Are there differences between de novo and secondary upper tract urothelial carcinoma tumors?

Authors

  • Hanan Goldberg Urology Division, Surgical Oncology Department, Princess Margaret Cancer Centre, University Health Network, University of Toronto http://orcid.org/0000-0002-5777-2138
  • Douglas C. Cheung Urology Division, Surgical Oncology Department, Princess Margaret Cancer Centre, University Health Network, University of Toronto
  • Thenappan Chandrasekar Urology Division, Surgical Oncology Department, Princess Margaret Cancer Centre, University Health Network, University of Toronto
  • Zachary Klaassen Urology Division, Surgical Oncology Department, Princess Margaret Cancer Centre, University Health Network, University of Toronto
  • Christopher J.D. Wallis Urology Division, Surgical Oncology Department, Princess Margaret Cancer Centre, University Health Network, University of Toronto
  • Girish S. Kulkarni Urology Division, Surgical Oncology Department, Princess Margaret Cancer Centre, University Health Network, University of Toronto
  • Rashid Sayyid Urology Division, Surgical Oncology Department, Princess Margaret Cancer Centre, University Health Network, University of Toronto
  • Andrew Evans Pathology Department, Princess Margaret Cancer Centre, University Health Network, University of Toronto
  • Mehdi Masoomian Pathology Department, Princess Margaret Cancer Centre, University Health Network, University of Toronto
  • Bharati Bapat Department of Laboratory Medicine and Pathobiology, University of Toronto; Lunenfeld Tanenbaum Research Institute, Sinai Health System
  • Theodorus van der Kwast Pathology Department, Princess Margaret Cancer Centre, University Health Network, University of Toronto
  • Robert J. Hamilton Urology Division, Surgical Oncology Department, Princess Margaret Cancer Centre, University Health Network, University of Toronto
  • Alexandre Zlotta Urology Division, Surgical Oncology Department, Princess Margaret Cancer Centre, University Health Network, University of Toronto
  • Neil Fleshner Urology Division, Surgical Oncology Department, Princess Margaret Cancer Centre, University Health Network, University of Toronto

DOI:

https://doi.org/10.5489/cuaj.5595

Keywords:

De-novo upper tract urothelial carcinoma, Secondary upper tract urothelial carcinoma, Carcinoma in situ, Recurrence, cancer specific survival

Abstract

Introduction: Upper tract urothelial carcinoma (UTUC) accounts for <5% of all urothelial cancers. We aimed to ascertain the clinical differences between UTUC tumous 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, tumor 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 fiveyear 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-center 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.

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Author Biography

Hanan Goldberg, Urology Division, Surgical Oncology Department, Princess Margaret Cancer Centre, University Health Network, University of Toronto

Uro-oncology fellow (SUO), Princess Margaret Cancer Centre, University Health Network, University of Toronto

Published

2018-12-13

How to Cite

Goldberg, H., Cheung, D. C., Chandrasekar, T., Klaassen, Z., Wallis, C. J., Kulkarni, G. S., Sayyid, R., Evans, A., Masoomian, M., Bapat, B., van der Kwast, T., Hamilton, R. J., Zlotta, A., & Fleshner, N. (2018). Are there differences between de novo and secondary upper tract urothelial carcinoma tumors?. Canadian Urological Association Journal, 13(9). https://doi.org/10.5489/cuaj.5595

Issue

Section

Original Research