Upper urinary tract urothelial carcinoma (UTUC) after intravesical bacillus Calmette-Guerin (BCG) therapy is rare, and its incidence, clinical impact, and risk factors are not fully understood. To elucidate the clinical implications of UTUC after intravesical BCG therapy, this retrospective cohort study used data collected between January 2000 and December 2019. A total of 3226 patients diagnosed with non-muscle-invasive bladder cancer (NMIBC) and treated with intravesical BCG therapy were enrolled (JUOG-UC 1901). UTUC impact was evaluated by comparing intravesical recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) rates. The predictors of UTUC after BCG treatment were assessed. Of these patients, 2873 with a medical history that checked UTUC were analyzed. UTUC was detected in 175 patients (6.1%) during the follow-up period. Patients with UTUC had worse survival rates than those without UTUC. Multivariate analyses revealed that tumor multiplicity (odds ratio [OR], 1.681; 95% confidence interval [CI], 1.005-2.812; p = 0.048), Connaught strain (OR, 2.211; 95% CI, 1.380-3.543; p = 0.001), and intravesical recurrence (OR, 5.097; 95% CI, 3.225-8.056; p < 0.001) were associated with UTUC after BCG therapy. In conclusion, patients with subsequent UTUC had worse RFS, CSS, and OS than those without UTUC. Multiple bladder tumors, treatment for Connaught strain, and intravesical recurrence after BCG therapy may be predictive factors for subsequent UTUC diagnosis.
Cancers. 2023 Mar 28*** epublish ***
Kazuyuki Numakura, Makito Miyake, Mizuki Kobayashi, Yumina Muto, Yuya Sekine, Nobutaka Nishimura, Kota Iida, Masanori Shiga, Shuichi Morizane, Takahiro Yoneyama, Yoshiaki Matsumura, Takashige Abe, Takeshi Yamada, Kazumasa Matsumoto, Junichi Inokuchi, Naotaka Nishiyama, Rikiya Taoka, Takashi Kobayashi, Takahiro Kojima, Hiroshi Kitamura, Hiroyuki Nishiyama, Kiyohide Fujimoto, Tomonori Habuchi
Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan., Department of Urology, Nara Medical University, Kashihara 634-8521, Japan., Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8576, Japan., Division of Urology, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan., Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8563, Japan., Department of Urology, Nara Prefecture General Medical Center, Nara 630-8054, Japan., Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo 060-8648, Japan., Department of Urology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan., Department of Urology, Kitasato University School of Medicine, Sagamihara 252-0373, Japan., Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan., Department of Urology, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan., Departments of Urology, Kagawa University Faculty of Medicine, Takamatsu 761-0793, Japan., Department of Urology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan., Department of Urology, Aichi Cancer Center, Nagoya 464-8681, Japan.