Intravesical Recurrence After Radical Nephroureterectomy of Upper Urinary Tract Urothelial Carcinoma: A Large Population-Based Investigation of Clinicopathologic Characteristics and Survival Outcomes

Abstract

Background: Of patients with upper urinary tract urothelial carcinoma (UTUC), 22–47% developed bladder recurrence after radical nephroureterectomy. Furthermore, the effect of surgery for UTUC-bladder cancer (BC) has not been well validated. The aim of this study was to assess the impact of standard primary BC surgical strategy on survival of patients diagnosed with UTUC-BC.Patients and Methods: A total of 676 UTUC-BC patients and 197,753 primary BC patients diagnosed from 2004 to 2016, were identified based on the SEER database. The Kaplan-Meier method and the Fine and Gray competing risks analysis were performed to assess overall survival (OS) and cancer-specific mortality (CSM). Multivariate Cox regression model and competing risks regression model were used to identify independent risk factors. Propensity score matching (PSM) was also performed to adjust potential confounding factors.Results: The baseline characteristics and survival outcomes of the two BC patient cohorts are quite different. For UTUC-BC patients, no significant difference in OS (NMIBC: p = 0.88; MIBC: p = 0.98) or cumulative incidence of CSM (NMIBC: p = 0.12; MIBC: p = 0.96) were noted for various surgical procedures. Local tumor treatment and partial cystectomy for UTUC-NMIBC patients produced lower 1-year (6.1%) and 3-year CSM (16.2%). Radical cystectomy for UTUC-MIBC patients produced lower 1-year (11.8%) but higher 3-year CSM (62.7%). After PSM for covariates, UTUC-BC patients still had a worse prognosis after surgery compared with primary BC patients. Based on regression models, older age, advanced T stage, N positive disease, M positive disease, and shorter interval between UTUC and BC were identified as independent risk factors for UTUC-BC patients.Conclusion: Standard primary BC surgical strategy did not provide significant survival benefit for UTUC-BC patients. Compared with primary BC patients, UTUC-BC patients had a worse prognosis after surgery, suggesting that current primary BC surgical guidelines are not entirely appropriate for UTUC-BC patients. Our findings underscore the continued importance and need for better prognosis and improved guidelines for management of UTUC-BC patients.

Prognostic Value of Bladder Involvement in the Outcome of Upper Tract Urothelial Carcinoma

“…However, recent data suggest that current primary UBC surgical guidelines are not entirely appropriate for UTUC-UBC patients [27].…”

Impact of previous, simultaneous or intravesical recurrence bladder cancer on prognosis of upper tract urothelial carcinoma after nephroureterectomy: a large population-based study

“…Impact of previous, simultaneous or intravesical recurrence bladder cancer on prognosis of upper tract urothelial carcinoma after nephroureterectomy: a large population-based study 22-47% of UTUC patients may experience intravesical recurrence (IVR) after nephroureterectomy (RNU) (4,5). Currently, the impact of previous, simultaneous or IVR on the prognosis of UTUC is controversial.…”

“…Nevertheless, several studies revealed that UTUC patients with concomitant or bladder cancer history had worse prognosis, and was an independent risk factor (2,9,10). Meanwhile, IVR was also reported to have an adverse effect on the prognosis of UTUC (2,5,11). In contrast, studies showed IVR after RNU did not affect the prognosis of UTUC (12,13).…”

Predicting and Decreasing Bladder Tumor Recurrence Following Nephroureterectomy

“…RNU with bladder cuff excision is the standard of care for non-metastatic UTUC (15). Despite recent advances in the care of urothelial carcinoma, the rate of BTR following RNU remains high (4,7,16,17). Multiple studies have examined the risk factors for BTR, but results vary significantly.…”