Login to Access Video or Poster Abstract: MP78-19
Sources of Funding: None

Introduction

Urothelial carcinoma can occur in both the upper and lower urinary tract; however, the natural history of disease recurrence and outcomes in patients who ultimately require both radical cystectomy (RC) and radical nephroureterectomy (RNU) is poorly understood. We aim to define outcomes in these populations to better inform surveillance strategies following upper and lower tract resection for urothelial carcinoma.

Methods

We retrospectively reviewed the medical records of patients who underwent both RC and RNU at the Mayo Clinic between 1995 and 2009. Patients who had undergone both RC and RNU were grouped by resection order. Time between resections and pathology data at the time of resection were determined, and Kaplan-Meier analysis was used to evaluate disease specific and overall survival.

Results

Of 524 patients who underwent RNU at our institution, 100 (19%) patients also underwent RC. 49/100 (49%) underwent initial RC followed by RNU (RC->RNU), 24/100 (24%) underwent RNU followed by RC (RNU->RC), and 27/100 (27%) underwent simultaneous RC and RNU (RC+RNU). The median time between procedures was shorter for patients undergoing RNU->RC (14.6 months) compared to patients undergoing RC->RNU (42.6 months). Upper tract disease after RC (RC->RNU) was more likely to be Grade 3 (80.0%) and T3 or T4 (22.7%) than bladder cancer after RNU (RNU->RC; Grade 3: 58.3%; T3 or T4: 12.5%). Nevertheless, after the second surgery, there was no significant difference in median disease specific survival (DSS, Log-Rank, P=0.28) or overall survival (OS, Log-Rank, P=0.74) between groups RC->RNU (DSS: 83.7 months; OS: 110.1 months), RNU->RC (DSS: 74.3 months; OS: 149.9 months) and RC+RNU (DSS: 62.5 months; OS: 109.2 months).

Conclusions

Our data highlight the high frequency of synchronous and metachronous upper and lower tract urothelial carcinoma, with nearly 20% of patients undergoing RNU also requiring RC. Disease recurrence in the bladder after RNU occurred more rapidly than upper tract recurrence after RC. However, patients with upper tract recurrence after RC presented later and with higher grade and stage disease compared to patients presenting with lower tract recurrence after RNU. These data highlight the importance of long-term oncologic surveillance after both RC and RNU.

Funding

None