Risk factors of the bladder cancer occurrence after radical nephroureterectomy of the upper tract urothelial carcinoma

Abstract

Objective To study the clinic features and risk factors of bladder cancer occurrence after radical nephroureterectomy of urothelial carcinoma of the upper tract. Methods 61 cases of urothelial carcinoma of the upper tract from March 2013 to December 2013 in Beijing Friendship Hospital are retrospectively studied. 31 patients are male, while the other 30 patients are female. Age of them ranges from 43 to 90 years old, and the average age is 69 years old. 17 patients are accompanied with diabetes. 32 patients are accompanied with hypertension. 12 patients have the history of chronic nephrosis. 7 patients have the history of renal transplation operation. 47 patients have the symptom of hematuresis. 16 patients have the symptom of lumbago. Body mass index <18.5 kg/m2 2 cases, 18.5~22.9 kg/m2 25 cases, 23.0~24.9 kg/m2 10 cases, 25.0~29.9 kg/m2 20 cases, ≥30.0 kg/m2 4 cases. 25 patients' serum creatinine is abnormal, while the other 36 patients' is normal. 36 patients have left tumors, while the other 25 patients have right tumors. 39 patients have hydronephrosis before operation. 25 patients go through ureteroscopy. 11 patients have the concurrence of bladder cancer preoperatively. 25 patients have renal pelvic carcinoma, while the other 36 patients have carcinoma of ureter. 14 patients have multiple tumors, while the other 47 patients just have single tumors. The size of tumor ranges from 0.5cm to 8.0cm, and the average size is 2.9cm. 27 patients have the cauliflower-like tumors, while the other 34 patients have other shaped tumors. 28 cases have the positive results of cytology, while the other 33 cases don't have. 6 patients go through cystoscopic operation of ureterovesical junction, while the other 55 patients go through open operation of ureterovesical junction. Kaplan Meier analysis is used to find univariate risk factors of the bladder cancer occurrence postoperatively, and Log-rank test is used after that. Cox regression analysis is used to identify the independent risk factor from all the univariate risk factors. Results Time of surgery ranges from 2.0 hours to 7.5 hours, and the average time is (4.9±1.2 ) hours.39 patients' tumors are equal or greater than T2 stage, while the other 22 patients' tumors are less than T2 stage. 2 patients have I grade tumors, 40 patients have Ⅱ grade tumors, and the other 19 patients have Ⅲ grade tumors. 12 patients go through systematic chemotherapy, while the other 49 patients don't. 23 patients go through intravesical instillation postoperatively, while the other 38 don't. Follow-up time of 61 cases ranges from 22 months to 31 months, and the average time is (27.3±2.7) months. 3 to 30 months after radical nephroureterectomy, 21 cases(34.4%) have bladder cancer occurrence. 4 of patients who have concurrence of bladder cancer preoperatively go through the occurrence of bladder cancer(57.1%, 4/7), and 17 of patients who don't have concurrence of bladder cancer preoperatively go through the occurrence of bladder cancer(31.5%, 17/54). 8 of patients with multiple tumors go through the occurrence of bladder cancer(57.1%, 4/7), while 13 of patients with a single tumor go through the occurrence of bladder cancer(27.7%, 13/47). 18 of patients who have tumors equal or greater than T2 stage have the occurrence of bladder cancer(46.2%, 18/39), while 3 of patients who have tumors less than T2 stage have the occurrence of bladder cancer(13.6%, 3/22). 3 of patients with postoperative intravesical instillation have the occurrence of bladder cancer(13.0%, 3/23), while 18 of patients without postoperative intravesical instillation have the occurrence of bladder cancer(47.4%, 18/38). Single factor analysis shows that preoperative concurrence of bladder cancer(P=0.003), multiple tumors(P=0.044), T stage(P=0.023) and postoperative intravesical instillation(P=0.002) have significant influence on the occurrence of bladder cancer. And Cox proportional hazards regression model analysis shows that the preoperative concurrence of bladder cancer (RR=2.860, P=0.024, regression coefficient=1.051) and postoperative intravesical instillation(RR=0.201, P=0.011, regression coefficient= -1.065) are significantly related to the occurrence of bladder cancer after radical nephroureterectomy. Conclusions The preoperative concurrence of bladder cancer and postoperative intravesical instillation are the independent risk factors of the bladder cancer occurrence after radical nephroureterectomy. And the preoperative concurrence of bladder cancer is a risk factor, while the postoperative intravesical instillation is a protective factor. Key words: Urothelial carcinoma of the upper tract; Bladder cancer; Risk factors