Yonsei Med J.  2015 Mar;56(2):375-381. 10.3349/ymj.2015.56.2.375.

The Characteristics of Recurrent Upper Tract Urothelial Carcinoma after Radical Nephroureterectomy without Bladder Cuff Excision

• Kang M
• Jeong CW
• Kwak C
• Kim HH
• Ku JH

• KMID: 2070013
• DOI: http://doi.org/10.3349/ymj.2015.56.2.375

Abstract

PURPOSE
To investigate oncological outcomes based on bladder cuff excision (BCE) during radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) and to provide clinical evidence of tumor recurrence in patients without BCE.
MATERIALS AND METHODS
We retrospectively collected data of 372 consecutive patients who underwent RNU at our institution from May 1989 through October 2010. After excluding some data, we reviewed 336 patients for the analysis.
RESULTS
Of the patients who underwent RNU with BCE (n=279, 83.0%) and without BCE (n=57, 17.0%), patients without BCE had poorer cancer-specific and overall survival rates. Among 57 patients without BCE, 35 (61.4%) experienced tumor recurrence. Recurrence at the remnant ureter resulted in poor oncological outcomes compared to those in patients with bladder recurrence, but better outcomes were observed compared to recurrence at other sites. No significant predictors for tumor recurrence at the remnant ureter were identified. In patients without BCE, pathological T stage [hazard ratio (HR), 5.73] and lymphovascular invasion (HR, 3.65) were independent predictors of cancer-specific survival, whereas age (HR, 1.04), pathological T stage (HR, 5.11), and positive tumor margin (HR, 6.50) were independent predictors of overall survival.
CONCLUSION
Patients without BCE had poorer overall and cancer-specific survival after RNU than those with BCE. Most of these patients experienced tumor recurrence at the remnant ureter and other sites. Patients with non-organ confined UTUC after RNU without BCE may be considered for adjuvant chemotherapy with careful follow-up.

Keyword

Upper urinary tract urothelial carcinoma; radical nephroureterectomy; bladder cuff excision; tumor recurrence; oncological outcomes

MeSH Terms

Adult
Aged
Carcinoma, Transitional Cell/*surgery
Chemotherapy, Adjuvant
Female
Humans
Male
Middle Aged
Neoplasm Recurrence, Local/*pathology
Nephrectomy/*methods
Retrospective Studies
Survival Rate
Treatment Outcome
Ureter/*surgery
Ureteral Neoplasms/*surgery
Urinary Bladder/pathology
Urinary Bladder Neoplasms/*pathology
Urologic Neoplasms/pathology/*surgery
*Urologic Surgical Procedures
Urothelium/*pathology

Figure

• 

  Fig. 1 The Kaplan-Meier analysis for (A) OS and (B) CSS after RNU with or without BCE for treating UTUC. The log-rank test was used to determine significant differences between the two groups. RNU, radical nephroureterectomy; BCE, bladder cuff excision; UTUC, upper tract urothelial carcinoma; OS, overall survival; CSS, cancer-specific survival.

• 

  Fig. 2 The Kaplan-Meier analysis for CSS in patents who experienced tumor recurrence after RNU without BCE for treating UTUC. Four groups of patients are compared in the graph; non-recurrence, remnant ureter, bladder, and other sites. The log-rank test was used to determine significant differences between the two groups. CSS, cancer-specific survival; RNU, radical nephroureterectomy; BCE, bladder cuff excision; UTUC, upper tract urothelial carcinoma.

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