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The Role of Prior Bladder Cancer on Recurrence in Patients Treated with Radical Nephroureterectomy
A. Martini, C. Lonati, F. Montorsi, A. Briganti, R. Colombo, A. Necchi, C. Simeone, S. Zamboni, L. Afferi, A. Mattei, R. Carando, G. Ploussard, F. Soria, G. Marra, M. Rouprêt, E. Xylinas, B. Pradere, M. Abufaraj, D. D'Andrea, SF. Shariat, M. Moschini
Language English Country United States
Document type Journal Article
- MeSH
- Carcinoma, Transitional Cell * pathology MeSH
- Humans MeSH
- Neoplasm Recurrence, Local pathology MeSH
- Urinary Bladder Neoplasms * pathology MeSH
- Nephroureterectomy MeSH
- Retrospective Studies MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
INTRODUCTION: The prognostic role of prior history of bladder cancer (BCa) among patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) is poorly addressed. We aimed to investigate the role of prior BCa on any recurrence, distant metastases, and bladder recurrence following RNU among low-grade (LG) and high-grade (HG) UTUC patients. PATIENTS AND METHODS: We retrospectively analyzed 1,580 UTUC patients treated with RNU at 8 tertiary referral centers between 1992 and 2016. Any recurrence was defined as recurrence in the urinary tract, in the resection bed, or distant metastases (defined as disease outside the urinary tract and regional lymph nodes). Time to recurrence was computed from RNU. Multivariable Cox models were generated to predict risk of any recurrence, distant metastases, and bladder recurrence according to prior BCa history, coded as no prior BCa, non-muscle-invasive (NMIBC), and muscle-invasive BCa (MIBC). RESULTS: Median follow-up for survivors was 4 years. Overall, 71%, 25%, and 4% of patients had no prior BCa, NMIBC and MIBC. 5-year any recurrence-free survival was 61%, 41%, and 19% in LG (P < .001) and 42%, 34%, and 30% in HG patients (P = .1) with no prior BCa, NMIBC, and MIBC. On multivariable models, LG patients with NMIBC and MIBC showed a significantly higher risk of any recurrence compared to no prior BCa (both p≤0.005); previous NMIBC was associated with any recurrence among HG patients (P = 0.04). 5-year distant metastases-free survival was 92%, 90%, and 87% in LG (P > .05) and 68%, 75%, and 45% in HG patients (P = .01) with no prior BCa, NMIBC, and MIBC. Previous NMIBC increased the risk of bladder recurrence among LG (P < .001) and HG (P = .003) patients. CONCLUSIONS: UTUC patients with prior history of BCa exhibit a higher risk of any recurrence after RNU. Our study provides important information which could address patient's counseling and decision-making process.
Clinica Luganese Moncucco Lugano Switzerland
Clinica S Anna Swiss Medical Group Sorengo Switzerland
Clinica Santa Chiara Locarno Switzerland
Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic
Department of Urology Bichat Hospital Paris Descartes University Paris France
Department of Urology CHU Institut Universitaire du Cancer Toulouse Oncopole Toulouse France
Department of Urology La Croix du Sud Hospital Toulouse France
Department of Urology Luzerner Kantonsspital Lucerne Switzerland
Department of Urology Spedali Civili of Brescia Brescia Italy
Department of Urology University of Texas Southwestern Medical Center Dallas TX
Department of Urology Weill Cornell Medical College New York NY
GRC 5 Predictive Onco Uro AP HP Urology Pitie Salpetriere Hospital Sorbonne University PARIS France
The National Center for Diabetes Endocrinology and Genetics The University of Jordan Amman Jordan
References provided by Crossref.org
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- $a Martini, Alberto $u Department of Urology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy. Electronic address: a.martini.md@gmail.com
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- $a The Role of Prior Bladder Cancer on Recurrence in Patients Treated with Radical Nephroureterectomy / $c A. Martini, C. Lonati, F. Montorsi, A. Briganti, R. Colombo, A. Necchi, C. Simeone, S. Zamboni, L. Afferi, A. Mattei, R. Carando, G. Ploussard, F. Soria, G. Marra, M. Rouprêt, E. Xylinas, B. Pradere, M. Abufaraj, D. D'Andrea, SF. Shariat, M. Moschini
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- $a INTRODUCTION: The prognostic role of prior history of bladder cancer (BCa) among patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) is poorly addressed. We aimed to investigate the role of prior BCa on any recurrence, distant metastases, and bladder recurrence following RNU among low-grade (LG) and high-grade (HG) UTUC patients. PATIENTS AND METHODS: We retrospectively analyzed 1,580 UTUC patients treated with RNU at 8 tertiary referral centers between 1992 and 2016. Any recurrence was defined as recurrence in the urinary tract, in the resection bed, or distant metastases (defined as disease outside the urinary tract and regional lymph nodes). Time to recurrence was computed from RNU. Multivariable Cox models were generated to predict risk of any recurrence, distant metastases, and bladder recurrence according to prior BCa history, coded as no prior BCa, non-muscle-invasive (NMIBC), and muscle-invasive BCa (MIBC). RESULTS: Median follow-up for survivors was 4 years. Overall, 71%, 25%, and 4% of patients had no prior BCa, NMIBC and MIBC. 5-year any recurrence-free survival was 61%, 41%, and 19% in LG (P < .001) and 42%, 34%, and 30% in HG patients (P = .1) with no prior BCa, NMIBC, and MIBC. On multivariable models, LG patients with NMIBC and MIBC showed a significantly higher risk of any recurrence compared to no prior BCa (both p≤0.005); previous NMIBC was associated with any recurrence among HG patients (P = 0.04). 5-year distant metastases-free survival was 92%, 90%, and 87% in LG (P > .05) and 68%, 75%, and 45% in HG patients (P = .01) with no prior BCa, NMIBC, and MIBC. Previous NMIBC increased the risk of bladder recurrence among LG (P < .001) and HG (P = .003) patients. CONCLUSIONS: UTUC patients with prior history of BCa exhibit a higher risk of any recurrence after RNU. Our study provides important information which could address patient's counseling and decision-making process.
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