[Predictive factors of metachronous bladder neoplasm after nephroureterectomy]

To determine prognostic factors of bladder recurrence in patients with upper urinary tract (UUT) urothelial carcinoma, who underwent nephroureterectomy.

Patients (N = 51) with UUT transitional cell carcinoma who underwent nephroureterectomy. A retrospective and prospective observational cohort study was made during the period 1995-2007, at Arquitecto Marcide Hospital, Ferrol Health Area, La Coruña. Differences between groups with and without recurrence were analized by means of chi-squared test in qualitative variables and t-Student and U Mann-Whitney test in quantitative variables. Kaplan-Meier methodology was used in order to predict bladder recurrence free survival (BRFS), developing a multivariate Cox regression model to identify variables related to bladder recurrence.

Mean age of patients was 68.51 +/- 12.11 (24-86). Histological grade distribution was as follows: 7 G1 (13.72%), 20 G2 (39.21%), 23 G3 (45.10%) and 1 undetermined case (1.97%). With regard to pT category, 19 cases were pT1 (37.25%), 12 pT2 (23.53%), 19 pT3 (37.25%) y 1 case undetermined (1.97%). Bladder recurrence was detected in 16 patients during follow-up (31.37%). 70.59% of recurrences were identified during first two years of follow-up. Differences related to follow-up period, presence of obstructive uropathy, microscopic growth pattern and tumour multifocality, were observed between patients without and with bladder recurrence. BRFS rates at 1, 2, 5 and 10 years were 85.10%, 67.90%, 56.60% y 31.80%, respectively. BRFS was significantly modified by tumour location (p = 0.019) and tumour multifocality (p = 0.002). Multivariate analysis showed that tumour multifocality was an independent factor in the prediction of bladder recurrence (RR = 7.35; 95% CI = 1.57-34.45; p = 0.011).

The development of bladder recurrence after nephroureterectomy was observed in 31.37% of patients in our study, detecting most of events during the first two years of follow-up. Tumour multifocality in UUT constitutes the most important risk factor for the development of bladder recurrence.