Outcomes of subsequent non-muscle invasive bladder cancer treated with intravesical Bacillus Calmette-Guérin after radical nephroureterectomy for upper urinary tract urothelial carcinoma: A propensity matched analysis with primary bladder cancer.

To describe the clinicopathologic characteristics and prognosis of subsequent non-muscle invasive bladder cancer (NMIBC) after radical nephroureterectomy for upper urinary tract urothelial carcinoma (UTUC), particularly its response to intravesical Bacillus Calmette-Guérin (BCG).

An observational study was conducted in 1463 patients with UTUC who had undergone radical nephroureterectomy and in 1555 patients with primary NMIBC. Of the 1463 UTUC patients, 256 (17%) subsequently developed NMIBC (UTUC-NMIBC) and were available for the analysis. The clinicopathological background and outcomes including intravesical recurrence-free survival and bladder progression-free survival were compared between the UTUC-NMIBC and primary NMIBC who were treated with intravesical BCG. Propensity score matching was performed to adjust for the potential differences in the backgrounds of the two groups. To validate the utility of the CUETO scoring model in our UTUC-NMIBC cohort, risk scores were calculated and compared with the published probability for recurrence and progression.

Compared to the unadjusted primary NMIBC group (n=352), the UTUC-NMIBC group (n=75) showed a worse prognosis for intravesical recurrence and progression, before propensity score matching. However, after propensity score matching for potential confounding factors, it showed a worse prognosis only for intravesical recurrence. The validation test of the CUETO scoring model for the UTUC-NMIBC group showed a significant difference in the rate of intravesical recurrence and progression for the 0-4 and 5-6 score groups between the UTUC-NMIBC group and the CUETO risk table reference data.

Compared to the primary NMIBC, the UTUC-NMIBC group has a worse prognosis after intravesical BCG, especially for intravesical recurrence. This suggests that the UTUC-NMIBC group inherently is a poor responder to BCG exposure. An optimal treatment strategy and risk scoring model to select patients for adjuvant intravesical BCG, chemotherapy, or immediate radical cystectomy should be established. This article is protected by copyright. All rights reserved.

BJU international. 2017 Dec 27 [Epub ahead of print]

Makito Miyake, Yoshihiro Tatsumi, Hiroaki Matsumoto, Kazuhiro Nagao, Hideyasu Matsuyama, Teruo Inamoto, Haruhito Azuma, Hiroaki Yasumoto, Hiroaki Shiina, Kiyohide Fujimoto, Nishinipon Uro-Oncology Collaborative Group

Department of Urology, Nara Medical University, Kashihara, Nara, Japan., Department of Urology Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan., Department of Urology, Osaka Medical College, Takatsuki, Osaka, Japan., Department of Urology, Shimane University School of Medicine, Izumo, Shimane, Japan.