Abstract:

Objective：To elucidate clinicopathological independent prognostic factors for intravesical recurrence after nephroureterectomy for native upper tract urothelial carcinoma (UTUC) in renal transplant recipients. Methods: In this study, 38 patients clinically diagnosed as localized UTUC after renal transplantation were included, and treated by retroperitoneal laparoscopic nephroureterectomy between April 2006 and March 2013, after exclusion of those with a previous and/or concurrent history of bladder cancer. The clinicopathologic features, risk factors, and intravesical recurrence free survival were analyzed using the Kaplan-Meier method. Univariate and multivariate analyses by Cox’s proportional hazards regression model were used to identify independent risk factors for intravesical tumor recurrence. Results: Of all the patients, 16/38 (42.1%) developed subsequent intravesical recurrence during a median follow-up period of 38 months (range 12 to 104 months), of whom, 12/16 (75.0%) developed recurrent bladder cancer within 2 years after nephroureterectomy, and the median interval between surgery and intravesical recurrence was 15.5 months (range 6 to 48 months). Multifocal tumors, native aristolochic acid nephropathy (AAN) and distal ureter involvement were determined as risk factors for intravesical recurrence by univariate analysis. The intravesical recurrence rate was 62.5%(5/8)  in the group of native AAN , and 46.2% (12/26) in the group of multifocality. By multivariate analyses, multifocality (HR=2.603, 95% CI=1.529-8.906, P=0.019) and native AAN (HR=2.179, 95% CI=1.085-8.093, P=0.038) were identified as independent predictors for the development of recurrent bladder cancer after surgery for UTUC in renal transplant recipients. Conclusion: The incidence of intravesical recurrence after laparoscopic nephroureterectomy for UTUC in renal transplant recipients is high, and most subsequent bladder cancers recur within 2 years after surgery. Tumor multifocality and native AAN are significant independent risk factors in developing initial intravesical recurrence after laparoscopic surgery for primary UTUC after renal transplantation.

Key words: Urinary tract, Carcinoma, transitional cell, Urinary bladder neoplasms, Neoplasm recurrence, local, Kidney transplantation