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AUA 2017

AUA 2017: Is De Novo Upper Tract Urothelial Carcinoma A Distinct Entity From Bladder Carcinoma?

Boston, MA (UroToday.com) Dr. Goldberg presented a project from the Princess Margaret Cancer center in Toronto focusing on the comparison between de novo urothelial upper tract carcinoma (DnUTUC) and secondary upper tract urothelial disease (SUTUC) )(i.e.: having had a prior history of bladder cancer). Due to the rarity of this disease, accounting for less than 5% of all urothelial cancers, they used the SEER cancer registry, accounting for 28% of all cancer in the USA. UTUC is usually considered a part of the spectrum of urothelial cancers, manifesting as bladder cancer (BC) primarily. Their goal was to find whether there are clinical differences between DnUTUC and SUTUC.

Overall 20,448 patients with UTUC were found between the years 1988-2013. However, patients with metastatic disease or those with unknown metastatic status were excluded to determine stratum specific differences, leaving 9,707 patients for the analysis. Approximately 72% of patients had DnUTUC, and almost 28% had a prior history of BC. Patients with DnUTUC were on average: younger, more likely to be female and more racially diverse. DnUTUC tumors tended to be larger and disproportionately high grade and stage. Interestingly, renal pelvic tumors were more prevalent as well.

In terms of survival, covariates associated with diminished cancer specific survival included: increasing age, tumor size, stage and grade and most importantly, whether the tumor was de novo. Furthermore, variables associated with impaired overall survival included: increasing age, tumor size, stage and grade.

This is the first large population based analysis suggesting that DnUTUC may represent a distinct clinical entity from bladder cancer. Although surveillance bias may explain the baseline differences in tumor characteristics, multivariate adjustment still demonstrated a distinct outcome for these patients. Further investigations including biomarker profiling between DnUTUC and SUTUC may further shed light into biological differences between these heretofore similar microscopic entities.

Presented By: Hanan Goldberg, Toronto, Canada

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA