Upper Urinary Tract Urothelial Cancer After Radical Cystectomy for Bladder Cancer: Survival Outcomes After Radical Nephroureterectomy

Abstract

Background

Systemic and local recurrences of urothelial bladder cancer (UBC) significantly impair survival after radical cystectomy (RC), but little is known about the impact of the recurrence of urothelial cancer in the upper urinary tract (UTUC). This report describes survival outcomes and their predictors for patients who underwent RC followed by radical nephroureterectomy (RNU) for UTUC.

Methods

The Surveillance, Epidemiology, and End Results database was queried to identify patients who underwent RC for UBC and subsequent RNU for UTUC. The Kaplan–Meier method and competing-risk Cox regression (CRR) were used for the survival analysis.

Results

Overall, 102 patients have undergone RNU within a median of 49 months (interquartile range [IQR], 27–76 months) since RC. Muscle-invasive UTUCs were predominant at RNU ( n = 58; 56.7%), but organ-confined bladder tumors were most frequent at RC ( n = 42, 41.5%). After RNU, the estimated 5-year overall survival (OS) was 25.9%, the cancer-specific survival (CSS) was 35.6%, the median OS was 23 months (IQR, 11–63 months), and the CSS was 34 months (IQR, 13–132 months). In the multivariable CRR, the factors predictive for CSS after RNU included male gender (hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.03–5.42; p < 0.05), muscle-invasive UTUC (HR, 2.20; 95% CI, 1.13–4.28; p < 0.05), and the presence of distant metastasis (HR,11.59; 95% CI, 5.33–25.2; p < 0.001).

Conclusions

In conclusion, the patients who underwent RNU for UTUC after RC for UBC experienced poor OS and CSS. The majority of RNUs were performed for locally advanced tumors. The independent risk factors for worse OS and CSS after RNU were UTUC T stage, presence of metastasis, and male gender.