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Surveillance Strategy for Patients With Upper Tract Urothelial Carcinoma

By: Kelly M. Hennessey, PhD
Posted: Tuesday, December 8, 2020

Upper tract urothelial carcinoma comprises somewhere between 5% and 10% of all urothelial cancers, with radical nephroureterectomy as the best available treatment. Although the risk of developing metachronous contralateral upper tract urothelial carcinoma after radical nephroureterectomy is very low, the risk of compromised renal function is serious. Lu et al, of West China Hospital, Sichuan University, China, and colleagues conducted a study to identify the risk factors associated with developing metachronous contralateral upper tract urothelial carcinoma and survival outcomes of patients with unilateral and contralateral tumors. They found that patients who developed contralateral upper tract urothelial carcinoma had better survival outcomes than those who developed unilateral tumors. Their results were published in Scientific Reports.

“Clinicians should provide individualized cancer surveillance for high-risk upper tract urothelial carcinoma patients, including younger patients, cases who had small tumor size, and the history of bladder cancer,” suggested the researchers.

Researchers used the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database and identified 26,117 eligible patients with upper tract urothelial carcinoma. Of them, 23,075 patients were diagnosed with unilateral tumors, 144 of whom later developed a new, metachronous contralateral upper tract urothelial carcinoma. The median interval of occurrence was 32 months.

In total, 70.1% (n = 101) of patients developed a new contralateral carcinoma within 5 years, 19.4% (n = 28) of patients between 5 and 10 years, and 10.4% (n = 15) of patients 10 years after primary diagnosis. When researchers compared the risk of new, metachronous contralateral tumors in patients with unilateral tumors to that in the general population, they found the overall risk of secondary tumors was more than 18-fold greater. Younger patients with unilateral upper tract urothelial carcinoma and smaller tumor size increased the risk of developing metachronous contralateral upper tract urothelial carcinomas; those with bladder cancer had a significantly elevated risk of developing contralateral carcinomas than patients without bladder cancer.  

Disclosure: The study authors reported no conflicts of interest.



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