The optimal oncologic surveillance in patients with upper tract urothelial carcinoma (UTUC) elected for conservative treatment is still a matter of debate.
Patients elected for endoscopic treatment of UTUC were followed up according to EAU guidelines recommendations after treatment. Bladder cancer recurrence-free survival (BCa-RFS), UTUC recurrence-free survival (UTUC-RFS), radical nephroureterectomy-free survival (RNU-FS), and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. The crude risks of BCa and UTUC recurrences over time were estimated with the Locally Weighted Scatterplot Smoothing method.
Overall, 54 and 55 patients had low- and high-risk diseases, respectively. Median follow-up was 46.9 (IQR: 28.7-68.7) and 36.9 (IQR: 19.8-60.1) months in low and high-risk patients, respectively. In low-risk patients, BCa recurrence risk was more than 20% at 24 months follow-up. At 60 months, time point after which cystoscopy and imaging should be interrupted, the risk of BCa recurrence and UTUC recurrence were 14% and 7%, respectively. In high-risk patients, the risk of BCa and UTUC recurrence at 36 months was approximately 40% and 10%, respectively. Conversely, at 60 months, the risk of bladder recurrence and UTUC recurrence was 28% and 8%, respectively.
For low-risk patients, cystoscopy should be performed semi-annually until 24 months, while upper tract assessment should be obtained up to 60 months, as per current EAU guidelines recommendations. For high-risk patients, upper tract assessment should be intensified to semi-annually up to 36 months, then obtained yearly. Conversely, cystoscopy should be ideally performed semi-annually until 60 months and yearly thereafter.
Minerva urology and nephrology. 2024 Feb [Epub]
Giuseppe Basile, Andrea Gallioli, Alberto Martini, Paolo Verri, Jorge Robalino, Lucia Dieguez, Pavel Gavrilov, Angelo Territo, Alessandro Uleri, Josep M Gaya, Ferran Algaba, Joan Palou, Alberto Breda
Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain - ., Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain., Department of Urology, MD Anderson Cancer Center, Houston, TX, USA., Department of Pathology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain.