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

To investigate the impact of previous, simultaneous or subsequent bladder cancer on clinical outcomes for upper urinary tract urothelial carcinoma.

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

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

Bladder cancer was significantly associated with worse clinical outcomes after radical nephroureterectomy for upper urinary tract urothelial carcinoma. Prevention of subsequent bladder cancer for pT0-2 upper urinary tract urothelial carcinoma may lead to better prognosis for patients undergoing radical nephroureterectomy.

The Journal of urology. 2019 Jun 28 [Epub ahead of print]

Kentaro Kuroiwa, Junichi Inokuchi, Hiroyuki Nishiyama, Takahiro Kojima, Yoshiyuki Kakehi, Mikio Sugimoto, Toshiki Tanigawa, Hiroyuki Fujimoto, Momokazu Gotoh, Naoya Masumori, Osamu Ogawa, Masatoshi Eto, Chikara Ohyama, Akira Yokomizo, Hideyasu Matsuyama, Tomohiko Ichikawa, Junki Mizusawa, Junko Eba, Seiji Naito, Urologic Oncology Study Group of the Japan Clinical Oncology Group (JCOG)

Department of Urology, Miyazaki Prefectural Miyazaki Hospital , Miyazaki , Japan., Department of Urology, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan., Department of Urology, University of Tsukuba , Ibaraki , Japan., Department of Urology, Faculty of Medicine, Kagawa University , Kagawa , Japan., Department of Urology, Niigata Cancer Center Hospital , Niigata , Japan., Urology Division, National Cancer Center Hospital , Tokyo , Japan., Department of Urology, Nagoya University Graduate School of Medicine , Nagoya , Japan., Department of Urology, Sapporo Medical University School of Medicine , Sapporo , Japan., Department of Urology, Kyoto University , Kyoto , Japan., Department of Urology, Hirosaki University Graduate School of Medicine , Hirosaki , Japan., Department of Urology, Harasanshin Hospital , Fukuoka , Japan., Department of Urology, Graduate School of Medicine, Yamaguchi University , Ube , Japan., Department of Urology, Graduate School of Medicine, Chiba University , Chiba , Japan., JCOG Data Center/Operations Office, National Cancer Center , Tokyo , Japan.

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