To identify factors prognostic for survival after urothelial recurrence after radical cystectomy for bladder cancer.

Of the 2029 patients with bladder cancer who underwent radical cystectomy at our institution, 80 (3.9%) patients experienced recurrence in the urothelium (upper urinary tract or urethra) and had sufficient follow-up for further analysis. Clinicopathologic characteristics were analyzed by univariate and multivariable analyses to identify factors prognostic for postrecurrence disease-specific (PRDSS) and overall (PROS) survival.

At median follow-up of 12 years, 25 (31.3%) and 55 (68.7%) patients experienced recurrence in the upper tract and urethra, respectively. Median time to recurrence, PRDSS, and PROS were 25.9, 58.4, and 48.7 months, respectively. Older age (P = .018), patients with tumors that were upstaged at cystectomy compared with their clinical stage (P = .049), and positive surgical margins (P = .022) were associated with a lower PROS. The presence of symptoms at follow-up was associated with a poor PRDSS (P = .028), which was confirmed by multivariable analysis. Patients experiencing urothelial recurrence within 2 years of cystectomy had a lower PRDSS (P = .002) and PROS (P = .003), which was confirmed by multivariable analysis. Site of urothelial recurrence did not influence time to recurrence (P = .87), PRDSS (P = .72), or PROS (P = .57).

Urothelial cancer relapse in the upper urinary tract or urethra has a comparable clinical course, and may be cured with extirpative surgery, with median PROS of 48.7 months after recurrence. Patients experiencing early urothelial recurrence face worse prognosis and should be considered candidates for adjuvant therapy.