Abstract
Purpose: We investigated the predictors for developing intravesical recurrence following curative surgery for primary upper tract transitional cell carcinoma (UTTCC). Materials and Methods: The data of 207 patients without a prior history of bladder tumor or distant metastasis were analyzed. We evaluated the influence of multiple clinicopathologic parameters, such as age, sex, T stage, N stage, grade, carcinoma-in-situ, anatomical location, multifocality, lymphovascular invasion (LVI), preoperative urine cytology, and operative methods, on intravesical recurrence. Considering the possibility of bias from the effect of adjuvant treatment, the same analyses were performed in 184 patients excluding those who underwent adjuvant therapy. Mean follow-up was 59.7 months. Results: Of 207 patients, 91 (44%) experienced intravesical recurrence at a mean interval of 13.2 months. Among them, 66% (60/91) experienced intravesical recurrence within 12 months postoperatively. Eighty-nine percent of the recurred bladder tumors were superficial tumors and 64% were grade 1 or 2. Among the multiple parameters analyzed, LVI was the only significant predictor for intravesical recurrence in univariate and multivariate analysis (p=0.008; HR=1.911), whereas preoperative urine cytology was marginally significant. Similar results were obtained in the analysis for 184 patients without adjuvant therapy. Ten patients (11%) underwent muscle-invasive bladder tumor recurrence. Muscle-invasive bladder tumor recurrence was significantly associated with the presence of LVI compared with superficial bladder tumor recurrence (70% vs. 30%; p=0.005). Conclusions: LVI in primary UTTCC was a significant predictor of intravesical recurrence after curative surgery, whereas preoperative urine cytology was a possible predictor. Therefore, we recommend more rigorous cystoscopic follow-up in patients with these risk factors. (Korean J Urol 2009;50:635-641)
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