Surveillance guidelines based on recurrence patterns for upper tract urothelial carcinoma

  • Jennifer A. Locke
  • Reza Hamidizadeh
  • Wassim Kassouf
  • Ricardo A. Rendon
  • David Bell
  • Jonathan Izawa
  • Joseph Chin
  • Anil Kapoor
  • Bobby Shayegan
  • Jean-Baptiste Lattouf
  • Fred Saad
  • Louis Lacombe
  • Yves Fradet
  • Adrien S. Fairey
  • Niels-Eric Jacobson
  • Darrel E. Drachenberg
  • Ilias Cagiannos
  • Alan I. So
  • Peter C. Black

Abstract

Introduction: 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.

Published
2018-04-12
How to Cite
Locke, J. A., Hamidizadeh, R., Kassouf, W., Rendon, R. A., Bell, D., Izawa, J., Chin, J., Kapoor, A., Shayegan, B., Lattouf, J.-B., Saad, F., Lacombe, L., Fradet, Y., Fairey, A. S., Jacobson, N.-E., Drachenberg, D. E., Cagiannos, I., So, A. I., & Black, P. C. (2018). Surveillance guidelines based on recurrence patterns for upper tract urothelial carcinoma. Canadian Urological Association Journal, 12(8). https://doi.org/10.5489/cuaj.5377
Section
Original Research