Abstract: PD19-02
Sources of Funding: none

Introduction

Patients with non-muscle invasive (NMI) bladder cancer (BC) are at increased risk for metachronous upper tract urinary cancer (UTUC). Thus, routine upper tract imaging surveillance is recommended for early detection of UTUC during BC follow-up of patients with high-grade BC. However, evidence for the utility of this investigation is scarce. We aimed to assess the effectiveness of routine upper tract imaging surveillance during NMIBC follow-up.

Methods

A retrospective analysis of all patients treated and followed for NMIBC in a tertiary care academic center between 2003 and 2013 was performed. Results of all routine upper tract computerized tomography (CT) scans were assessed for UTUC detection. Kaplan-Meier curves were calculated to assess 5- and 10-year UTUC-free survival.

Results

315 patients were followed in our center after NMIBC treatment (pTa: 206 patients (66%), pT1: 99 patients (31%), CIS: 10 patients (3%)). 159 patients (50%) presented with LG and 156 (50%) with HG disease. Mean follow-up was 56 months. Overall, 396 abdominal CT scans were performed of which 230 were classified as routine upper tract imaging surveillance. The overall 5- and 10-year UTUC-free survival was 98.5% (standard error (SE) 0.9) and 97.6% (SE 1.3), respectively. Four patients (1.2%) were diagnosed with UTUC in the follow-up. All patients presented with pTa LG disease. Two of these patients (50%) were diagnosed by routine upper tract imaging, whereas the other two patients (50%) were diagnosed after detection of hydronephrosis on ultrasound (n=1) or hematuria (n=1). Overall 115 routine upper tract CT scans had to be performed to detect one UTUC.

Conclusions

In our cohort the prevalence of UTUC was only 1.2%. Interestingly, all UTUCs were diagnosed in LG NMIBC patients, questioning the recommendation to perform upper tract surveillance exclusively in high-risk BC. Of the patients diagnosed with UTUC only half was detected by routine upper tract imaging. A large-scale prospective study is warranted to assess the role of upper tract surveillance in general and to define the optimal modalities for UTUC detection.

Funding

none