AUTHOR=Wu Jie , Xu Pei-Hang , Luo Wen-Jie , Dai Bo , Shen Yi-Jun , Ye Ding-Wei , Wang Yu-Chen , Zhu Yi-Ping 

TITLE=Intravesical Recurrence After Radical Nephroureterectomy of Upper Urinary Tract Urothelial Carcinoma: A Large Population-Based Investigation of Clinicopathologic Characteristics and Survival Outcomes

JOURNAL=Frontiers in Surgery

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2021.590448

DOI=10.3389/fsurg.2021.590448

ISSN=2296-875X

ABSTRACT=Background: Of patients with upper urinary tract urothelial carcinoma (UTUC), 22%–47% developed bladder recurrence after radical nephroureterectomy. Furthermore, the benefit of surgery for UTUC-bladder cancer (BC) has not been well validated. The aim of this study was to comprehensively compared UTUC-BC with primary BC and assess the impact of standard primary BC surgical strategy on survival of patients diagnosed with UTUC-BC.
Patients and methods: A total of 676 UTUC-BC patients and 197753 primary BC patients diagnosed from 2004–2016, were identified based on the SEER database. The Kaplan-Meier method and the Fine and Gray competing risks analysis were performed to assess overall survival (OS) and cancer-specific mortality (CSM). Multivariate Cox regression model and competing risks regression model were used to identify independent risk factors.
Results: The baseline characteristics and survival outcomes of the two BC patient cohorts are quite different. For UTUC-BC patients, no significant difference in OS (NMIBC: p=0.88; MIBC: p=0.98) or cumulative incidence of CSM (NMIBC: p=0.12; MIBC: p=0.96) were noted for various surgical procedures. Local tumor treatment and partial cystectomy for UTUC-NMIBC patients produced lower 1-year (6.1%) and 3-year CSM (16.2%). Radical cystectomy for UTUC-MIBC patients produced lower 1-year (11.8%) but higher 3-year CSM (62.7%). Based on regression models; older age, advanced T stage, N positive disease, M positive disease, and shorter interval between UTUC and BC were identified as independent risk factors for UTUC-BC patients.
Conclusion: These results highlight the significant difference among UTUC-BC and primary BC patient outcomes and suggest that current primary BC surgical guidelines are not entirely appropriate for UTUC-BC patients.