Primary urothelial carcinoma of the upper tract: Important clinicopathological factors predicting bladder recurrence after surgical resection

Abstract

The aim of the present study was to further characterize potential clinicopathological predictors for urinary bladder recurrence-free survival (UBRFS) in patients with primary urothelial carcinoma of the upper urinary tract (UUT-UC). The present series included 385 cases of surgically treated primary localized UUT-UC without previous or concurrent urothelial carcinoma of the urinary bladder. Among the 374 patients with follow-up information, clinicopathological features and therapeutic information including whether they received a laparoscopy-assisted nephroureterectomy (LNU) and adjuvant chemotherapy were correlated with UBRFS. After a median follow up of 69 months, 86 patients (23%) developed urinary bladder recurrence. The median time to develop urinary bladder recurrence was 12 months. At the univariate level, an increment in histological grade (P= 0.0321), a prominent papillary configuration (P= 0.0004), LNU (P= 0.0397) and male gender (P= 0.0401) significantly predicted an inferior UBRFS. At the multivariate level, increase of histological grade (P < 0.0001, relative risk (RR) = 3.776), prominent papillary configuration (P < 0.0001, RR = 3.244), and male gender (P= 0.0463, RR = 1.444) independently predicted UBRFS. In conclusion, male patients and those with high-grade and papillary UUT-UC, and who received LNU had higher risks of urinary bladder recurrence. Accordingly, for these patients, more intensive follow up coupled with postoperative intravesical adjuvant therapy to prevent urinary bladder recurrence should also be considered.

Prophylactic Intravesical Chemotherapy to Prevent Bladder Tumors after Nephroureterectomy for Primary Upper Urinary Tract Urothelial Carcinomas: A Systematic Review and Meta-Analysis

“…Tumor multifocality [6,7,28] and prior history of bladder cancer [8,9,28] are the most frequently reported risk factors for bladder recurrence. Other variables such as tumor location [10], tumor stage [6,7] and gender [11] have also been discussed. The identification of factors that allow accurate risk stratification for future bladder relapse is disappointing [28], and it is difficult to select high-risk patients before instillation.…”

“…The reported recurrence rate within the bladder after treatment of a primary UUT-UC is thought to be 20-50% [6,7,8,9,10,11]. Recurrent bladder tumors require transurethral resection, which is associated with surgical complications, higher costs of treatment and potential further radical cystectomy [12].…”

Low-level Ki-67 expression as an independent predictor of bladder tumour recurrence in patients with primary upper tract urothelial carcinoma after radical nephroureterectomy

“…Up to .2% of patients may develop bladder tumour after radical nephroureterectomy (RNU) (3)(4)(5). Previously, few available methods could prevent bladder tumour recurrence.…”

Intravesical Recurrence after Surgical Management of Urothelial Carcinoma of the Upper Urinary Tract

“…The current mainstay for treating UUC-UC is complete resection of the tumor via nephroureterectomy, with bladder cuff excision to effectively prevent local recurrence in the ipsilateral urothelium [4]. However, 22–50% of patients undergoing surgical treatment for UUT-UC develop subsequent urinary bladder recurrence [5,6,7,8,9,10,11,12,13,14,15,16,17]. Several possible predictive factors for this high incidence of intravesical recurrence (IVR) have been reported including tumor multiplicity [5,6,8,13,17], stage [5,8,13], grade [10,15], size [8], and ureteric location [10], as well as gender [14,15] and surgical modality [8].…”