Fatores preditivos da recorrência vesical do carcinoma urotelial do trato urinário superior após nefroureterectomia radical

Abstract

Objectives

To identify the predictive factors associated with bladder recurrence of UTUC in patients undergoing radical nephroureterectomy and determine the overall survival of these individuals.

Materials and methods

Retrospective analysis of 64 patients with UTUC subjected to radical nephroureterectomy between 2003 and 2013 in Department of Urology–Hospital S. João, Porto, Portugal. The following variables were analysed: age, gender, tumour characteristics (stage, grade, location, lymphovascular invasion, multifocality), previous malignant neoplasia of the bladder, surgical approach of the distal ureter and adjuvant (systemic) chemotherapy.

Results

The median age was 71.0 years (percentile25‐percentile75: 64.5‐75.5) and 65.6% were male. The median follow‐up was 33.8 months (P25‐P75: 15.0‐64.6). T3 and T4 stages [Hazard ratio (HR) = 1.35 (95%confidence interval: 0.47‐3.94)], the location in the ureter [HR = 1.47 (95%CI: 0.53‐4.06)], multifocality [HR = 2.86 (95%CI: 0.89‐9.12)] and adjuvant chemotherapy [HR = 3.84 (95%CI: 0.90‐16.45)] were associated with worse overall survival, although not statistically significant. Previous malignant neoplasia of the bladder [HR = 2.03 (95%CI: 0.66‐6.26)], lymphovascular invasion [HR = 1.40 (95%CI: 0.49‐4.05)] and high‐grade tumours [HR = 1.43 (95%CI: 0.33‐6.29)] showed higher bladder recurrence, although not statistically significant. A tendency to a lower risk of bladder recurrence was observed among patients receiving adjuvant chemotherapy [HR = 0.78 (95%CI: 0.22‐2.72)].

Conclusions

The previous history of malignant neoplasia of the bladder was the strongest predictor of bladder recurrence and individuals with worse prognostic markers tend to have a lower risk of bladder recurrence, due to supposed competing risks between death and recurrence.