Publication:

The prognostic factors of bladder urothelial carcinoma after radical nephroureterectomy

Background We aimed to determine the factors for prediction of bladder transitional cell carcinoma (TCC) development secondary to upper urinary system TCC.

Methods Fifty-six patients that underwent radical nephroureterectomy and concomitant partial cystectomy at a single site. All patents were diagnosed with cystoscopy, cytological study and CT-urography. International prostate symptom score and post-void residual urine >50 ml were taken as basis to identify lower urinary tract symptoms (LUTS). The relationship between age, gender, tumor localization, tumor grade, tumor size, disease stage, carcinoma in situ (CIS) positivity, LUTS positivity and development of TCC were analyzed. The SPSS 25.0 software package was used in the statistical analysis of the data. The survival curve was plotted using the standard Kaplan-Meier methodology. P<0.05 was considered statistically significant in all tests.

Results Thirty patients developed bladder TCC (53.6%). Mean age for patients with and without bladder TCC were 71.40±7.6 and 65.73±7.1, respectively. None of the patients enrolled had concomitant TCC. Single variable analysis revealed advanced age (p<0.006), tumor stage (p<0.0001), LUTS (p<0.0001) to TCC development was statistically significant. Risk of developing TCC was 9-fold in LUTS (+) patients. Multivariate analysis results showed LUTS to TCC development was statistically significant (OR=34.52, 95% CI=3.8-52.3; p<0.002).

Conclusions As a result, tumor stage, LUTS and age increases the risk of developing blader TCC after nephroureterectomy. LUTS should also be investigated, and if positive, we postulate that its early treatment is important for preventing development of bladder TCC.