Predictors Of Upper Tract Urothelial Cell Carcinoma After Primary Bladder Cancer: A Population Based Analysis

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Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 03 Apr 2009 - 8:00 PDT

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UroToday.com - Upper tract tumors (UTT) after primary bladder cancer are difficult to detect and are relatively rare. Historically, the literature has quoted a 2-7% chance of developing secondary UTT after primary bladder cancer. Despite the adoption of many different surveillance protocols, patients routinely present with symptoms.

Since much of the literature on UTT after primary bladder cancer comes from single institution series following cystectomy we sought to determine the rate of UTT after primary bladder cancer using a population-based cancer registry and to identify risk factors for developing UTT. Incident cases of urothelial cell carcinoma of the bladder were identified over the years 1988 - 2003. Subsequent cases of UTT were then determined and multivariate analysis used to determine risk factors for UTT development.

In contrary to the existing literature, we found only a 0.8% cumulative incidence of UTT. Higher bladder cancer grade, bladder cancer location near the trigone, ureteral orifice or bladder neck, and CIS of the bladder were all independently associated with a higher risk of developing UTT. Interestingly, higher stage tumors (T2 or greater) were less likely to develop UTT. This is likely due to shorter survival time and the competing risk of death in those with muscle invasive disease.

The median time to UTT was 33 months. However, one-third of the recurrences developed after 5 years and the time to UTT was not associated with UTT stage, grade or location (ureter vs. renal pelvis). Since many recurrences are not picked up on routine screening but present with gross hematuria regardless of methodology used, more investigation is required to determine if specific screening protocols are effective at reducing morbidity and mortality from UTT after a diagnosis of bladder cancer Tailored surveillance strategies targeting those at highest risk are one potential way to improve the yield of imaging at detecting asymptomatic UTT recurrences after primary bladder cancer.

Written by Jonathan L. Wright, MD as part of Beyond the Abstract on UroToday.com

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