CUA 2017: Is Tumor Location in Upper Tract Urothelial Carcinoma an Important Prognostic Factor?

Toronto, Ontario ( Urothelial carcinoma (UC) is often treated as one entity. However, more and more evidence is demonstrating that upper tract urothelial carcinoma (UTUC) and bladder urothelial carcinoma (BCa) may be two distinct entities. Within UTUC, there has often been debate regarding the impact of location on cancer-specific survival (CSS) – renal pelvis (RENPEL) vs ureteral (UL) UTUC may progress differently due to the environment surrounding their growth (ie depth of tissue, flow of urine, etc.). 

In this study, the authors utilize the SEER database from the United States to address this question, specifically focusing on patients with de novo UTUC. Patients were stratified according to their tumor location and compared for CSS in univariate and multivariate analyses.

They identified 15,298 patients with de novo UTUC (and no prior bladder cancer). Both groups were primarily male (55-60%) and white (80%), and median follow-up was similar (24-27 months). Patients with RENPEL tumors constituted almost 65% of the population, and on average, are larger and more advanced that their UL counterparts. Interestingly, over 46% in both groups subsequently developed UBC. Importantly, however, the management of these patients were different; 85% of RENPEL tumors underwent nephroureterectomy, while only 5% of UL tumors did – 60% of UL tumors underwent ureterectomy and 24% underwent local resection/endoscopic management.

In terms of survival, covariates associated with reduced CSS on multivariable analysis included: increasing age, grade, TNM stage, and renal pelvic tumour (vs. ureteral), while undergoing a nephroureterectomy was associated with an improved CSS.

Despite being more likely to undergo nephroureterectomy, patients with RENPEL tumors still had a worse CSS than UL tumors. While it is uncertain how of much of this is driven by higher tumor stage, patients with RENPEL tumors should be considered higher risk than UL tumors. Contrary to common belief, UL tumors are likely diagnosed earlier and less advanced that RENPEL tumors. Conservative management for RENPEL tumors may not be appropriate.

Presented By: Hanan Goldberg, MD, Princess Margaret Hospital, University Health Network, Toronto, ON

Co-Authors: Zachary Klaassen, Thenappan Chandrasekar, Robert J. Hamilton, Girish S. Kulkarni, Neil E. Fleshner
Institutions: University of Toronto

Written By: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto   Twitter: @tchandra_uromd at the  72nd Canadian Urological Association Annual Meeting - June 24 - 27, 2017 - Toronto, Ontario, Canada