Abstract: PD73-12
Sources of Funding: None

Introduction

Intravesical recurrence after radical nephroureterectomy (RNU) ranges from 15% to 50%. However, only a few studies have investigated pathologic characteristics of bladder tumor recurrence, and even fewer have evaluated risk factors for muscle invasive bladder cancer (MIBC) after RNU for primary treatment of upper tract urothelial carcinoma (UTUC). Therefore, we present our data on the clinical course of intravesical recurrence and pathologic features for MIBC following RNU.

Methods

Between 1995 and 2009 we identified 395 patients who underwent RNU at Mayo Clinic for urothelial carcinoma. We identified 113 patients who subsequently developed intravesical recurrence. Patients with a prior radical cystectomy were excluded. Charts were retrospectively reviewed. Kaplan Meier analysis and Cox Proportional hazard regression models were used to estimate predictors and the risk of intravesical recurrence and MIBC from the time of RNU.

Results

Of the 395 patients, 28.6% (113) developed intravesical recurrence and 4.5% (18) had MIBC following RNU. Over a median follow up period of 43.4 months, 18.5% (21) of patients underwent radical cystectomy for intravesical recurrence; of these 52% (11) was for MIBC. Median time to intravesical recurrence was 7.8 months and median time to development of MIBC was 17.9 months. The 5-year probability of developing intravesical recurrence was 37.5%; while the 2, 5, and 10-year estimates of MIBC were 1.1%, 6.0%, and 6.7%, respectively. The 5-year cancer specific survival for patients who developed intravesical recurrence and MIBC after RNU was 86.1% and 65.2%, respectively (p=0.01). Specifically, high grade pathology, ureteral tumors and concomitant CIS were associated with an increased risk of MIBC (HR 3.4, p=0.01; HR 6.7, p<0.01; and HR 2.7, p=0.05; respectively).

Conclusions

Approximately 5% of patients develop MIBC following RNU for primary UTUC. High grade pathology, ureteral tumors and concomitant CIS at the time of RNU are predictive of MIBC on subsequent intravesical recurrence.

Funding

None