Tumor distribution affects bladder recurrence but not survival outcome of multifocal upper tract urothelial carcinoma treated with radical nephroureterectomy

Abstract

Tumor multifocality and location are prognostic factors for upper tract urothelial carcinoma (UTUC). However, confounding effects can appear when these two factors are analyzed together. Therefore, we aimed to investigate the impact of tumor distribution on the outcomes of multifocal UTUC after radical nephroureterectomy. From the 2780 UTUC patients in the Taiwan UTUC Collaboration Group, 685 UTUC cases with multifocal tumors (defined as more than one tumor lesion in unilateral upper urinary tract) were retrospectively included and divided into three groups: multiple renal pelvic tumors, multiple ureteral tumors, and synchronous renal pelvic and ureteral tumors included 164, 152, and 369 patients, respectively. We found the prevalence of carcinoma in situ was the highest in the synchronous group. In multivariate survival analyses, tumor distribution showed no difference in cancer-specific and disease-free survival, but there was a significant difference in bladder recurrence-free survival. The synchronous group had the highest bladder recurrence rate. In summary, tumor distribution did not influence the cancer-specific outcomes of multifocal UTUC, but synchronous lesions led to a higher rate of bladder recurrence than multiple renal pelvic tumors. We believe that the distribution of tumors reflects the degree of malignant involvement within the urinary tract, but has little significance for survival or disease progression.

Preoperative systemic inflammation response index enhances the prognostic value of tumor multifocalityin upper tract urothelial carcinoma

“…Milojevic et al ( 16 ) highlighted a significant association between multifocal UTUC and disease recurrence but not CSS. Moreover, Sheu et al ( 17 ) found that multifocal tumors in different locations of the upper urinary tract did not influence survival or disease progression, but synchronous involvement of the ureter and pelvis resulted in a significantly higher rate of subsequent bladder cancer recurrence compared with multiple renal pelvic/ureter tumors. These findings indicated that tumor number had a significant impact on survival outcomes independent of tumor distribution.…”

“…Some studies have suggested that multifocal UTUC is associated with a more aggressive biological behavior and poorer clinical outcome ( 10 , 13 , 14 ). Some evidence showed that multifocal tumors, regardless of the tumor location, are only significantly associated with bladder tumor recurrence and not cancer-specific survival (CSS) ( 15 – 17 ). In addition, emerging research has highlighted the role of inflammatory markers in tumor development and progression ( 18 – 23 ).…”

75–45 degree conversion-modified posterior laparoscopic one-piece radical surgery for uroepithelial carcinoma

“…Uroepithelial carcinoma is the most prevalent pathological type among malignant tumors of the renal pelvis and ureter, and upper tract urothelial carcinoma (UTUC) encompasses renal pelvic and ureteral carcinomas. The prevalence of urothelial carcinoma is high, although this disease primarily affects the bladder [1] . In Europe and the US, the incidence of UTUC has been estimated to be 5-10% among the cases of urothelial carcinoma [2] .…”