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.
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.
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 had a three-year survival for urothelial recurrence of 72%, 66%, and 63%, respectively, and a three-year survival for regional/distant recurrence of 93%, 87%, and 62%. 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.
Based on recurrence patterns in large, multicentre patient cohort, we have proposed an evidence-based, risk-adapted post-RNU surveillance protocol.
Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2018 Apr 12 [Epub ahead of print]
Jennifer A Locke, Reza Hamidizadeh, Wassim Kassouf, R Ricardo Rendon, David Bell, Jonathan Izawa, J Joseph Chin, Anil Kapoor, Bobby Shayegen, Jean-Baptiste Lattouf, Fred Saad, Louis Lacombe, Yves Fradet, Adrien Fairey, Niels-Eric Jacobson, Darrel Drachenberg, Ilias Cagiannos, Alan So, Peter C Black
University of British Columbia, Vancouver, BC., McGill University, Montreal, QC., Dalhousie University, Halifax, NS., University of Western Ontario, London, ON., McMaster University, Hamilton, ON., University of Montreal, Montreal, QC., Laval University, Quebec City, QC., University of Alberta, Edmonton, AB., University of Manitoba, Winnipeg, MB., University of Ottawa, Ottawa, ON; Canada.