Advanced or high-grade tumors in patients with upper tract urothelial carcinoma (UTUC) are among the risk factors associated with poor prognosis and postoperative bladder cancer (BC) recurrence, according to researchers.

A team led by Qingwei Wang, MD, of the First Affiliated Hospital of Zhengzhou in China, identified 439 UTUC patients from their institution (mean age 67 years; 54% male) who underwent radical nephroureterectomy (RNU). Overall survival rates at 1, 3, and 5 years were 90%, 76%, and 68%, respectively, according to results published in BMC Urology. Patients with advanced tumors fared worse than those with lower stage tumors: The 5-year survival rates of patients with T1, T2, T3, and T4 tumors were 90%, 78%, 44%, and 19%, respectively.

Certain factors correlated with worse survival, including smoking, taking traditional Chinese medicine containing aristolochic acid, history of muscle-invasive urothelial carcinoma of the bladder, age older than 50 years, larger tumor size, advanced tumor stage, high tumor grade, and lymph node metastasis. Bladder cancer recurrence was more likely to occur after surgery in UTUC patients with advanced tumor stage, high grade tumor, preoperative ureteroscopy, ureteral urothelial carcinoma, no postoperative bladder perfusion chemotherapy, and diabetes without metformin use.

Preoperative ureteroscopy might increase the risk for postoperative bladder cancer recurrence by promoting cancer cell exfoliation and implantation in the bladder after ureteroscopy, the authors discussed. Metformin might reduce cancer risk by inhibiting the proliferation of tumor cells. Traditional Chinese herbal medicines (such as Longdanxiegan pills, Paishi granule, Paishi decoction, and Caulis aristolochiae manshuriensis) containing aristolochic acid may promote mutations and dysfunction of the cancer suppressor gene.

In light of these findings, “we suggest that UTUC patients with the above risk factors for BC recurrence should compulsorily undergo regular bladder perfusion chemotherapy,” Dr Wang and colleagues concluded. “In addition, we suggest that preoperative ureteroscopy should not be exercised except when preoperative imaging diagnosis is difficult.”

Reference

Wang Q, Zhang T, Wu J, et al. Prognosis and risk factors of patients with upper urinary tract urothelial carcinoma and postoperative recurrence of bladdercancer in central China. BMC Urol 2019;19:24. doi:10.1186/s12894-019-0457-5