The Impact of Upper Tract Urothelial Carcinoma Diagnostic Modality on Intravesical Recurrence after Radical Nephroureterectomy: A Single Institution Series and Updated meta-Analysis.

Diagnostic ureteroscopic biopsy for upper tract urothelial carcinoma (UTUC) has been hypothesized to increase intravesical recurrence of urothelial carcinoma after radical nephroureterectomy (RNU). Moreover, the impact of ureteroscopy without biopsy or percutaneous biopsy on intravesical recurrence remains unknown. Herein, we compared post-RNU intravesical recurrences across UTUC diagnostic modalities.

Patients undergoing RNU at our institution between 1995-2019 were categorized by UTUC diagnostic modality: 1) no ureteroscopy or percutaneous biopsy; 2) percutaneous biopsy; 3) ureteroscopy without biopsy; 4) ureteroscopic biopsy. Intravesical recurrences were compared using Kaplan-Meier analyses and cox-proportional hazard models. Results of group 4 vs 1 were pooled with the literature using a fixed effects meta-analysis.

In a cohort of 834 RNU patients, 210 (25.2%) had undergone no ureteroscopy, 57 (6.6%) percutaneous biopsy, 125 (15.0%) ureteroscopy without biopsy, and 442 (53.0%) ureteroscopic biopsy. Two-year intravesical recurrence rates were 15.0%, 12.7%, 18.4%, and 21.9% for groups 1-4, respectively (p=0.09). Multivariable analysis found that group 4 had increased intravesical recurrences (HR 1.40, p=0.04) relative to group 1 while group 2 (HR 1.07, p=0.87) and group 3 (HR 1.15, p=0.54) did not. Group 4 remained associated with intravesical recurrence on subset analyses accounting for post-RNU surveillance cystoscopy frequency. On meta-analysis including eleven other series, ureteroscopic biopsy was associated with intravesical recurrence (HR 1.47, p <0.01).

Ureteroscopic biopsy before RNU, but not percutaneous biopsy or ureteroscopy without biopsy, was associated with increased intravesical recurrence. Clinical trials of intravesical chemotherapy after ureteroscopic biopsy are warranted to reduce intravesical recurrences.

The Journal of urology. 2021 Apr 28 [Epub ahead of print]

Vidit Sharma, Tanner S Miest, Tristan S Juvet, Amir Toussi, Vignesh Packiam, Karim Chamie, Surena F Matin, Stephen A Boorjian, R Houston Thompson, Igor Frank, Matthew K Tollefson, Aaron M Potretzke

Department of Urology, Mayo Clinic, Rochester, Minnesota., Department of Urology, MD Anderson Cancer Center, Houston, Texas., Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Department of Urology, University of Iowa Medical Center, Iowa City, Iowa., Department of Urology, University of California, Los Angeles, California.