Login to Access Video or Poster Abstract: MP78-18
Sources of Funding: none

Introduction

Patients with bladder urothelial carcinoma (UC) are at risk for developing second primary tumors (SPTs) in the upper urinary tract (UUT). Peri-operative cisplatin-based therapy (CBT) is a standard of care for muscle invasive bladder UC, but requires adequate renal function which may be a limiting factor after definitive surgery for UUT carcinoma. In this study, we evaluate the outcomes of patients with UUT-SPTs after radical cystectomy (RC), with an emphasis on change in renal function associated with extirpative surgical treatment and eligibility for peri-operative CBT.

Methods

From January 1996 to October 2016, two surgeons at a high volume academic institution performed 486 consecutive RCs for bladder UC. Excluding patients with prior UUT carcinoma, 26 patients developed UUT-SPTs requiring surgical treatment and were the focus of this study. Patient outcomes were measured using end points of survivorship and estimated glomerular filtration rate (eGFR) in relation to tumor stage, tumor grade and time from RC to SPT.

Results

The 26 (5.3%) patients who developed UUT-SPTs requiring surgical treatment after RC had predominantly invasive cancers (Ta = 23.1%, Tis = 11.5%, T1 = 26.9%, T2 = 19.2%, T3= 15.4%, T4 = 3.9%) which were also predominantly high grade (G3= 88.5%, G2 = 7.7 %, G1 = 3.8). The mean time from RC to the development of SPT was 33.8 months. In a linear regression analysis that controlled for age, bladder pathologic tumor stage was significantly associated with decreased time to SPT (p= 0.030). Neoadjuvant CBT was given to 11.5 % of bladder UC patients prior to RC and 19.2% received adjuvant CBT after RC . Mean eGFR decreased from 69.3 prior to RC to 55.7 prior to UUT-SPT surgical treatment. UUT-SPTs were managed with nephroureterectomy (92.3%) or ureterectomy (7.7%), and ipsilateral lymphadenectomy (77%). Neoadjuvant CBT prior to UUT surgery was administered to 15.4% of patients. Mean eGFR further decreased after UUT-SPT surgery to 39.5, and 23.1% of patients received adjuvant CBT following UUT surgery. Patient were followed for a mean of 76.1 months and 38.5% of patients died of disease, 29.9% died of unknown/other causes, and 34.6% are alive with no evidence of disease.

Conclusions

UUT-SPTs manifest as more advanced disease after RC. Decreased renal function occurs frequently post RC and may impair the use of peri-operative CBT for patients with high grade SPTs of the UUT. This warrants further studies to develop novel non-nephrotoxic targeted therapies in the peri-operative setting of surgery for SPTs.

Funding

none