the preoperative setting, and gender, adjuvant chemotherapy and pathological node status in the postoperative setting.

CONCLUSIONS:

Bladder cancer was significantly associated with worse clinical outcomes after radical nephroureterectomy of upper urinary tract urothelial carcinoma. Preventing subsequent bladder cancer in patients with pT0-2 upper urinary tract urothelial carcinoma may lead to better prognosis in those who undergo radical nephroureterectomy.

KEYWORDS:

mortality; nephroureterectomy; outcome assessment (health care); urinary bladder neoplasms; urothelium

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