|The following article features coverage from the American Urological Association (AUA) 2019 meeting. Click here to read more of Renal & Urology News’ conference coverage.|
CHICAGO—Patients who undergo radical nephroureterectomy for upper tract urothelial carcinoma (UTUC) commonly experience disease recurrence in the bladder, but the risk of recurrence appears to be lower among those who receive neoadjuvant chemotherapy (NAC), new data presented at the 2019 American Urological Association annual meeting suggest.
In a retrospective study of 202 patients who underwent nephroureterectomy (RNU) for UTUC, investigators at Johns Hopkins School of Medicine in Baltimore identified 89 patients (44%) with urothelial disease recurrence in the bladder over a median of 12 months. Recurrence rates at 1 and 5 years after surgery were 32% and 52%, respectively, for patients with low-grade UTUC and 37% and 59%, respectively, for those with high-grade UTUC, Joseph Cheaib, MD, MPH, and colleagues reported in a poster presentation.
Recurrence developed in 48 (42%) of 115 patients with biopsy-proven high-grade disease prior to RNU. In this group, NAC recipients had a significantly longer bladder recurrence-free survival (BRFS) rate compared with the RNU-only group. The median BRFS time was 28 months in the RNU-only arm and not yet reached at 39 months in the NAC group.
“At our institution, patients with biopsy-proven high-grade disease on diagnostic ureteroscopy and a visible lesion on axial imaging receive cisplatin-based neoadjuvant chemotherapy prior to nephroureterectomy,” Dr Cheaib told Renal & Urology News. “Those with high-grade disease but no visible lesion on imaging typically undergo nephroureterectomy immediately.”
In patients with high-grade UTUC, the rates of bladder recurrence at 1 year post-RNU were 21% among NAC recipients compared with 40% among those who did not receive NAC. NAC was associated with a significant 66% decreased risk of bladder recurrence compared with no NAC after adjusting for disease stage, surgical margin status, use of adjuvant chemotherapy, and prior history of urothelial bladder cancer.
Dr Cheaib, with senior authors Jeannie Hoffman-Censits, MD, and Phillip Pierorazio, MD, found no significant difference in BRFS between patients with high-grade and low-grade disease on surgical pathology. Patients with high-grade disease were significantly more likely to have muscle-invasive bladder recurrence than those with low-grade disease (39% vs 0%). “Surprisingly, we found that bladder recurrence rates were independent of disease grade,” Dr Cheaib said. “These findings suggest that strategies to reduce bladder recurrence, such as intravesical chemotherapy, are highly recommended, even in patients with low-grade disease and especially in patients who do not receive neoadjuvant chemotherapy.”
Read more of Renal & Urology News’ coverage of the AUA 2019 meeting by visiting the conference page.
Cheaib J, Liao R, Gupta M, et al. Bladder recurrence in patients with upper tract urothelial carcinoma. Presented at the 2019 American Urological Association annual meeting held May 3-6 in Chicago. Abstract MP50-09.