SES AUA 2022: Are Metachronous Bladder Tumors Predictive of Upper Tract Urothelial Carcinoma Recurrence in Patients Treated with Radical or Endoscopic Surgery

(UroToday.com) The 2022 Southeastern Section of the AUA’s annual meeting included a bladder cancer session and Dr. Christian Ericson discussing whether metachronous bladder tumors are predictive of upper tract urothelial carcinoma recurrence in patients treated with radical or endoscopic surgery. Upper tract urothelial carcinoma comprises 5% of urothelial cancers, and treatment with nephroureterectomy or endoscopically with ureteroscopy with dual laser ablation using holmium and neodymium fibers are current management strategies. Regular surveillance for recurrence is performed post operatively with cross sectional imaging or by ureteroscopy. Patients with metachronous bladder tumors after a nephroureterectomy have been shown to have lower 5-year overall survival, as well as increased risk of contralateral recurrence.1,2 Metachronous bladder tumors are often identified during surveillance and there is a paucity of literature defining their role in predicting upper tract recurrence of upper tract urothelial carcinoma. The objective of this study was to describe the significance of metachronous bladder tumors in predicting recurrence of upper tract urothelial carcinoma in patients who have received endoscopic versus radical management of their disease.


For this study, data was retrospectively evaluated from 131 patients who were treated for upper tract urothelial carcinoma with either nephroureterectomy or endoscopic management from 2016 to 2020. Patients underwent surveillance for a maximum of 48 months and the rates of upper tract recurrence (ipsilateral or contralateral) were recorded. Patients were stratified by the presence or absence of metachronous bladder tumors. The rates of upper tract recurrence overall, as well as solely in the contralateral kidney were compared in the two groups. A Pearson’s chi-squared test was utilized to determine statistical significance of the two groups.

Overall, upper tract recurrence occurred in 23 of 131 (17.6%) patients and 35 of 131 (26.7%) patients developed metachronous bladder tumors. Presence of metachronous bladder tumors vs absence of metachronous bladder tumors was predictive of overall upper tract urothelial carcinoma recurrence with incidence of 12 of 35 (34.3%) vs 11 of 96 (11.5%) (p = 0.0035). Presence of metachronous bladder tumors versus absence of metachronous bladder tumors was also predictive of solely contralateral upper tract urothelial carcinoma recurrence with incidence of 3 of 26 (11.5%) vs 0 of 81 (0%) (p = 0.0019):

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Dr. Ericson concluded his presentation with the following take-home messages:

  • Identification of metachronous bladder tumors during surveillance for upper tract urothelial carcinoma is predictive of upper tract recurrence
    • Contralateral recurrence only occurred in patients with positive bladder recurrence
  • This is applicable to patients who have bilateral renal units being treated with endoscopic management, as well as in patients with a solitary kidney after nephroureterectomy
  • Physicians should be aware of the increased rate of recurrence in these patients when performing surveillance and risk adapted upper tract surveillance should be considered if further studies confirm this data


Presented By: Christian Ericson, MD, Department of Urology, Mayo Clinic, Jacksonville, FL

Co-Authors: Anthony Compton, Bryce Baird, MD, Raymond Pak, MD, Affiliations: Department of Urology, Mayo Clinic, Jacksonville, FL

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 86th Annual Meeting of the Southeastern Section of the American Urological Association, San Juan, PR, Mar 16 – 19, 2022


References:
  1. Kang CH, Yu TJ, Hsieh HH, Yang JW, Shu K, Huang CC, Chiang PH, Shiue YL. The development of bladder tumors and contralateral upper urinary tract tumors after primary transitional cell carcinoma of the upper urinary tract. Cancer. 2003 Oct 15;98(8):1620-6.
  2. Mukamel, E., Simon, D., Servadio, C., Konichezky, M., Hadar, H. and Edelman, A. (1994), Metachronous bladder tumors in patients with upper urinary tract transitional cell carcinoma. J. Surg. Oncol., 57: 187-190
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