To evaluate the impact of upper tract urothelial carcinoma (UTUC) on BCG response and progression in patients with non-muscle invasive bladder cancer (NMIBC).
We performed an IRB approved review of patients with NMIBC treated with adequate intravesical BCG, as defined by the US FDA, at our institution between 2000 and 2018. Patients were stratified by presence of any UTUC and time of UTUC diagnosis (preceding vs synchronous to NMIBC diagnosis or metachronous disease after NMIBC diagnosis). Descriptive statistics summarized the data overall and by groups. T-tests or Wilcoxon's rank sum and Pearson's chi-square or Fisher's exact test were used to analyze continuous vs. categorical data, respectively.
Of 541 patients with NMIBC treated with adequate BCG, 59 (10.9 %) were diagnosed with UTUC. Of these, 34 patients had a history of UTUC prior (UTUC-P) to NMIBC (median 13.1 months prior, IQR 7.4-27.6 months), while 25 developed UTUC after diagnosis of NMIBC (6 synchronous and 19 metachronous; median 12.1 months after, 1.7-28.1 months). Compared to the non-UTUC group, patients with UTUC-P were more likely to exhibit Tis without papillary tumor in the bladder (20.6% vs 5.0%, p < 0.001) but less likely to have T1 disease on index transurethral resection (8.8% vs 49.4%, P<0.001). Patients with UTUC-P developed more recurrences (55.9% vs. 34.0%, P=0.010), any stage/grade progression (23.5% vs 9.8%, P=0.012) and progression to muscle invasive or metastatic disease (17.6% vs 6.4%, P=0.014). The presence of high-grade (HG) UTUC-P compared to low-grade UTUC-P was associated with increased NMIBC recurrence (68.2% vs. 25.0%, P=0.049). There was no significant difference in rates of recurrence or progression based on timing of UTUC with respect to the index bladder tumor, albeit this analysis is limited by small numbers.
Presence of UTUC prior to a diagnosis of NMIBC was associated with an almost 2-fold increased recurrence and progression rates following adequate BCG therapy. This should be considered when counselling patients and designing cohorts for clinical trials.
BJU international. 2021 Jan 22 [Epub ahead of print]
Kelly K Bree, Patrick J Hensley, Nathan A Brooks, Justin Matulay, Roger Li, Graciela M Nogueras Gonzalez, Neema Navai, H Barton Grossman, Surena F Matin, Colin P Dinney, Ashish M Kamat
Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Urology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA., Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA., Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.