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Presence of Concomitant Non-muscle-invasive Bladder Cancer in Chinese Patients with Upper Tract Urothelial Carcinoma: Risk Factors, Characteristics, and Predictive Value

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To explore the characteristics, predictive risk factors, and prognostic effect of concomitant non-muscle-invasive bladder cancer (NMIBC) in patients with upper tract urothelial carcinoma (UTUC).

Methods

We evaluated 727 consecutive UTUC patients treated with radical resection between 2000 and 2012 in a high-volume center of China. Preoperative cystoscopy was performed in all patients. Patients with previous or concomitant total cystectomy were excluded.

Results

Overall, 73 patients (10.0 %) had NMIBC. Concomitant NMIBC was associated with previous bladder cancer (p = 0.003), tumor located in ureter (p = 0.008), multifocality (p < 0.001), and preoperative renal insufficiency (p = 0.023). The presence of concomitant NMIBC was predictive for lower tumor stage (p = 0.019), papillary architecture (p = 0.023), and organ-confined disease (pT < 3 and N−, p = 0.006). The median follow-up duration was 57 months. The presence of concomitant NMIBC was a risk factor for bladder recurrence (p < 0.001), and particularly in patients with non-muscle-invasive UTUCs, it affects cancer-specific survival (odds ratio 1.614, p = 0.030) and contralateral recurrence (odds ratio, 1.907, p = 0.016). Most concomitant NMIBC were found at the lateral wall or bladder neck, while most intravesical recurrences occurred near the site of surgery or posterior wall.

Conclusions

The most common site for concomitant NMIBC was lateral wall and bladder neck, and previous bladder cancer, tumor located in ureter, tumor multifocality, and preoperative renal insufficiency were risk factors for concomitant NMIBC. The presence of concomitant NMIBC is predictive for relative better pathologic outcomes but higher rate of bladder recurrence, while the effect on postoperative survival was limited with patients early-stage UTUCs. The potential mechanisms need further investigation.

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Acknowledgment

This work was supported by grants from the Collaborative Research Foundation of Peking University Health Science Center and National Taiwan University, the College of Medicine (BMU20120318), the Natural Science Foundation of Beijing (7122183), the Natural Science Foundation of China (81172419, 81372746), and Research Foundation of Peking University First Hospital. The authors thank staff of the Department of Urology, Peking University First Hospital.

Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China

    Dong Fang MD, Lei Zhang MD, Xuesong Li MD, PhD, Wei Yu MD, PhD, Guangzhi Zhao MD, Gengyan Xiong MD, Yi Song MD, PhD, Qun He MD, PhD, Zhisong He MD, PhD & Liqun Zhou MD, PhD

  2. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Nirmish Singla MD

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  1. Dong Fang MD
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  2. Lei Zhang MD
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  3. Xuesong Li MD, PhD
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  4. Wei Yu MD, PhD
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Corresponding authors

Correspondence to Xuesong Li MD, PhD or Liqun Zhou MD, PhD.

Additional information

Dong Fang and Lei Zhang have contributed equally to this article.

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Fang, D., Zhang, L., Li, X. et al. Presence of Concomitant Non-muscle-invasive Bladder Cancer in Chinese Patients with Upper Tract Urothelial Carcinoma: Risk Factors, Characteristics, and Predictive Value. Ann Surg Oncol 22, 2789–2798 (2015). https://doi.org/10.1245/s10434-014-4302-5

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  • DOI: https://doi.org/10.1245/s10434-014-4302-5

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