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ResumoObjetivosIdentificar os fatores preditivos associados com a recorrência vesical do carcinoma urotelial do aparelho urinário superior (CTUS), em doentes submetidos a nefroureterectomia radical e determinar a sobrevivência global destes indivíduos.Materiais e métodosAnálise retrospetiva de 64 doentes com CTUS submetidos a nefroureterectomia radical, entre 2003‐2013, no Serviço de Urologia do Hospital de São João, Porto, Portugal. Analisaram‐se as seguintes variáveis: idade, género, características do tumor (estádio, grau, localização, invasão linfovascular, multifocalidade), neoplasia maligna prévia da bexiga, tipo de abordagem cirúrgica do ureter distal e quimioterapia adjuvante (sistémica).ResultadosA idade mediana foi de 71,0 anos (percentil 25‐percentil 75: 64,5‐75,5) e 65,6% eram do género masculino. O follow‐up mediano foi de 33,8 meses (P25‐P75: 15,0‐64,6). Os estádios T3 e T4 (hazard ratio [HR]=1,35 [95%intervalo de confiança {IC}: 0,47‐3,94]), a localização no ureter (HR=1,47 [95%IC: 0,53‐4,06]), multifocalidade (HR=2,86 [95%IC: 0,89‐9,12]) e quimioterapia adjuvante (HR=3,84 [95%IC:0,90‐16,45]) estavam associados com pior sobrevivência global, embora de forma não estatisticamente significativa. Neoplasia maligna prévia da bexiga (HR: 2,03 [95%IC: 0,66‐6,26]), invasão linfovascular (HR=1,40 [95%IC: 0,49‐4,05]) e tumores de alto grau (HR=1,43 [95%IC: 0,33‐6,29]) apresentaram recorrência vesical mais alta, embora não estatisticamente significativa. Uma tendência a um menor risco de recorrência vesical foi observada entre os pacientes sujeitos a QT adjuvante (HR=0,78 [95%IC: 0,22‐2,72]).ConclusõesA história prévia de neoplasia maligna da bexiga foi o preditor mais forte de recorrência vesical e indivíduos com marcadores de pior prognóstico tendem a ter um menor risco de recorrência vesical, devido a supostos riscos competitivos entre morte e recorrência.AbstractObjectivesTo identify the predictive factors associated with bladder recurrence of UTUC in patients undergoing radical nephroureterectomy and determine the overall survival of these individuals.Materials and methodsRetrospective analysis of 64 patients with UTUC subjected to radical nephroureterectomy between 2003 and 2013 in Department of Urology–Hospital S. João, Porto, Portugal. The following variables were analysed: age, gender, tumour characteristics (stage, grade, location, lymphovascular invasion, multifocality), previous malignant neoplasia of the bladder, surgical approach of the distal ureter and adjuvant (systemic) chemotherapy.ResultsThe median age was 71.0 years (percentile25‐percentile75: 64.5‐75.5) and 65.6% were male. The median follow‐up was 33.8 months (P25‐P75: 15.0‐64.6). T3 and T4 stages [Hazard ratio (HR)=1.35 (95%confidence interval: 0.47‐3.94)], the location in the ureter [HR=1.47 (95%CI: 0.53‐4.06)], multifocality [HR=2.86 (95%CI: 0.89‐9.12)] and adjuvant chemotherapy [HR=3.84 (95%CI: 0.90‐16.45)] were associated with worse overall survival, although not statistically significant. Previous malignant neoplasia of the bladder [HR=2.03 (95%CI: 0.66‐6.26)], lymphovascular invasion [HR=1.40 (95%CI: 0.49‐4.05)] and high‐grade tumours [HR=1.43 (95%CI: 0.33‐6.29)] showed higher bladder recurrence, although not statistically significant. A tendency to a lower risk of bladder recurrence was observed among patients receiving adjuvant chemotherapy [HR=0.78 (95%CI: 0.22‐2.72)].ConclusionsThe previous history of malignant neoplasia of the bladder was the strongest predictor of bladder recurrence and individuals with worse prognostic markers tend to have a lower risk of bladder recurrence, due to supposed competing risks between death and recurrence

Fatores preditivos da recorrência vesical do carcinoma urotelial do trato urinário superior após nefroureterectomia radical