Patients who have upper tract urothelial carcinoma (UTUC) with multifocal tumors have a higher risk for the most common type of recurrence following surgery, according to investigators.

Of 550 patients with UTUC patients (median age 68 years; 57% female) from Taichung Veterans General Hospital in Taiwan, urinary bladder recurrence occurred in 164 patients (29.8%) at a median 8.4 months from radical nephroureterectomy. Another 5.5% of patients experienced contralateral recurrence.

In a multivariate analysis of 15 clinicopathological factors, such as tumor grade and stage and lymphovascular invasion, UTUC tumor multifocality emerged as the sole significant prognostic factor for urinary bladder recurrence, Chuan-Shu Chen, MD, and collaborators from the hospital reported in Diagnostics. Patients with multifocal tumors had a 40% higher risk for urinary bladder recurrence than patients with single tumors.

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Other studies have also identified tumor multifocality as a recurrence factor, Dr Chen and colleagues noted, so it may be of increased importance. In their univariate analysis, positive surgical margins also appeared predictive, signaling the need for more research on this point.

In this study, urinary bladder recurrence was not associated with worse overall or cancer-specific survival. All urinary bladder recurrences, however, were stage T1 without muscle invasion.

According to Dr Chen’s team, late detection of urinary bladder recurrence (UBR) or its recurrence, resulting in muscle-invasive bladder cancer, would negatively impact a patient’s survival. Therefore, a postoperative cystoscopic follow-up protocol (every 3 months for the first 2 years, every 6 months for the following 3 years, and then once annually thereafter) is critical for avoiding a delayed diagnosis or muscle-invasive bladder cancer due to UBR.

In this retrospective study, few patients received prophylactic intravesical chemotherapy to prevent UBR. It is now recommended.

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Chen CS, Li JR, Wang SS, et al. Tumor Multifocality is a significant risk factor of urinary bladder recurrence after nephroureterectomy in patients with upper tract urothelial carcinoma: A single-institutional study [published online April 3, 2020]. Diagnostics (Basel). 2020 Apr 3;10(4). pii: E201  doi: 10.3390/diagnostics10040201