Ureteral Involvement and Diabetes Increase the Risk of Subsequent Bladder Recurrence after Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma
Che-Yuan Hu1, Yu-Chieh Tsai2, Shuo-Meng Wang1, Chao-Yaun Huang1, Huai-Ching Tai1, Chung-Hsin Chen1, Yeong-Shiau Pu1, Wei-Chou Lin3 and Kuo-How Huang1
1Department of Urology, 2Department of Oncology and 3Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
To investigate the prognostic factors for bladder recurrence after radical nephroureterectomy (RNU) in patients with upper urinary tract urothelial carcinoma (UUT-UC)
Materials and Methods:
From 1994 to 2012, 695 patients with UUT-UC treated with RNU were enrolled in National Taiwan University Medical Center. Among them, 532 patients with no prior bladder UC histories were recruited for analysis. We assessed the impact of potentially prognostic factors on bladder recurrence after RNU.
The median follow-up period was 47.8 months. In the Cox model, ureteral involvement and diabetes mellitus (DM) were significantly associated with a higher bladder recurrence rate in the multivariate analysis (hazard ratio [HR]: 1.838; p=0.003 and HR: 1.821; p=0.010, respectively). In the Kaplan-Meier analysis, DM patients with concomitant ureteral UC experienced about a three-fold increased risk of bladder recurrence as compared to those without both factors (HR: 3.222; p< 0.001). Patients with either one of the two risk factors experienced about a two-fold increased risk as compared to those without both factors (with DM, HR: 2.184, p= 0.024; with ureteral involvement, HR: 2.006, p= 0.003).
Ureteral involvement and DM are significantly related to bladder recurrence after RNU in patients with UUT-UC.