The Role of Prior Bladder Cancer on Recurrence in Patients Treated with Radical Nephroureterectomy.

The prognostic role of prior history of bladder cancer (BCa) among patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) is poorly addressed. We aimed to investigate the role of prior BCa on any recurrence, distant metastases, and bladder recurrence following RNU among low-grade (LG) and high-grade (HG) UTUC patients.

We retrospectively analyzed 1,580 UTUC patients treated with RNU at 8 tertiary referral centers between 1992 and 2016. Any recurrence was defined as recurrence in the urinary tract, in the resection bed, or distant metastases (defined as disease outside the urinary tract and regional lymph nodes). Time to recurrence was computed from RNU. Multivariable Cox models were generated to predict risk of any recurrence, distant metastases, and bladder recurrence according to prior BCa history, coded as no prior BCa, non-muscle-invasive (NMIBC), and muscle-invasive BCa (MIBC).

Median follow-up for survivors was 4 years. Overall, 71%, 25%, and 4% of patients had no prior BCa, NMIBC and MIBC. 5-year any recurrence-free survival was 61%, 41%, and 19% in LG (P < .001) and 42%, 34%, and 30% in HG patients (P = .1) with no prior BCa, NMIBC, and MIBC. On multivariable models, LG patients with NMIBC and MIBC showed a significantly higher risk of any recurrence compared to no prior BCa (both p≤0.005); previous NMIBC was associated with any recurrence among HG patients (P = 0.04). 5-year distant metastases-free survival was 92%, 90%, and 87% in LG (P > .05) and 68%, 75%, and 45% in HG patients (P = .01) with no prior BCa, NMIBC, and MIBC. Previous NMIBC increased the risk of bladder recurrence among LG (P < .001) and HG (P = .003) patients.

UTUC patients with prior history of BCa exhibit a higher risk of any recurrence after RNU. Our study provides important information which could address patient's counseling and decision-making process.

Clinical genitourinary cancer. 2021 Dec 11 [Epub ahead of print]

Alberto Martini, Chiara Lonati, Francesco Montorsi, Alberto Briganti, Renzo Colombo, Andrea Necchi, Claudio Simeone, Stefania Zamboni, Luca Afferi, Agostino Mattei, Roberto Carando, Guillaume Ploussard, Francesco Soria, Giancarlo Marra, Morgan RouprĂȘt, Evanguelos Xylinas, Benjamin Pradere, Mohammad Abufaraj, David D'Andrea, Shahrokh F Shariat, Marco Moschini

Department of Urology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy. Electronic address: ., Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Urology, Spedali Civili of Brescia, Brescia, Italy., Department of Urology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy., Department of Medical Oncology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, Spedali Civili of Brescia, Brescia, Italy., Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland., Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland; Clinica Luganese Moncucco, Lugano, Switzerland; Clinica S.Anna, Swiss Medical Group, Sorengo, Switzerland; Clinica Santa Chiara, Locarno, Switzerland., Department of Urology, CHU-Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France; Department of Urology, La Croix du Sud Hospital, Toulouse, France., Division of Urology, Department of Surgical Sciences, AOU CittĂ  della Salute e della Scienza di Torino, Torino School of Medicine, Torino, Italy., GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, PARIS, France., Department of Urology, Bichat Hospital, Paris Descartes University, Paris, France., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; The National Center for Diabetes, Endocrinology and Genetics, The University of Jordan, Amman, Jordan., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Department of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic., Department of Urology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy; Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.