Assessing the Influence of Bladder Cancer on Upper Tract Urothelial Carcinoma Prognoses Following Radical Nephroureterectomy: A Retrospective, Propensity Score-Based Multicenter Cohort Study.

Background: Bladder cancer (BCa) is relatively common in patients diagnosed with upper tract urothelial carcinoma (UTUC); however, the impact of BCa history on UTUC prognoses after radical nephroureterectomy (RNU) is unclear. This retrospective, multicenter cohort study aimed to assess this relationship and improve clinical decision making.

Materials And Methods: We conducted a comprehensive analysis of propensity score-matched (PSM) data from two Chinese centers and the Surveillance, Epidemiology, and End Results (SEER) database. Patients were categorized into three groups: BCa-UTUC (defined as patients with a BCa history or BCa occurring within 3 months following RNU); UTUC-BCa (defined as patients who had BCa for 3 months or more following RNU); or solely UTUC (defined as patients with no BCa). Kaplan-Meier analysis and log-rank tests were used to compare survival differences, and Cox's regression analysis was used to identify risk factors associated with overall survival (OS) and cancer-specific survival (CSS).

Results: Overall, 7249 cases were included (1010 from China, 6239 from the SEER database). PSM ensured well-balanced baseline characteristics. In the Chinese cohort, BCa-UTUC cases had significantly poorer CSS than solely UTUC (hazard ratio [HR] 2.334, 95% confidence interval [CI] 1.547-3.523; p < 0.001). UTUC-BCa also had worse CSS (HR 1.697, 95% CI 1.178-2.446; p = 0.005). BCa-UTUC was associated with worse OS (HR 2.404, 95% CI 1.703-3.393; p < 0.001). SEER findings were consistent, with both BCa-UTUC and UTUC-BCa linked to adverse CSS.

Conclusion: BCa history, whether prior, concurrent, or subsequent, negatively affects UTUC prognosis after RNU, highlighting the need for enhanced surveillance and management for these high-risk patients.