Incidence and Predictors of Secondary Upper Tract Urothelial Cancer in Patients with High-Risk Non-Muscle Invasive Urinary Bladder Cancer and its Impact on Imaging Surveillance: A Retrospective Analysis with 1501 Patients

Objectives: We aimed to study the incidence and predictors of upper tract urothelial cancer (UTUC) in patients with high-risk non-muscle invasive bladder cancer (HR-NMIBC). Methods: Patients who had HR-NMIBC were reviewed to identify those who subsequently developed UTUC. Complete transurethral resection was performed, and biopsies were collected for histopathology followed by intravesical chemoimmunotherapy. Patients were screened annually by computed tomography (CT) for UTUC. Results: Data for 1501 patients were reviewed. UTUC developed in 59 (4%) after a median of 20 months after HR-NMIBC. Most patients were symptomatic, but UTUC was discovered on routine follow-up imaging in 28%. On bivariate analysis, only multiple bladder tumors and the number of bladder recurrences were predictors for UTUC (P = 0.01 and P = 0.008, respectively). Multiple bladder tumors and ≥ 3 bladder recurrences remained significant on multivariable analysis. Conclusion: UTUC after HR-NMIBC is uncommon (4%). Despite routine follow-up CT imaging, recurrence was detected due to symptoms in most patients, and based on imaging only in 28%. Imaging surveillance can be prioritized in patients with multiple bladder tumors and those with ≥ 3 bladder recurrences. For the other patients, the benefit of imaging surveillance has to be weighed against the risks.

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1054 Adequacy and usefulness of EAU guidelines recommendation of routine upper tract imaging in high risk non-muscle invasive bladder cancer follow-up

European Urology Supplements ◽

10.1016/s1569-9056(15)61042-9 ◽

2015 ◽

Vol 14 (2) ◽

pp. e1054

Author(s):

A. Guijarro ◽

E. De La Peña ◽

V. Hernández ◽

E. Pérez-Fernández ◽

B. López ◽

...

Keyword(s):

Bladder Cancer ◽

High Risk ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Upper Tract ◽

Muscle Invasive

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Effectivity of intravescical thermo-chemotherapy prophylaxis for patients with high recurrence and progression risk for non-muscle invasive bladder cancer

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2017.2.102 ◽

2017 ◽

Vol 89 (2) ◽

pp. 102 ◽

Cited By ~ 3

Author(s):

Ali Serdar Gözen ◽

Paolo Umari ◽

Walter Scheitlin ◽

Fuat Ernis Su ◽

Yigit Akin ◽

...

Keyword(s):

Bladder Cancer ◽

High Risk ◽

Recurrent Disease ◽

Bladder Wall ◽

Invasive Bladder Cancer ◽

Outpatient Basis ◽

High Grade ◽

Muscle Invasive Bladder Cancer ◽

Muscle Invasive

Background&Aim: High grade non-muscle invasive bladder cancer (NMIBC) is common in urological practice. Most of these cancers are or become refractory to intravesical immunotherapy and chemotherapy. Here we evaluated the efficacy of combined local bladder hyperthermia and intravesical mitomycin-C (MMC) instillation in patients with high-risk recurrent NMIBC. Materials and methods: Between February 2014 and December 2015, 18 patients with high risk NMIBC were enrolled. Patients were treated in an outpatient basis with 6 weekly induction sessions followed by monthly maintenance sessions with intravesical MMC in local hyperthermia with bladder wall thermo-chemotherapy (BWT) system (PelvixTT system, Elmedical Ltd., Hod Hasharon, Israel). The follow-up regimen included cystoscopy after the induction cycle and thereafter with regular intervals. Time to disease recurrence was defined as time from the first intravesical treatment to endoscopic or histological documentation of a new bladder tumour. Adverse events were recorded according to CTC 4.0 (Common Toxicity Criteria) score system. Results: Mean age was 72 (32-87) years. 10 patients had multifocal disease, 9 had CIS, 6 had recurrent disease and 2 had highly recurrent disease (> 3 recurrences in a 24 months period). 6 patients underwent previous intravesical chemotherapy with MMC. The average number of maintenance sessions per patient was 7.6. After a mean follow-up of 433 days, 15 patients (83.3%) were recurrence-free. 3 patients had tumour recurrence after a mean period of 248 days without progression. Side effects were limited to grade 1 in 2 patients and grade 2 in 1 patient. Conclusions: BWT seems to be feasible and safe in high grade NMIBC. More studies are needed to identify the subgroup of patients who may benefit more from this treatment.

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