Open AccessSurveillance guidelines based on recurrence patterns for upper tract urothelial carcinoma
Author(s) -
Jennifer A. Locke,
Ramin Hamidizadeh,
Wassim Kassouf,
Ricardo Rendon,
David Bell,
Jonathan I. Izawa,
Joseph L. Chin,
Anil Kapoor,
Bobby Shayegen,
JeanBaptiste Lattouf,
Fred Saad,
Louis Lacombe,
Yves Fradet,
A.S. Fairey,
Niels-Eric Jacobson,
Darrel Drachenberg,
Ilias Cagiannos,
Alan So,
Peter C. Black
Publication year - 2018
Publication title -
canadian urological association journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.477
H-Index - 38
eISSN - 1920-1214
pISSN - 1911-6470
DOI - 10.5489/cuaj.5377
Subject(s) - lymphovascular invasion , medicine , urothelial carcinoma , urothelium , retrospective cohort study , cohort , pathological , disease , adverse effect , proportional hazards model , oncology , urology , cancer , urinary system , bladder cancer , metastasis
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.