Abstract: PD73-11
Sources of Funding: None

Introduction

Contralateral recurrence after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) is rare and difficult to manage. Clinicians and patients are faced with the difficult decision of balancing oncologic control while preserving renal function. We report our experience on management and outcomes of contralateral recurrence in patients after RNU for UTUC.

Methods

Between 1995 and 2009 we retrospectively reviewed 480 patients who underwent RNU at Mayo Clinic. We identified 21 (4.3%) patients who developed UC recurrence in the contralateral system following initial RNU. Patients with metastatic disease before or at the time contralateral recurrence and patients with non-UC primary tumors were excluded. Charts were retrospectively reviewed. Progression to metastatic disease from the time of contralateral recurrence was investigated as the primary outcome of interest.

Results

The median age of the cohort was 72 years. Of the 21 patients, 14 (70%) were male, 19 (91%) were smokers, 13 (62%) had a history of bladder cancer and 10 (77%) had previously undergone a cystectomy. The urine cytology was positive in 15 (71%) prior to the initial RNU. During the initial RNU, 17 (81%) had non-muscle invasive disease; 10 (48%) had high grade pathology; 7 (33.3%) had concomitant CIS and 10 (48%) had multifocal disease. Median time to contralateral recurrence from the initial RNU was 12 months. Over a median follow up of 42 months, the overall median number of endoscopic procedures to manage contralateral recurrence was 3 (IQR 2, 4.5). 11 (52%) patients had intrapelvic instillation either via a nephrostomy tube or reflux through a stent. 6 (29%) patients eventually underwent definitive treatment with a second RNU. Of these, 5 had attempts at endoscopic control before second RNU; and the median number of endoscopic procedures was 2. The 3-year metastasis free survival was 68% and there was no statistically significant difference in progression to metastatic disease between patients undergoing RNU and those managed with only endoscopic approach (p=0.31). Progression to metastasis was seen more frequently in patients with a history of bladder cancer (p=0.01).

Conclusions

Approximately, 5% of patients with UTUC following RNU develop contralateral recurrence. Patients with a history of bladder cancer who develop contralateral recurrence are more likely to die of metastatic disease. Therefore, more studies are needed to elucidate the role of early definitive treatment in this unique patient population.

Funding

None