AUA 2017: Is there a role for upper tract urinary tract imaging surveillance in the follow-up of non-muscle invasive bladder cancer?
The authors performed a retrospective study assessing patients diagnosed with NMIBC from 2003 to 2013 at their institution. They assessed computerized tomography imaging used in surveillance and 5 to 10 year UTUC-free survival.
A total of 315 patients were studied. There were a total of 396 CT scans assessed of which 230 CT scans were obtained for surveillance purposes. The majority patients were male (80%), median age 60 years with pathology at diagnosis being Ta (66%), T1 (31%) and CIS (3%). Median follow-up was 56 months.
The 5 and 10 year UTUC-free survival was 98.5% and 97.6%, respectively. Only 4 patients had UTUC recurrence. Only 2 of those recurrences were identified by surveillance CT. A total of 150 CT scans would need to be obtained to detect one UTUC recurrence.
The authors concluded 1.2% UTUC recurrences detected on surveillance with only 0.6% detected by upper tract CT imaging. These findings support further large prospective evaluation of appropriate and less costly surveillance regimens in these patients. The findings need to be interpreted in the context of the study study design. First, the study is retrospective with inherent selection bias. Second, the low use of CT surveillance imaging is not in accordance with current guidelines. Third, radiology interpretation of imaging is critical and may limit the generalizability of these findings. Lastly, other confounders such as smoking and occupation were not controlled in the present analysis.
In summary, the authors propose a timely value-based question and further research in a larger cohort (preferably randomized) may elucidate the omission of upper tract imaging as a surveillance strategy among NMIBC deemed ‘low-risk’ (i.e. former or non-smoker with low risk NMIBC) for recurrence.
Presented by: Benedict Kranzbuhler, Zurich, Switzerland
Written By: Stephen B. Williams, M.D., Assistant Professor in Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish M. Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA