Longitudinal risk of upper tract recurrence following radical cystectomy for urothelial cancer and the potential implications for long-term surveillance Journal Article


Authors: Tran, W.; Serio, A. M.; Raj, G. V.; Dalbagni, G.; Vickers, A. J.; Bochner, B. H.; Herr, H.; Donat, S. M.
Article Title: Longitudinal risk of upper tract recurrence following radical cystectomy for urothelial cancer and the potential implications for long-term surveillance
Abstract: Purpose: The defined risk of upper tract recurrence in published series ranges from 2% to 6%, with most recurrence reported within 2 to 3 years of surgery. However, these recurrence rates are based on statistical methodology that does not take censoring into account. We used landmark time analysis to determine whether the risk of upper tract recurrence changes over time. Materials and Methods: We present a retrospective institutional review board approved review of 1,329 patients who underwent radical cystectomy from 1990 to 2004. Upper tract recurrence was defined as any radiographic, endoscopic or pathologically proven recurrence in the kidney or ureter. Cumulative incidence of upper tract recurrence was estimated by accounting for death without recurrence as a competing risk. Landmark analyses were used to estimate the probability of upper tract recurrence within the next 3 years if recurrence-free at various times after surgery. Results: A total of 80 patients experienced upper tract recurrence. Median followup for patients alive and recurrence-free was 38 months. The 3 and 5-year cumulative incidence of upper tract recurrence was 4% (95% CI 3, 6) and 7% (95% CI 5, 8), respectively. Landmark time analysis showed the 3-year cumulative incidence of upper tract recurrence remained 4% to 6% even at 4 years after radical cystectomy. Any ureteral involvement at radical cystectomy (including carcinoma in situ) portends a significantly higher risk of upper tract recurrence. Conclusions: The incidence for upper tract recurrence was 4% at 3 years and 7% at 5 years. However, the 3-year risk of upper tract recurrence remained around 4% to 6% at any point measured up to 4 years after radical cystectomy and, therefore, did not change over time. This indicates the critical importance of long-term vigilance for upper tract recurrence following radical cystectomy. © 2008 American Urological Association.
Keywords: controlled study; retrospective studies; major clinical study; cancer recurrence; cancer risk; disease free survival; follow up; follow-up studies; cancer incidence; incidence; analytic method; risk factors; recurrence; retrospective study; urinary bladder neoplasms; kidney neoplasms; cancer mortality; time factors; risk; confidence interval; probability; carcinoma in situ; cystectomy; urogenital tract tumor; ureteral neoplasms; neoplasms, second primary; carcinoma, transitional cell; urinary tract
Journal Title: Journal of Urology
Volume: 179
Issue: 1
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2008-01-01
Start Page: 96
End Page: 100
Language: English
DOI: 10.1016/j.juro.2007.08.131
PUBMED: 17997449
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 23" - "Export Date: 17 November 2011" - "CODEN: JOURA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Ganesh Raj
    20 Raj
  2. Guido Dalbagni
    253 Dalbagni
  3. Sherri M Donat
    135 Donat
  4. Andrew J Vickers
    565 Vickers
  5. Angel M Cronin
    145 Cronin
  6. Bernard Bochner
    327 Bochner
  7. Harry W Herr
    407 Herr
  8. William Chanhandiep Tran
    1 Tran