The patterns and risk factors for subsequent bladder recurrence in patients with transitional cell carcinoma of the upper urinary tract: A long-term follow-up study

Purpose: We wanted to evaluate the patterns and risk factors for subsequent bladder recurrence after surgical management for upper urinary tract transitional cell carcinoma (TCC). Materials and Methods: Between 1986 and 2004, the medical records of the patients who were diagnosed and surgically treated for upper urinary tract TCC were retrospectively analyzed. A total of 215 patients were enrolled in this study, and the median follow-up duration was 53 months (range: 12-240). The bladder recurrence-free survival curve was generated by the Kaplan-Meier method. To investigate the risk factors for subsequent bladder recurrence among the various clinicopathological features, the log rank test and Cox's proportional hazard model were used. Results: Recurrence developed in 81 patients (37.7%). Of them, 70 patients (86.4%) had recurred within 24 months, and 76 patients (93.8%) had superficial bladder cancer. Muscle-invasive bladder cancer developed in only 8 patients (9.9%) during follow-up. On univariate analysis, the T stage, age and urine cytology had an influence on bladder recurrence with statistical (borderline) significance. Multivariate analysis revealed that urine cytology was the only independent risk factor for bladder recurrence (p=0.020). Conclusions: Subsequent bladder recurrence after treatment for upper urinary tract transitional cell cancer usually occurred within two years after surgery, and positive urine cytology is an independent prognostic factor for subsequent bladder recurrence.