BJUI compass · 2026
When disease travels downstream: The effect of intravesical recurrences in patients treated for upper tract urothelial carcinoma.
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Figaroa Orlane J A, Jonker Sanne J, Fris Felix J, Kamphuis Guido M, Bins Adriaan D, van Moorselaar R Jeroen A, Baard Joyce
Аннотация
BACKGROUND: Treatment of upper tract urothelial carcinoma (UTUC) depends on risk stratification and tumour characteristics. Kidney-sparing surgery (KSS) is preferred for low-risk disease, whereas radical nephroureterectomy (RNU) is the standard for high-risk UTUC. Intravesical recurrences (IVR) are common after both treatment modalities, but their impact on survival remains unclear.
OBJECTIVE: To assess the IVR rate and cumulative hazard following UTUC treatment and oncological outcomes based on the presence of IVR during follow-up. Second, the relation between UTUC and IVR tumour grade in patients treated with endoscopic KSS (eKSS).
METHODS: A single-centre study, including non-metastatic UTUC patients treated between 2010 and 2023. Analysis was performed in a cohort of patients without a history of bladder cancer.
RESULTS: In total 164 patients were selected; 85 treated with eKSS, 79 by RNU. Overall, 91 patients (55%) developed an IVR, 53 (62%) after eKSS and 38 (48%) after RNU, during a median follow-up of 33 months (IQR 11-72). eKSS-treated patients showed a significantly higher cumulative hazard for IVR (HR 0.6, 95% CI 0.42-0.95, p = 0.02). The CSS and MFS were comparable between patients with or without IVR during follow-up. In patients treated by eKSS, we found IVR upgrading in 24% of patients treated with eKSS.
CONCLUSIONS: Patients treated by eKSS showed a higher cumulative hazard of IVR, without an impact on oncological outcomes. These findings support the use of kidney-sparing approaches in well-selected cases and highlight the need for proper follow-up including the bladder and evaluate IVR preventive measures as intravesical instillations.
OBJECTIVE: To assess the IVR rate and cumulative hazard following UTUC treatment and oncological outcomes based on the presence of IVR during follow-up. Second, the relation between UTUC and IVR tumour grade in patients treated with endoscopic KSS (eKSS).
METHODS: A single-centre study, including non-metastatic UTUC patients treated between 2010 and 2023. Analysis was performed in a cohort of patients without a history of bladder cancer.
RESULTS: In total 164 patients were selected; 85 treated with eKSS, 79 by RNU. Overall, 91 patients (55%) developed an IVR, 53 (62%) after eKSS and 38 (48%) after RNU, during a median follow-up of 33 months (IQR 11-72). eKSS-treated patients showed a significantly higher cumulative hazard for IVR (HR 0.6, 95% CI 0.42-0.95, p = 0.02). The CSS and MFS were comparable between patients with or without IVR during follow-up. In patients treated by eKSS, we found IVR upgrading in 24% of patients treated with eKSS.
CONCLUSIONS: Patients treated by eKSS showed a higher cumulative hazard of IVR, without an impact on oncological outcomes. These findings support the use of kidney-sparing approaches in well-selected cases and highlight the need for proper follow-up including the bladder and evaluate IVR preventive measures as intravesical instillations.