Muscle-invasive bladder and urethral cancer recurrence after surgical management of upper tract urothelial carcinoma: A review of 305 patients

Abstract

Objective: Bladder cancer recurrence after management of upper tract urothelial carcinoma (UTUC) is a common disease. Although the incidence and risk factors for the development of noninvasive bladder tumor have been reported in many series, rare studies have reported on muscle invasive bladder cancer (MIBC) and its urethral recurrence. We aimed to report the incidence, risk factors and survival rate for the development of MIBC and urethral tumors after surgical management of UTUC. Material and methods:We retrospectively reviewed patients who were surgically treated for UTUC from 1983 to 2013. The tumor was categorized according to the 1997 TNM staging and the 3-tiered WHO grading systems. The primary endpoint of this study was the occurrence of any posttreatment MIBC and its urethral recurrences. We studied the possible risk factors that may contribute to the development of such pathology as well as the prognosis of this pathology.Results: A total of 297 patients were eligible for analysis. Intravesical tumor recurrence was observed in 139 (46.8%) patients and radical cystectomy was warranted for 36 patients (MIBC or multicentric bladder recurrence). Twenty-seven patients were fit for surgery with ileal loop conduit was the urinary diversion for the majority, and others received radiotherapy. Ureteral tumor was the only statistically significant risk factor (p=0.001) and the incidence increased as the ureteral tumors became more distal (p=0.01). Occurrence of invasive or multicenteric bladder recurrence was a predictor for local, urethral recurrence and distant metastasis (p=0.016, 0.0001 and 0.01 respectively). Seven patients had urethral urothelial carcinoma; 5 were diagnosed at the time of cystectomy and 2 were discovered later (1 and 3 years after cystectomy). Conclusion:MIBC is a relatively uncommon (6%) post UTUC, and ureteral tumors, especially distal in location, are the independent risk factor. Extended surveillance for those patients is needed. Urethral cancer recurrence is rare (2%); most cases are localized in the posterior urethra, they are noninvasive, and may develop even after cystectomy.

Prognostic Significance of Primary Tumor Location in Upper Tract Urothelial Carcinoma Treated with Nephroureterectomy: A Retrospective, Multi-Center Cohort Study in Taiwan

“…We found that compared with RPT, UT was significantly correlated with inferior BRFS. In previous studies, the role of tumor location in bladder recurrence was not consistent; some found UT had a lower BRFS rate than RPT [21][22][23], but some concluded there was no difference between RPT and UT [24][25][26]. As mentioned, the actual impact of tumor location on prognosis can be revealed by excluding multifocal cases.…”

Postoperative adjuvant radiotherapy for patients with upper tract urothelial carcinoma (UTUC) who underwent kidney-sparing surgery (KSS): a single-center study

“…The effective rates were higher than those of patients who underwent surgery alone reported in the literature [ 23 , 24 ] and similar to those of postoperative radiotherapy groups [ 11 , 25 ]. Bladder recurrence is common postoperatively in patients with UTUC and a risk factor for a poor prognosis [ 26 ]. The bladder recurrence rate can reach 27 to 47% [ 27 , 28 ] after surgery, as described in the literature.…”

Metastatic transitional cell carcinoma of the bladder in an ileal conduit stoma. A case report and literature review

“…(6) Another study found that a distal ureteral tumor was an independent risk factor for the development of MIBC and radical cystectomy. (7) In 1974, Grabstald described the first case of tumor surrounding the ileal stoma 4 years after a radical cystectomy, assigning the direct implantation of tumor cells during surgery as the probable cause. It was treated with surgical resection, and before performing the urinary diversion, the skin was thoroughly washed and the instruments were replaced.…”