The frequency of hydronephrosis at initial diagnosis and its effect on recurrence and progression in patients with superficial bladder cancer.

PURPOSE

We determined the frequency of hydronephrosis at initial diagnosis, and its effect on recurrence and progression in patients with superficial bladder cancer.

MATERIALS AND METHODS

Between January 1993 and April 2006 we retrospectively reviewed the records of 931 patients with superficial transitional cell carcinoma of the bladder at our institute. Hydronephrosis status was determined by excretory urogram, ultrasound or computerized tomography of the abdomen and pelvis at initial evaluation. The number of tumors, tumor size, tumor location, T category (pTa vs pT1) and histological grade were assessed at study entry. The absence or presence of unilateral or bilateral upper tract obstruction/hydronephrosis was recorded for all cohorts. We examined the frequency of hydronephrosis in patients with superficial bladder carcinoma according to T status and investigated the relationship between hydronephrosis, and recurrence-free and progression-free survival for pTa and pT1 stage. The end points assessed were recurrence and progression.

RESULTS

Histopathological results showed that 63.8% of all superficial bladder cancer cases were pT1 stage. Preoperative radiological evaluation revealed unilateral and bilateral hydronephrosis in 70 (7.5%) and 19 (2.1%) patients in all cohorts, respectively. Of patients with pTa tumors 304 (90.2%) had low grade lesions and 207 (61.4%) had a single tumor. Unilateral and bilateral hydronephrosis was detected in 16 (4.7%) and 4 (1.2%) patients with pTa, respectively. Of patients with pT1 tumors 196 (33.0%) had low grade lesions and 283 (47.6%) had a single tumor. Unilateral and bilateral hydronephrosis was detected in 54 (9.1%) and 15 (2.5%) patients with pT1 disease, respectively. The increased probability of hydronephrosis was detected in higher stage, higher grade multiple tumors and in tumors larger than 3 cm. Of 931 patients 37.9% had at least 1 recurrence with an incidence of 27.3% for Ta and 43.9% for T1 disease. The recurrence rate was 52.8% for patients with hydronephrosis, that is 35.0% for Ta and 58.0% for T1 disease. Median time to first recurrence was 22 months. Multivariate Cox analysis confirmed that T category, grade, tumor size and hydronephrosis were significant prognostic variables of recurrence. Of the cases 11% progressed to muscle invasive bladder cancer. Multivariate analysis revealed that progression was statistically significant for T category, disease grade, multiplicity, tumor size and the presence or absence of hydronephrosis.

CONCLUSIONS

Unilateral/bilateral hydronephrosis detected at the first evaluation at diagnosis of superficial bladder tumors is an independent prognostic factor for recurrence and progression.