Impact of Previous, Simultaneous or Subsequent Bladder Cancer on Prognosis after Radical Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma.

PURPOSE To investigate the impact of previous, simultaneous or subsequent bladder cancer on clinical outcomes for upper urinary tract urothelial carcinoma. MATERIALS AND METHODS We retrospectively collected data for 2,668 patients who underwent radical nephroureterectomy for non-metastatic upper urinary tract urothelial carcinoma in 1995-2009. We evaluated the impact of bladder cancer on overall mortality and the predictive factors for subsequent bladder cancer. RESULTS A total of 631 (23.7%) patients had previous or simultaneous bladder cancer. Patients with previous or simultaneous bladder cancer had significantly shorter overall survival compared with patients without previous or simultaneous bladder cancer (HR 1.29, 95% CI 1.09-1.53; p=0.0026). Of 2,037 patients without previous or simultaneous bladder cancer, 683 (33.5%) had subsequent bladder cancer after radical nephroureterectomy. In pT0-2 disease, patients with subsequent bladder cancer had significantly shorter overall survival compared with those without subsequent bladder cancer (HR 1.81, 95% CI 1.23-2.67; p=0.0025). In pT3-4 disease, subsequent bladder cancer was not associated with worse overall survival. In multivariable analyses, independent predictors for subsequent bladder cancer were gender, preoperative urine cytology and clinical node status in pre-operative setting, and gender, adjuvant chemotherapy and pathological node status in post-operative setting. CONCLUSIONS Bladder cancer was significantly associated with worse clinical outcomes after radical nephroureterectomy for upper urinary tract urothelial carcinoma. Prevention of subsequent bladder cancer for pT0-2 upper urinary tract urothelial carcinoma may lead to better prognosis for patients undergoing radical nephroureterectomy.

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