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AUA 2017

AUA 2017: Outcomes of Urothelial Bladder Cancer Patients Who Had Previous Upper Tract Urothelial Disease

Boston, MA (UroToday.com) It is known that upper tract urothelial carcinoma (UTUC) accounts for <5% of all urothelial cancers. Studies show that urothelial bladder carcinoma recurrence (UBCR) occurs in 22–47% of deNovo UTUC (dNUTUC) patients. Various guidelines recommend surveying the bladder with cystoscopies for at least a period of 5-10 years. The authors’ goal was to compare UBCR rates, predictors and disease specific mortality in dNUTUC and to try to ascertain the length of required bladder surveillance after dNUTUC diagnosis.

For this study, the SEER database was queried for all patients with dNUTUC from 1988-2013, including all those who developed UBCR. Data collected consisted of demographic, clinical and pathological parameters. Lastly, UCBR and cancer specific mortality (CSM) were examined using multivariate regression models.

A total of 18,338 patients with dNUTUC disease were found between 1988 – 2013 with 19.3% developing UBCR within a median of 12.9 months. Demographic parameters were clinically similar between dNUTUC patients with or without UBCR. dNUTUC patients with UBCR had a lower percentage of stage T2 and above disease and a lower percentage of high grade disease as well. Additionally, dNUTUC patients with UBCR had lower rates of chemotherapy and radiotherapy compared to dNUTUC patients without UBCR.

Multivariate regression analyses were performed to ascertain predictors of UBCR. This showed that male gender, residing in the south of US and being surgically treated increased the rate of UBCR. Predictors of increased CSM included increasing age, residing in south US, higher grade and stage disease and being treated with radiotherapy.

Finally, the authors tried to ascertain the ideal length of time required for bladder surveillance to diagnose UBCR. The results showed that median time to diagnosis of UBCR was 12.9 months, with 75% of UBCR being diagnosed within a 1.5 years, and 91% of UBCR being diagnosed within 3.5 years of dNUTUC diagnosis.

In summary, almost a 1/5 of dNUTUC patients will develop UBCR. Bladder surveillance should continue for 3.5 years to diagnose > 90% of UBCR. Male gender, residing in the south, and dNUTUC surgical TX predict increased UBCR. It is important to take into account that results are probably subject to a competing risk bias due to the fact that patients with worse dNUTUC disease did not have a chance to develop UBCR.

Presented By: Hanan Goldberg, Toronto, Canada

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA