Patients with upper tract urothelial carcinoma (UTUC) benefit from surgery with bladder cuff resection. Otherwise, their prognosis hinges on mostly unmodifiable factors, according to investigators presenting new study findings during the American Urological Association 2020 Virtual Experience.

Michael Staehler, MD, PhD, of Ludwig Maximilian University of Munich, and colleagues identified 231 UTUC patients (median age 71 years; 61% male) who underwent radical nephroureterectomy (RNU) at a tertiary center. ECOG performance status was 0 (fully active) in 42% and 1 (restricted in strenuous activity) in 27%. Nearly half of patients were current or former smokers, 60% suffered from gross hematuria, and 20% had flank pain. One in 10 had synchronous bladder cancer.

Patients’ median overall survival (OS) was 58.9 months, Dr Staehler’s team reported. Baseline characteristics—Bellmunt risk factors, body mass index, and creatine and C-reactive protein levels—correlated significantly with poor overall survival. With respect to cancer features, tumors localized in the ureter, larger than 5 cm, and considered carcinoma in situ or high grade were significantly associated with worse overall survival.

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Bladder cuff resection improved overall survival time compared with no resection: 86.7 vs to 39.9 months, the investigators highlighted. On multivariate analysis, ECOG performance status, localization in the ureter, initial creatine, surgical expertise, and bladder cuff resection proved prognostic.

“UTUC patients benefit from aggressive surgical therapy and need a bladder cuff resected,” Dr Staehler’s team concluded. “Prognosis mainly depends on baseline characteristics that can’t be medically influenced.”

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Staehler M, Mayer V, Graser A, et al. Prognostic factors in a contemporary cohort of patients with upper tract urothelial carcinoma (UTUC). Presented at the American Urological Association 2020 Virtual Experience, May 15-19, 2020. Abstract MP21-13.