Investigators have identified predictors of recurrence after surgery for low-grade upper tract urothelial carcinoma (UTUC).

In a presentation at the American Urological Association’s 2022 annual meeting in New Orleans, Louisiana, Heather L. Huelster, MD, of H. Lee Moffitt Cancer Center & Research Institute in Tampa, Florida, and colleagues presented findings from their study of  87 patients who underwent radical nephroureterectomy (RNU) for low-grade UTUC at their institution. Of the 87 patients, 39 (44.8%) experienced recurrence, including 2 who recurred in the bladder, over a mean 34 months. Two-thirds of recurrences (69.2%) were low grade.

On multivariable analysis, current smoking and tumor multifocality were significantly associated with 4.0- and 3.5-fold increased odds for recurrence, respectively, Dr Huelster reported. Tumor multifocality was also significantly associated with early urothelial recurrence within 6 months of RNU in unadjusted analyses.

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Of the cohort, 90.9% were current or former smokers and 50.6% had a history of urothelial carcinoma of the bladder. The mean age at surgery was 71.8 years. Median overall survival was 97.9 months.

After definitive management with RNU, low-grade UTUC may recur in the bladder, but development of metastatic disease and cancer-related death is “very rare,” Dr Huelster said in an interview. “Current smoking and tumor multifocality are independently associated with recurrence of UC after RNU and may inform surveillance strategies. Currently guidelines do not stratify surveillance recommendations by UTUC grading, but follow-up cystoscopy may be warranted at 3-6 months intervals after RNU for patients with these risk factors.”


Huelster H, Bilotta A, Britt J, et al. Predictive risk factors for early recurrence after radical nephroureterectomy for low-grade upper tract urothelial carcinoma. Presented at: AUA 2022; May 13-16, 2022, New Orleans, Louisiana. Abstract MP40-04.