The Prognostic Impact of Tumor Location in pT3N0M0 Upper Urinary Tract Urothelial Carcinoma: A Retrospective Cohort Study

Abstract

BackgroundWe aimed to evaluate the impact of tumor location on cancer outcomes in patients with pT3N0M0 upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU) with bladder cuff excision.Materials and MethodsWe retrospectively reviewed 302 patients with pT3N0M0 UTUC who underwent RNU with bladder cuff excision at our institution between 2005 and 2019, including 191 renal pelvis tumors and 111 ureteral tumors. Clinicopathologic characteristics were compared between renal pelvis and ureter urothelial carcinomas. Multivariate Cox proportional hazard regression was used to assess the association between outcomes and clinical factors. Outcomes of interest included intravesical recurrence-free survival (IVRFS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and cancer-specific survival (CSS), which were measured using the Kaplan–Meier curve with a log-rank test.ResultsA total of 302 patients underwent RNU with bladder cuff excision. During the median follow-up of 42.7 months, 70 (23.2%), 95 (31.5%), and 99 (32.8%) patients experienced intravesical recurrence, local recurrence, and distant metastasis, respectively. Seventy (23.2%) patients died from UTUC. Multivariate Cox regression analysis showed that tumor location was an independent predictor of local recurrence (HR = 2.05, p = 0.001), with borderline independent significance in intravesical recurrence (HR = 1.54, p = 0.074) and distant metastasis (HR = 1.45, p = 0.08). Kaplan–Meier analysis showed that ureter tumors had a worse 5-year local recurrence (log-rank p < 0.001) and borderline worse 5-year intravesical recurrence (log-rank p = 0.055) and 5-year distant metastasis (log-rank p = 0.073).ConclusionUreter tumors seem to be associated with worse oncological outcomes, especially with local recurrence in UTUC. Further large and long-term studies are warranted for investigating biological differences based on tumor location.

Upper Tract Urothelial Carcinoma: A Narrative Review of Current Surveillance Strategies for Non-Metastatic Disease

“…The predominant sites of metastasis were the lungs, liver, and bones [49]. Other studies have reported similar metastasis rates post RNU, ranging from 8.3% to 46% [44][45][46][47][48]51]. Consequently, abdominal and chest imaging are part of the surveillance protocols of the NCCN, AUA, and EAU guidelines, allowing for the detection of these metastasis patterns.…”

“…Unlike intravesical recurrences, which can be effectively monitored through frequent cystoscopies, the emergence of loco-regional and distant recurrences necessitates regular abdominopelvic and chest imaging. Generally, local recurrence rates after RNU are reported to range from 5 to 32% in retrospective studies [ 43 , 44 , 45 , 46 , 47 , 48 ]. In a study conducted by Martini et al, the risk of non-bladder recurrence was assessed in 1378 prospectively collected UTUC patients treated with RNU across various European academic centers.…”

Upper Tract Urothelial Carcinoma (UTUC): Prevalence, Impact and Management Challenge

“…5 This is evident in Taiwan, where UTUC has a high incidence and female predominance, accounting for 30% of UC cases. 6 This proportion of patients also exhibited more adverse pathological features compared to other international centres, suggesting variation in the pathogenesis of the disease. 7 UTUCs are most commonly sporadic; however, genetic risk factors have also been identified.…”