Clinical implications of intravesical recurrence after radical nephroureterectomy for upper XXXX .

@entity3484 @entity1 @entity2558 @entity1494 @entity150 @entity3137
OBJECTIVES: To characterize the site and clinical implications of intravesical recurrence after radical nephroureterectomy for upper @entity3484 . METHODS: @entity1 who underwent radical nephroureterectomy for upper @entity3484 between 2000 and 2011 at 12 institutions participating in the Tohoku Urological Evidence-Based Medicine Study Group were included in the present study. Those who underwent prior or simultaneous radical cystectomy were excluded. The site of intravesical recurrence was investigated, and the survival curves after radical nephroureterectomy were analyzed retrospectively using the Kaplan-Meier method. Multivariate analyses of factors predicting survival were carried out. RESULTS: A total of 534 @entity1 were eligible for the present study. With a median follow up of 47  months, 205 @entity1 (38.4%) had intravesical recurrence. The intravesical recurrence-free survival rates at 1, 2, and 5  years were 74.6%, 62.5% and 56.3%, respectively. In a subset of 137 @entity1 with intravesical recurrence who did not have @entity150 before or at the diagnosis of upper @entity3484 , the most frequent site of intravesical recurrence was around the cystotomy (52.6%), followed by at the posterior wall (39.4%) and at the @entity1494 (35.8%). A total of 36 @entity1 (17.6%) developed @entity150 after radical nephroureterectomy. On multivariate analyses for the subset of @entity1 with non-muscle invasive ( <= @entity2558 ) upper @entity3484 , intravesical recurrence was an independent predictor of cancer-specific survival (HR 4.27, P  =  0.016) and overall survival (HR 3.00, P  =  0.018). CONCLUSIONS: Most intravesical recurrences occur around the site of bladder @entity3137 within 1  year after radical nephroureterectomy, providing important insight into the mechanism of intravesical recurrence. Intravesical recurrence after radical nephroureterectomy had an impact on oncological outcomes of @entity1 with non-muscle invasive upper @entity3484 .
