Risk factors for the development of bladder transitional cell carcinoma following surgery for transitional cell carcinoma of the upper urinary tract

To determine the risk factors for development of transitional cell carcinom a (TCC) of the bladder (BTCC) following surgery for TCC of the upper urinar y tract (UUT-TCC) in patients without history of BTCC, 85 patients surgical ly treated for UUT-TCC (34 female, 51 male; median age 66, range 42-85 year s) were reviewed retrospectively. The Cox proportional hazards model was us ed to assess the association of relevant clinicopathologic factors with BTC C-free survival in patients without a history of BTCC and TCC-specific surv ival in all. Median follow-up duration was 35 (range 1-193) months. Six pat ients (7%) had previous histories of BTCC, and 6 others (7%) had concurrent BTCC at the time of surgery for UUT-TCC. Of 70 patients who had no history of BTCC and underwent follow-up cystoscopy, 24 (34%) developed BTCC during follow-up after surgery. Univariate analysis identified female sex, postop erative systemic chemotherapy, and incomplete distal ureterectomy as signif icant risk factors for new development of BTCC. After multivariate analysis adjusted for age and pathological (p) T stage in the TNM classification, a ll three factors remained significant, with respective hazard ratios of 5.5 6 (95% confidence interval (Cl), 1.99-15.6; p = 0.001), 3.19 (95% Cl, 1.34- 7.62; p = 0.009) and 2.99 (95% Cl, 1.08-8.26; p = 0.03). Only pT stage was a significant independent risk factor for TCC-specific death. Female sex an d postoperative systemic chemotherapy, as well as incomplete distal uretere ctomy, are possible riks factors for development of BTCC following surgery for UUT-TCC. Copyright (C) 2001 S. Karger AG, Basel.