The Impact of Non-Muscle-Invasive Recurrence of Upper Tract Urothelial Carcinoma on The Survival of Patients After Radical Nephroureterectomy

Abstract

Introduction. After radical nephroureterectomy for the upper tract urothelial carcinoma (UTUC), 15–50 % of patients have a relapse in the bladder. Non-muscle invasive relapse in the bladder (NMIR) occurs in 80–90 % of all types of bladder relapses.The purpose of the study is to evaluate the effect of NMIR on patient survival after RNUE, and study the characteristics of the primary tumor and its effect on the occurrence of NMIR.Materials and methods. 157 patients underwent surgical treatment for UTUC during the period from 2011 to 2021. Overall (OS), progressive free (PFS), and cancer-specific (CSS) survival in patients with a relapse in the bladder was analyzed. Cox regression analysis was used to estimate the risk of NMIR.Results. NMIR was observed in 32 patients (20.4 %). 5‑year OS, PFS and CSS of patients with NMIR was higher than in the group of patients without NMIR and amounted to 92.4 %, 96.6 %, 93.4 % versus 61.4 %, 74.9 %, 68.9 % respectively. When comparing the clinical and pathomorphological characteristics, it was found that the primary tumor G3, locally advanced tumor are significantly less common in the NMIRC group, while concomitant bladder cancer, simultaneous lesion of the renal pelvis and ureter, as well as non-muscle-invasive cancer are significantly more common in the NMIRC group. According to the multivariate regression analysis, the risk of NMIRC increases by 2 times with simultaneous tumor lesion of the renal pelvis and ureter (HR — 2.93; 95 % CI — 1.43–7.13; p = 0.005) and concomitant bladder cancer (HR — 2.89; 95 % CI — 1.01–6.11; p = 0.035).Conclusion. Significantly better survival rates were found for patients with UTUC in the presence of NMIR. Patients with NMIR are significantly less common to have aggressive forms of the primary tumor and a locally advanced disease.