Upper Urinary Tract Recurrence Following Radical Cystectomy for Bladder Cancer: A Meta-Analysis on 13,185 Patients

OverviewAn estimated 79,030 new cases of urinary bladder cancer (60,490 men and 18,540 women) will be diagnosed in the United States in 2017 and approximately 16,870 deaths (12,240 men and 4630 women) will occur. Please NoteThe NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines Disclosures for the NCCN Bladder Cancer PanelAt the beginning of each NCCN Guidelines panel meeting, panel members review all potential conflicts of interest. NCCN, in keeping with its commitment to public transparency, publishes these disclosures for panel members, staff, and NCCN itself.Individual disclosures for the NCCN Bladder Cancer Panel members can be found on page 1267 (The most recent version of these guidelines and accompanying disclosures are available on the NCCN Web site at NCCN.org.)These guidelines are also available on the Internet. For the latest update, visit NCCN.org.

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“…66 Surveillance by urine cytology or upper tract imaging detected recurrences in 7% and 30% of cases, respectively.…”

Section: Follow-upmentioning

confidence: 99%

Bladder Cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology

Spiess¹,

Agarwal²,

Bangs³

et al. 2017

J Natl Compr Canc Netw

219

171

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“…However, it is still controversial with respect to the recurrence rate of upper tract urothelial carcinoma after bladder surgery 3, 9…”

Section: Resultsmentioning

confidence: 99%

“…Upper tract urothelial recurrence (UTUR) following bladder surgery is an infrequent event 1, 2, 3, 4. In patients with primary bladder cancer, the risk of UTUR is <4% 5, 6.…”

Section: Introductionmentioning

confidence: 99%

“…In patients with primary bladder cancer, the risk of UTUR is <4% 5, 6. It has been reported that the overall prevalence of transitional cell carcinoma within the upper tract urothelium following cystectomy ranged from 0.75% to 6.4% 3. Given the rare incidence of UTUR after bladder surgery, there are few patients from previous studies that could be examined regarding the pattern and predictive factors of upper tract recurrence and survival following bladder surgery.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Risk factors for upper tract urothelial recurrence following local excision of bladder cancer

Lin

et al. 2018

Cancer Medicine

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The mechanism of upper tract recurrence after local excision of bladder cancer remains unknown. This study was designed to identify risk factors for upper tract urothelial recurrence following local tumor excision of bladder cancer. To identify 76 597 bladder cancer patients, comprising 76 537 nonrecurrence and 60 recurrence patients, the Surveillance, Epidemiology, and End Results database was used. Kaplan‐Meier analysis and univariate and multivariate Cox proportional hazards regression models were used to determine the risk factors. Compared with the nonrecurrence group, the recurrence group was associated with older age, higher grade, high T stage, and higher proportional squamous cell carcinomas. Univariate Cox proportional hazards regression model showed that age, grades III and IV, T stage, and pathology were significantly associated with worse upper tract urothelial recurrence (UTUR) survival. However, after adjusting for prognostic factors, grade was no longer an independent prognostic factor in multivariate analysis. This study demonstrates that clinical prognosis of UTUR after local bladder tumor excision has significant independent risk factors that include age ≥60 years, T1 and T2 stage, and squamous cell carcinoma, and will require more careful consideration during follow‐up.

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“…A history of cystectomy is a clear risk factor for the development of UTUC and one meta-analysis found the prevalence in this setting to be 0.75-6.4%. 11 Thus, an upper tract defect on imaging is more likely to raise clinical suspicious of UTUC in patients with this history. As such, these patients may have been more likely to undergo RNU despite their cytology status or lack thereof.…”

Section: Group B N=7mentioning

confidence: 99%

The role of urinary cytology when diagnostic workup is suspicious for upper tract urothelial carcinoma but tumour biopsy is nonconfirmatory

Horovitz

Meng

Joseph

et al. 2017

CUAJ

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Introduction: We sought to determine the value of obtaining preoperative urinary cytology when diagnostic workup of an upper tract mass is suspicious for upper tract urothelial carcinoma (UTUC), but biopsy fails to confirm the diagnosis. Methods: Using billing code data, 239 patients were identified as having undergone radical nephroureterectomy (RNU) by 16 urologists from September 29, 1998 to July 31, 2015. Of this group, 19 adult patients had a presumed preoperative diagnosis of UTUC in a native kidney, at least three months of followup, no history of concurrent radical cystectomy with RNU, and negative/non-diagnostic tissue biopsy. These patients were divided into three groups: Group A had no urinary cytology taken (n=6); Group B had upper and/or lower tract cytology performed with neither positive nor atypical (n=7); Group C had upper and/or lower tract cytology performed with at least one positive or atypical (n=6). Results: Demographic information and diagnostic workup was similar between the groups, although Group A had more patients with a history of prior radical cystectomy for bladder cancer (p=0.02). One patient in Group B had benign tissue on final pathology. All patients in Groups A and C had malignancy on final pathology and overall, the three groups had similar rates of malignancy. Conclusions: When a composite of clinical findings suggest UTUC, performing urinary cytology may not be necessary. A negative result in this setting should not be used to rule out UTUC, as this is often discordant with final pathology. A positive cytology result may help solidify the diagnosis when other findings are less clear. IntroductionIntrarenal masses that are suspicious for upper tract urothelial carcinoma (UTUC) may be found either incidentally, during surveillance for bladder cancer, or after the development of symptoms such as flank pain or gross hematuria; however, obtaining a firm preoperative diagnosis may be challenging.If a mass is noted on imaging studies, endoscopy may be performed, with the goal of visualizing the lesion and obtaining a tissue sample, either through cold-cup biopsy or brushings. However, endoscopy may be difficult and tissue samples may be challenging to obtain through ureteroscopes. In cases of a positive biopsy result, nephron-sparing approaches are generally preferred when complete tumour ablation is possible and tumours are low-grade, non-invasive, solitary, small, and easily accessible.1 Otherwise, if the patient has normal renal function and is healthy enough to tolerate it, radical nephroureterectomy (RNU) with bladder cuff excision is the gold standard treatment.In the setting of negative or non-diagnostic biopsy results, the differential diagnosis remains broad. When faced with this dilemma, some urologists will rely on urinary cytology (from the upper tract, lower tract, or both) to help solidify the diagnosis. When used for UTUC, it was reported to have a sensitivity of 45-64% and a specificity of 94-100%. 2-5Our group aimed to retrospectively study the outcomes of...

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Upper Urinary Tract Recurrence Following Radical Cystectomy for Bladder Cancer: A Meta-Analysis on 13,185 Patients

Cited by 145 publications

References 31 publications

Bladder Cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology

Bladder Cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology

Risk factors for upper tract urothelial recurrence following local excision of bladder cancer

The role of urinary cytology when diagnostic workup is suspicious for upper tract urothelial carcinoma but tumour biopsy is nonconfirmatory

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