Predictive factors of bladder tumor recurrence after radical treatment of upper urinary tract cancer


Yassine Ouanes
Kays Chaker
Slaheddine Yaich
Daly Foued
Mahdi Marrak
Yassine Nouira


Introduction :

The main problem after Radical Nephroureterectomy (RNU) for localized non-metataic upper urinary tract urothelial cancer (NM-UUT-UC) is bladder recurrence.

Aim :

To identify factors of bladder recurrence of localized NM-UUT-UC after radical treatment.

Methods :

It is an analytical and observational study that was conducted in the depertment of urology of La Rabta Hospital in Tunis. We collected the data of patients diagnosed with localized NM-UUT-UC who had RNU between 2005 and 2019.

Results :

The mean age of the 73 eligible patients was 68 years (±11). The sex ratio was 5/2. Macroscopic hematuria was the revealing clinical sign in 66% of patients, while low back pain was the most frequent sign in 88% of patients. The most frequent tumor stage was pT1 in 20 patients while 32% of them had a pT2-T3 stage. Bladder recurrence was reported in 22% of patients with a median time of nine months [4-27] and extremes of three and 69 months. Factors of bladder recurrence in the univariate analysis were smoking, tumor localization in the ureter and the extravesical excision of the intramural ureter and bladder cuff. On multivariate analysis, the only independent predictor of bladder tumor recurrence was ureteral location (OR=3.65 ; CI95%=[1.02-13.1] ; p=0.047).

Conclusion :

Tumor localization in the ureter was an independent predictor of bladder recurrence after radical treatment for localized NM-UUT-UC.


Ureteral neoplasms, Nephroureterectomy, Risk factors, Recurrence, Urinary Bladder , Neoplasms



  1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. Cancer J Clin 2022;72:7-33.
  2. Seisen T, Granger B, Colin P, Leon P, Utard G, Renard-Penna R, et al. A systematic review and meta-analysis of clinicopathologic factors linked to intravesical recurrence after radical nephroureterectomy to treat upper tract urothelial carcinoma. Eur Urol 2015;67:1122-33.
  3. Neuzillet Y, Seisen T, Traxer O, Allory Y, Audenet F, Leon P, et al. Guidelines update 2022-2024 : upper urinaru tract urothelial cancer. Prog Urol 2022;32:1164-94.
  4. Hou G, Zheng Y, Zhang L, Lai D, Wang F, Li X, et al. Development and validation of a prognostic nomogram for patients with intravesical recurrence after radical nephroureterectomy for non-metastatic upper tract urothelial carcinoma. World J Urol 2020;38(8):1969‑75.
  5. Jones TD, Wang M, Eble JN, MacLennan GT, Lopez-Beltran A, Zhang S, et al. Molecular evidence supporting field effect in urothelial carcinogenesis. Clin Cancer Res 2005;11(18):6512‑9.
  6. Fradet V, Mauermann J, Kassouf W, Rendon R, Jacobsen N, Fairey A, et al. Risk factors for bladder cancer recurrence after nephroureterectomy for upper tract urothelial tumors: Results from the Canadian Upper Tract Collaboration. Urol Oncol 2014;32(6):839‑45.
  7. Xylinas E, Kluth L, Passoni N, Trinh QD, Rieken M, Lee RK, et al. Prediction of intravesical recurrence after radical nephroureterectomy: development of a clinical decision-making tool. Eur Urol 2014;65(3):650‑8.
  8. Li WM, Li CC, Ke HL, Wu WJ, Huang CN, Huang CH. The prognostic predictors of primary ureteral transitional cell carcinoma after radical nephroureterectomy. J Urol 2009;182(2):451‑8.
  9. Ito A, Shintaku I, Satoh M, Ioritani N, Aizawa M, Tochigi T, et al. Prospective randomized phase ii trial of a single early intravesical instillation of Pirarubicin (THP) in the prevention of bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma: the thp monotherapy study group trial. J Clin Oncol 2013;31(11):1422‑7.
  10. Marchioni M, Primiceri G, Cindolo L, Hampton LJ, Grob MB, Guruli G, et al. Impact of diagnostic ureteroscopy on intravesical recurrence in patients undergoing radical nephroureterectomy for upper tract urothelial cancer: a systematic review and meta-analysis. BJU Int 2017;120:313-9.
  11. Guo RQ, Hong P, Xiong GY, Zhang L, Fang D, Li XS, et al. Impact of ureteroscopy before radical nephroureterectomy for upper tract urothelial carcinomas on oncological outcomes: a meta-analysis. BJU Int 2018;121:184-93.
  12. Baboudjian M, Al-Balushi K, Michel F, Lannes F, Akiki A, Gaillet S, et al. Diagnostic ureteroscopy prior to nephroureterectomy for urothelial carcinoma is associated with a high risk of bladder recurrence despite technical precautions to avoid tumor spillage. World J Urol 2020;38:159-65.
  13. Chung Y, Lee DH, Lee M, Kim H, Lee S, Hong SK, et al. Impact of diagnostic ureteroscopy before radical nephroureterectomy on intravesical recurrence in patients with upper tract urothelial cancer. Investig Clin Urol 2020;61:158-65.