Bladder cancer after managing upper urinary tract transitional cell carcinoma: risk factors and survival

• Published in: International urology and nephrology 2011-09, Vol.43 (3), p.729-735
• Main Authors: Milojevic, Bogomir, Djokic, Milan, Sipetic-Grujicic, Sandra, Milenkovic-Petronic, Dragica, Vuksanovic, Aleksandar, Dragicevic, Dejan, Bumbasirevic, Uros, Tulic, Cane
• Format: Article
• Language: English
• Subjects: Aged; Antineoplastic Agents - therapeutic use; Bladder cancer; Carcinoma, Transitional Cell - drug therapy; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - surgery; Chemotherapy, Adjuvant; Chi-Square Distribution; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Kidney Neoplasms - drug therapy; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Logistic Models; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Neoplasms, Multiple Primary - pathology; Neoplasms, Multiple Primary - surgery; Nephrology; Retrospective Studies; Risk Factors; Serbia; Ureteral Neoplasms - drug therapy; Ureteral Neoplasms - pathology; Ureteral Neoplasms - surgery; Urinary Bladder Neoplasms - diagnosis; Urology; Urology – Original Paper
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1007/s11255-011-9902-4

Objective To identify independent risk factors for the development of bladder cancer after surgical management of upper urinary tract transitional cell carcinoma (UUT-TCC). Patients and methods Between January 1999 and December 2008, 154 patients were treated surgically for UUT-TCC at the Clinic of Urology, Clinical Center of Serbia. Patients with a previous history of bladder cancer and patients with concomitant bladder cancer were excluded from the study. In all, 92 patients were then available for evaluation. The median follow-up after surgery was 39.5 months. Univariate and multivariate analyses using the logistic regression model were performed. The intravesical disease-free rate and survival were calculated using the Kaplan–Meier method, and the log-rank test was used to determine statistical differences. Results and limitations In this study, 21.7% patients treated for UUT-TCC developed subsequent bladder tumors. Tumor multifocality was the only independent predictor associated with the development of subsequent bladder cancer ( P  = 0.028, RR  = 3.52). Intravesical recurrence-free survival rates for these 92 patients at 1, 3, 5, and 7 years were 85.8, 80, 79.3, and 78.3%, respectively. Patients with tumors extending to multiple sites were significantly more likely to present subsequent intravesical recurrence ( P  = 0.006). The development of bladder cancer had no significant effect on the survival of patients who underwent surgical treatment of UUT-TCC, compared to patients without bladder cancer development ( P  = 0.660). Neither did the type of surgery mode affect patient survival ( P  = 0.245). This study is limited by biases associated with its retrospective design. Conclusion The multiplicity of the UUT-TCC is an independent risk factor for the occurrence of bladder cancer.