Predictive Factors of Bladder Tumor Recurrence after Nephro-Ureterectomy for Urothelial Carcinoma

Abstract

Objectives: To evaluate the incidence of bladder cancer after nephro-ureterectomy (NUT) and determine the potential risk factors of bladder recurrence in patients with upper urinary tract urothelial carcinoma (UUT-UC). Materials and Methods: We retrospectively assessed 37 patients with UUT-UC including a significant follow-up after NUT of 34 months (range 12 - 120 months). The median age of the population was 72 years (range 48 - 83 years). Patients with a previous history of bladder cancer, concomitant diagnosis of bladder tumor and UUT-UC; or a metastatic UUT-UC were excluded from the study. Results: Out of these 37 patients, 17 presented a bladder recurrence within an average time of 12 months (range 3 to 31 months) after the NUT. In 94% of the cases, bladder recurrence occurred within the first 24 months following the NUT. Histological distribution was: 13 Ta tumors (76%), 2 pT1 tumors (11.7%); 11 patients had a high stage lesion (76%), whereas 4 patients had a low stage lesion (23.5%). As regards the anatomo-pathological characteristics of the UUT-UC, the supra iliac localization of the tumor is a significant risk factor of bladder recurrence (p = 0.04). Conclusion: Bladder recurrence after NUT occurred frequently and could have possibly been under-estimated. The use of intra-vesical instillation of Mitomycin C after NUT has been recently recommended by the European Association of Urology, but no predictive factors have yet been identified. Early diagnosis of bladder recurrence could certainly have reduced mortality in this patient population.