Surveillance guidelines based on recurrence patterns for upper tract urothelial carcinoma Academic Article uri icon

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abstract

  • Introduction: Upper tract urothelial carcinoma (UTUC) accounts for 5% of all urothelial tumours. Due to its rarity, evidence regarding postoperative surveillance is lacking. The objective of this study was to develop a post-radical nephroureterectomy (RNU) surveillance protocol based on recurrence patterns in a large, multi-institutional cohort of patients.Methods: Retrospective clinical and pathological data were collected from 1029 patients undergoing RNU over a 15-year period (1994–2009) at 10 Canadian academic institutions. A multivariable model was used to identify prognostic clinicopathological factors, which were then used to define risk categories. Risk-based surveillance guidelines were proposed based on actual recurrence patterns.Results: Overall, 555 (49.9%) patients developed recurrence, including 289 (25.9%) in the urothelium and 266 (23.9%) with loco-regional and distant recurrences. Based on multivariable analysis, three risk groups were identified: 1) low-risk patients with pTa-T1, pN0 disease, and no adverse histological features (high tumour grade, lymphovascular invasion [LVI], tumour multifocality); 2) intermediate-risk patients with pTa-T1, pN0 disease with one or more of the adverse histological features; and 3) high-risk patients with a ≥pT2 tumour and/or nodal involvement. Low-, intermediate-, and high-risk patients were free of urothelial recurrence at three years in 72%, 66%, and 63%, respectively, and free of regional/distant recurrence in 93%, 87%, and 62%, respectively. The risks of loco-regional and distant recurrences (p<0.0001) and time to death (p<0.0001) were significantly different between the low-, intermediate-, and high-risk patients.Conclusions: Based on recurrence patterns in a large, multicentre patient cohort, we have proposed an evidence-based, risk-adapted post-RNU surveillance protocol.

authors

  • Locke, Jennifer A
  • Hamidizadeh, Reza
  • Kassouf, Wassim
  • Rendon, Ricardo A
  • Bell, David
  • Izawa, Jonathan
  • Chin, Joseph
  • Kapoor, Anil
  • Shayegan, Bobby
  • Lattouf, Jean-Baptiste
  • Saad, Fred
  • Lacombe, Louis
  • Fradet, Yves
  • Fairey, Adrien S
  • Jacobson, Niels-Eric
  • Drachenberg, Darrel E
  • Cagiannos, Ilias
  • So, Alan I
  • Black, Peter C

publication date

  • August 1, 2018