Risk Factors of Intravesical Recurrence in Patients with Upper Tract urothelial Carcinoma After Radical Nephroureterectomy - Expert Commentary

Intravesical recurrence (IVR) rates remain high in urothelial carcinoma of the upper urinary tract (UTUC) patients following radical nephroureterectomy (RNU). Understanding the risk factors that predict IVR is critical for optimal management of these patients. A recent study published by Rinaldetti et al. in Clinical Genitourinary Cancer investigated the significance of the presence of preoperative pyuria in predicting IVR in UTUC patients who underwent RNU.

The authors studied IVR risk factors and outcomes in 268 patients. The median postoperative follow-up of patients with IVR-free survival was 29.1 months (interquartile range, 15.4-55.3 months). They found that IVR is significantly associated with the presence of pyuria (P = 0.025). The authors found a significant increase in IVR risk is associated with the presence of pyuria (HR, 1.70; P = 0.007), tumor site at the ureter (HR, 1.64; P = 0.012), and the presence of positive surgical margins (HR, 2.70; P = 0.013) in multivariate analysis. The investigators developed a postoperative risk stratification model using these factors to predict IVR rates. The 5-year IVR-free survival rate was 69.1% for the low-risk group, 51.8% for the intermediate-risk group in contrast to 18.8% for the high-risk group (P =0.004).

Emerging evidence suggests that the majority of urothelial cancers arising in the bladder following the development of UTUC are ‘drop metastasis’. Developing new strategies to decrease IVR is an important priority following RNU.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York City, New York

Reference:

1. Sato, Goro, Takashi Yoshida, Masaaki Yanishi, Ryoichi Saito, Takashi Murota, Gen Kawa, Hidefumi Kinoshita, and Tadashi Matsuda. "Preoperative Pyuria Predicts for Intravesical Recurrence in Patients With Urothelial Carcinoma of the Upper Urinary Tract After Radical Nephroureterectomy Without a History of Bladder Cancer." Clinical genitourinary cancer (2019).

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