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Article Abstract
Objective: To examine differences in cancer-specific mortality (CSM) in nonmetastatic upper tract urothelial carcinoma (UTUC) patients with vs. without secondary bladder cancer (BCa) after radical nephroureterectomy (RNU).
Methods: Within the Surveillance, Epidemiology, and End Results database (SEER 2000-2021), T1-T4N0M0 UTUC patients treated with RNU and diagnosed with secondary BCa were identified. A landmark approach was used, requiring the diagnosis of secondary BCa within 18 months of the UTUC diagnosis. Additionally, a minimum follow-up of 18 months after the UTUC diagnosis was required. Subsequently, Kaplan-Meier plots and time-dependent multivariable Cox regression (MCR) models were fitted. Sensitivity analyses were performed in patients with late BCa diagnoses (6 to 18 months after UTUC diagnosis).
Results: Of 3,013 eligible UTUC patients who fulfilled the landmark and follow-up criteria, 269 (9.0%) harbored secondary BCa. Ten-year CSM-free survival rates were respectively 60 vs 73% in patients with vs without secondary BCa. In MCR models, secondary BCa independently predicted higher CSM (hazard ratio [HR]: 1.53, p < 0.001). Subgroup analyses by tumor stage confirmed the independent predictor status of secondary BCa in T1-T2 stages (HR: 2.04, p < 0.001), primary renal pelvic (HR: 1.47, p = 0.003) and ureteral (HR: 1.63, p = 0.01) UTUC. Sensitivity analyses confirmed the independent predictor status of secondary BCa also in patients with late secondary BCa (HR: 1.68, p < 0.001).
Conclusion: In general, secondary BCa in UTUC patients treated with RNU is associated with higher CSM. This disadvantage primarily affects patients with T1-T2 stage UTUC involving the ureter or renal pelvis.
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