Introduction:
Risk stratification of upper tract urothelial carcinoma is central to current clinical guidelines on postoperative surveillance after management with radical nephroureterectomy (RNU). While low-grade upper tract urothelial carcinoma (LG-UTUC) is generally classified as low risk and previously shown to lack significant association with cancer-specific mortality, urothelial recurrence in the bladder is not uncommon. This study aims to describe recurrence patterns of and to identify predictive risk factors for urothelial carcinoma recurrence after RNU for LG-UTUC in order to improve surveillance strategies and treatment outcomes.
Methods:
Retrospective electronic medical record review of 214 RNUs performed at our institution from February 2010 to April 2017 identified 37 patients with LG-UTUC on final pathology. Patients with high-grade UTUC at time of RNU, evidence of nodal or distant metastatic disease, and pre-treatment with systemic therapy were excluded. Clinical, pathologic, recurrence, and survival data were obtained. Descriptive statistics, independent t tests, Pearson chi squared analysis, Kaplan-Meier survival curves, Mantel-Cox log rank testing, and logistic regression modeling were utilized to examine the cohort and compare risk factors for early recurrence of urothelial malignancy, defined as recurrence within 6 months following RNU.
Results:
Among 214 RNUs performed, 37 had LG-UTUC on final histology. Mean age at surgery was 71.9 years, and most patients were male (74.8%), white (89.2%), and current/former smokers (83.8%). 40.5% had history of urothelial carcinoma of the bladder. Median overall survival was 91.3 months with 13 patients deceased at last follow up (Figure 1).
Twenty patients (54.1%) with LG-UTUC experienced any recurrence of urothelial carcinoma over a mean follow up of 43.5 months. Recurrence was diagnosed at median 6.0 months post-RNU, and median recurrence-free survival was 12.7 months. One patient developed metastases and succumbed 36 months after RNU.
Tumor multifocality and increasing tumor size were significantly associated with early urothelial recurrence within 6 months of RNU on unadjusted analysis (Table 1). Multivariable analysis of demographics, surgical factors, and tumor characteristics demonstrated that current smoking (OR 10.6, p=0.03) and increasing tumor size (OR 1.9, p=0.03) were independently associated with early recurrence.
Conclusion:
LG-UTUC is at risk of recurrence in the bladder; however, development of metastatic disease and cancer-related mortality is very rare after definitive management with RNU. Current smoking and larger tumor size are independently associated with early recurrence of urothelial carcinoma within 6 months of RNU. These risk factors may inform clinicians’ surveillance strategies after RNU for LG-UTUC.
Funding: N/A
Image(s) (click to enlarge):
PREDICTIVE RISK FACTORS FOR EARLY RECURRENCE AFTER RADICAL NEPHROURETERECTOMY FOR LOW-GRADE UPPER TRACT UROTHELIAL CARCINOMA
Category
Bladder Cancer > Upper Tract Urothelial Carcinoma
Description
Poster #117
Thursday, Dec 2
2:00 p.m. - 3:00 p.m.
Kidney/UTUC
Presented By: Heather L Huelster
Authors:
Heather L Huelster
Alyssa Bilotta
Nicholas Russo
Jacob Britt
Elizabeth Green
Kyle Rose
Wade J Sexton
Michael A Poch
Scott M Gilbert
Alice Yu
Philippe E Spiess
Roger Li