Open AccessAre there differences between de novo and secondary upper tract urothelial carcinoma tumours?
Author(s) -
Hanan Goldberg,
Douglas Cheung,
Thenappan Chandrasekar,
Zachary Klaassen,
Christopher J.D. Wallis,
Girish S. Kulkarni,
Rashid K. Sayyid,
Andrew Evans,
Mehdi Masoomian,
Bharati Bapat,
Theodorus van der Kwast,
Robert J. Hamilton,
Alexandre R. Zlotta,
Neil Fleshner
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.5595
Subject(s) - medicine , lymphovascular invasion , hazard ratio , bladder cancer , urology , proportional hazards model , propensity score matching , univariate analysis , confidence interval , confounding , carcinoma in situ , carcinoma , stage (stratigraphy) , cancer , oncology , multivariate analysis , metastasis , biology , paleontology
Upper tract urothelial carcinoma (UTUC) accounts for <5% of all urothelial cancers. We aimed to ascertain the clinical differences between UTUC tumours presenting de novo (DnUTUC) and those presenting secondary (SUTUC) following a bladder cancer diagnosis.
Methods: Our institutional database was queried for all UTUC patients who were surgically treated with radical nephroureterectomy or ureterectomy between 2003 and 2017. Bladder recurrence and cancer-specific mortality were compared. To reduce the possible bias due to confounding variables obtained from a simple comparison of outcomes, DnUTUC patients were matched (for age, gender, tumour location, type of surgery, grade, TNM staging, presence of carcinoma in situ, and lymphovascular invasion) with propensity score to SUTUC patients. Bladder recurrence and cancer-specific mortality were assessed with Cox proportional hazards model.
Results: A total of 117 UTUC patients were identified: 80 with DnUTUC (68.4%) and 37 with SUTUC (31.6%). A greater proportion of males with SUTUC was demonstrated (89.2% vs. 68.8; p=0.02). In both groups, 67.5% of patients had high-grade disease, but SUTUC demonstrated a higher carcinoma in situ rate (43.2% vs. 25%; p=0.047). Univariate analysis demonstrated that the five-year bladder recurrence rate was trending to be higher in SUTUC (65.3% vs. 20.5%; p=0.099). In the Cox model, however, it was associated with increased bladder recurrence (hazard ratio [HR] 3.69; 95% confidence interval [CI] 1.68–8.09; p=0.001). Although univariate analysis demonstrated that SUTUC patients were more likely to die of their disease (30.6% vs. 9%; p=0.009), the multivariable Cox model did not demonstrate this association. The limitations of this study include its retrospective, single-centre design and relatively small cohort of patients.
Conclusions: In this hypothesis-generating study, some evidence suggests that further research is needed to delineate differences between SUTUC and DnUTUC.