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Upper Urinary Tract Urothelial Carcinoma (UTUC) with Bladder Recurrence: Surgical Outcomes, Prognosis, and Survival - Expert Commentary

Upper urinary tract urothelial carcinoma (UTUC) arises from the renal pelvicalyceal system and ureters and accounts for 5–10% of all urothelial carcinomas. After definitive UTUC treatment by radical nephroureterectomy with bladder cuff excision (RNU), 25-45% of the patients develop intravesical recurrences (IVR). Management of these recurrences is primarily extrapolated from primary bladder cancer (PBC) treatment guidelines.


Recently, Wu et al. compared the clinicopathologic, prognostic factors, and survival outcomes between UTUC-IVR and PBC patients. They used the Surveillance, Epidemiology and End Results (SEER) database of the National Cancer Institute to collect data on 676 patients with UTUC-IVR compared to a cohort of 197,753 PBC patients. The authors used propensity score matching to account for potential confounding factors,

The majority of patients with primary UTUC had renal pelvis cancer (74.7%), grade III/IV (67.6%) with initial node-negative disease (91.0%). The median interval between UTUC and IVR was 22.75 months. The analysis identified significant differences between the two cohorts. The investigators found that patients with UTUC-IVR included more women, were associated with lower TNM stage, smaller tumor size, and had lower radical cystectomy rates than PBC patients. The median overall survival of PBC was significantly higher than UTUC-IVR (97 months vs. 54 months, p <0.001). Radical cystectomy or transurethral resection of the bladder tumor (TURBT) were not associated with a survival benefit for UTUC-IVR patients.

This study highlights the more aggressive nature and poorer prognosis of bladder cancer after initial UTUC diagnosis compared to PBC. The shorter interval between UTUC and IVR was identified as an independent risk factor. This data suggest that current PBC surgical guidelines may not be appropriate for UTUC-IVR patients. Prospective clinical trial designs are needed to define the most effective management strategies for bladder tumors diagnosed after initial UTUC incorporating surgical and systemic therapies.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York City, New York

References:

  1. Wu J, Xu PH, Luo WJ, Dai B, Shen YJ, Ye DW, et al. Intravesical Recurrence After Radical Nephroureterectomy of Upper Urinary Tract Urothelial Carcinoma: A Large Population-Based Investigation of Clinicopathologic Characteristics and Survival Outcomes. Front Surg. 2021;8(February):1–11. PMID: 33693025

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