Long-term risk of upper urinary tract recurrence after organ-preserving therapy of nonmuscle-invasive bladder cancer

B24: Long-term risk of upper urinary tract recurrence after organ-preserving therapy of nonmuscle-invasive bladder cancer Rolevich A.I. N.N. Alexandrov National Cancer Centre of Belarus, Dept. of Urology, Minsk, Belarus INTRODUCTION & OBJECTIVES: Although development of urothelial upper urinary tract tumors (UUTT) after organpreserving therapy of nonmuscle-invasive bladder cancer (NMIBC) is rare event it requires life-long follow-up with appropriate imaging modalities. Thorough assessment of risk factors may individualize follow-up strategy according to individual probability of UUTT development. However there was no any reliable prediction model proposed for the assessment of UUTT risk after NMIBC therapy. We analyzed our institutional database to evaluate risk of UUTT development after organ-preserving therapy of NMIBC and to establish risk factors of this event. MATERIAL & METHODS: A retrospective analysis of data of patients with primary or recurrent NMIBC treated at our institution within 2004 and 2007 by TURB with or without re-TURB or intravesical therapy was conducted. Patients without long-term follow-up information were excluded. A total of 261 patients (64 females, 197 males) were included with median age of 66 years. According to EORTC recurrence risk classification there were 21 (8%) low risk patients, 94 (36%) intermediate risk, 121 (46%) high risk and 25 (10%) very high risk patients. Cumulative risk of UUTT development and its 95% confidence intervals (CI) were calculated. Prognostic factors were assessed with Cox proportional hazard model. RESULTS: With median follow-up of 72 month (from 3 to 102) 6 UUTT were registered: 2 in renal pelvis and 4 in ureter. The tumors were diagnosed 3-50 month (median 28 month) after treatment of the initial tumor. Cumulative risk of UUTT development within 5 and 7 years were 2.3% (95%CI 0.3%– 4.2%) and 3.1% (95%CI 0.8-5.4%), respectively. In multivariate analysis tumor location near ureteral orifice (HR 20.6; 95%CI 3.5-121.4; p=0.001) and recurrent state of the tumor (HR 2.9; 95%CI 1.1-7.4; p=0.039) were statistically significant predictors of the UUTT development. Common risk factors as multifocality (HR 3.9, 95%CI 0.5-33.2) or EORTC high/intermediate recurrence risk group (HR 4.1, 95%CI 0.5-35.3) failed to show predictive ability. Combination of statistically significant factors was present in 6 (2.3%) patients of the entire cohort and 3/6 (50%) UUTT developed in this group with cumulative risk of UUTT within 5 years 51% (95%CI 11-91%). In the rest 255 (98%) patients of the cohort only 3 (1.2%) UUTT were diagnosed during follow-up with 5-year cumulative risk of UUTT 1.7% (95%CI 0.04-3.3%). CONCLUSIONS: Cumulative risk of UUTT after organ-preserving therapy of NMIBC is low. Risk factors of UUTT development were tumor location and recurrent tumor status. Stratification according to these factors enables to select small group of patients with high cumulative rate of UUTT. Eur Urol Suppl 2014; 13(2): e1163

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