OBJECTIVES: To identify risk factors and develop a model for predicting recurrence of upper urinary tract urothelial carcinoma (UUTUC) in the bladder in patients without a history of bladder cancer after radical nephroureterectomy (NU).
PATIENTS AND METHODS: We retrospectively reviewed 754 upper tract urothelial carcinoma patients without prior or concurrent bladder cancer and distant metastasis at 13 institutes in Japan. Univariate and multivariate Fine and Gray competing risks proportional hazards models were used to examine the cumulative incidence of bladder recurrence. A risk stratification model and a nomogram were constructed. Two prediction models were compared using the concordance-index (c-index) focusing on the predictive accuracy and decision curve analysis, which indicate whether a model is appropriate for decision making and subsequent patient prognosis.
RESULTS: The cumulative incidence of bladder recurrence at 1 and 5 years was 15% and 29%, respectively; the median time to bladder recurrence was 10 months. Multivariate analysis revealed that papillary tumor architecture, absence of lymph vascular invasion, and higher pathologic T stage were both predictive factors for bladder cancer recurrence. Predictive accuracy of the risk stratification model and the nomogram for bladder cancer recurrence was not different (c-index: 0.60 and 0.62). According to the decision curve analysis, the risk stratification is an acceptable nomogram because the net benefit of the risk stratification was equivalent to that of the nomogram. The overall cumulative incidence rate of bladder cancer 5 years after NU was 10%, 26%, and 44% in the low-, intermediate-, and high-risk groups, respectively.
CONCLUSIONS: We identified risk factors and developed a risk stratification model for UUTUC recurrence in the bladder after radical NU. This model could be used to provide an individualized strategy to prevent recurrence and risk-stratified surveillance protocol.
Written by:
Ishioka J, Saito K, Kijima T, Nakanishi Y, Yoshida S, Yokoyama M, Matsuoka Y, Numao N, Koga F, Masuda H, Fujii Y, Sakai Y, Arisawa C, Okuno T, Nagahama K, Kamata S, Sakura M, Yonese J, Morimoto S, Noro A, Tsujii1 T, Kitahara S, Gotoh S, Higashi Y, Kihara K. Are you the author?
Department of Urology, Tokyo Medical and Dental University Graduate School.
Reference: BJU Int. 2014 Feb 25. Epub ahead of print.
doi: 10.1111/bju.12707
PubMed Abstract
PMID: 24612074
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