A Prognostic Nomogram for Patients with Intravesical Recurrence After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma - Expert Commentary

Defining the prognosis of patients who develop intravesical recurrence (IVR) after radical nephroureterectomy (RNU) is critical for the optimal management of these patients. A recent study published by Hou et al. in the World Journal of Urology examined the independent prognostic factors and constructed a nomogram to predict the 1-, 3-, and 5-year probability of individual cancer-specific survival (CSS).

In this retrospective analysis, the authors included 468 upper tract urothelial carcinoma (UTUC) patients who developed IVR from the SEER database. They identified several independent risk factors including age at IVR ≥ 80 years, UTUC stage ≥ T3, bladder cancer stage T1, and bladder cancer stage ≥ T2. Interestingly, a time interval of > 24 months between UTUC and bladder cancer was found to be independently associated with better CSS.

The 1-, 3-, and 5-year predictive accuracy of the nomogram were 0.74, 0.70, and 0.71, respectively. Additionally, the 1-, 3-, and 5-year calibration curves demonstrated perfect agreement between the nomogram-predicted and the actual CSS.
Recent molecular studies have highlighted that at the genomic level, bladder cancers that develop following UTUC are 'drop metastases'. Our group recently discovered that UTUC has a distinct luminal-papillary and T-cell depleted phenotype. Understanding whether these subtypes are stable in IVR tumors is important for determining the optimal interventions.

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

References: 

  1. Hou, Guangdong, Yu Zheng, Lei Zhang, Dong Lai, Fuli Wang, Xi’an Li, Fei Yan et al. "Development and validation of a prognostic nomogram for patients with intravesical recurrence after radical nephroureterectomy for non-metastatic upper tract urothelial carcinoma." World journal of urology (2019): 1-7.
  2. Audenet, François, Sumit Isharwal, Eugene K. Cha, Mark TA Donoghue, Esther N. Drill, Irina Ostrovnaya, Eugene J. Pietzak et al. "Clonal relatedness and mutational differences between upper tract and bladder urothelial carcinoma." Clinical Cancer Research 25, no. 3 (2019): 967-976.
  3. Robinson, Brian D., Panagiotis J. Vlachostergios, Bhavneet Bhinder, Weisi Liu, Kailyn Li, Tyler J. Moss, Rohan Bareja et al. "Upper tract urothelial carcinoma has a luminal-papillary T-cell depleted contexture and activated FGFR3 signaling." Nature communications 10, no. 1 (2019): 1-11.
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