Andrew B Katims1, Rollin Say1, Ithaar Derweesh2, Robert Uzzo3, Andrea Minervini4, Zhenjie Wu5, Firas Abdollah6, Chandru Sundaram7, Matteo Ferro8, Koon Rha9, Alex Mottrie10, Giuseppe Rosiello10, Giuseppe Simone11, Daniel D Eun12, Adam Reese12, Laura C Kidd12, James Porter13, Amit Satish Bhattu14, Mark L Gonzalgo14, Vitaly Margulis15, Jamil Marcus6, Alyssa Danno6, Margaret Meagher2, Riccardo Tellini3, Andrea Mari3, Alessandro Veccia16, Alireza Ghoreifi17, Riccardo Autorino16, Hooman Djaladat17, Reza Mehrazin1. 1. Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York. 2. Department of Urology, University of California San Diego School of Medicine, La Jolla, California. 3. Department of Urological Oncology, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, Pennsylvania. 4. Department of Urology, University of Florence, Florence, Italy. 5. Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China. 6. Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan. 7. Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana. 8. Division of Urology, European Institute of Oncology, Milan, Italy. 9. Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. 10. Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium. 11. Department of Urology, Regina Elena National Cancer Institute, Rome, Italy. 12. Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania. 13. Swedish Urology Group, Seattle, Washington. 14. Department of Urology, University of Miami Miller School of Medicine, Miami, Florida. 15. Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas. 16. Division of Urology, VCU Health System, Richmond, Virginia. 17. Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California.
Abstract
PURPOSE: Intravesical recurrence (IVR) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) has an incidence of approximately 20%-50%. Studies to date have been composed of mixed treatment cohorts-open, laparoscopic and robotic. The objective of this study is to assess clinicopathological risk factors for intravesical recurrence after RNU for UTUC in a completely minimally invasive cohort. MATERIALS AND METHODS: We performed a multicenter, retrospective analysis of 485 patients with UTUC without prior or concurrent bladder cancer who underwent robotic or laparoscopic RNU. Patients were selected from an international cohort of 17 institutions across the United States, Europe and Asia. Univariate and multiple Cox regression models were used to identify risk factors for bladder recurrence. RESULTS: A total of 485 (396 robotic, 89 laparoscopic) patients were included in analysis. Overall, 110 (22.7%) of patients developed IVR. The average time to recurrence was 15.2 months (SD 15.5 months). Hypertension was a significant risk factor on multiple regression (HR 1.99, CI 1.06; 3.71, p=0.030). Diagnostic ureteroscopic biopsy incurred a 50% higher chance of developing IVR (HR 1.49, CI 1.00; 2.20, p=0.048). Treatment specific risk factors included positive surgical margins (HR 3.36, CI 1.36; 8.33, p=0.009) and transurethral resection for bladder cuff management (HR 2.73, CI 1.10; 6.76, p=0.031). CONCLUSIONS: IVR after minimally invasive RNU for UTUC is a relatively common event. Risk factors include a ureteroscopic biopsy, transurethral resection of the bladder cuff, and positive surgical margins. When possible, avoidance of transurethral resection of the bladder cuff and alternative strategies for obtaining biopsy tissue sample should be considered.
PURPOSE: Intravesical recurrence (IVR) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) has an incidence of approximately 20%-50%. Studies to date have been composed of mixed treatment cohorts-open, laparoscopic and robotic. The objective of this study is to assess clinicopathological risk factors for intravesical recurrence after RNU for UTUC in a completely minimally invasive cohort. MATERIALS AND METHODS: We performed a multicenter, retrospective analysis of 485 patients with UTUC without prior or concurrent bladder cancer who underwent robotic or laparoscopic RNU. Patients were selected from an international cohort of 17 institutions across the United States, Europe and Asia. Univariate and multiple Cox regression models were used to identify risk factors for bladder recurrence. RESULTS: A total of 485 (396 robotic, 89 laparoscopic) patients were included in analysis. Overall, 110 (22.7%) of patients developed IVR. The average time to recurrence was 15.2 months (SD 15.5 months). Hypertension was a significant risk factor on multiple regression (HR 1.99, CI 1.06; 3.71, p=0.030). Diagnostic ureteroscopic biopsy incurred a 50% higher chance of developing IVR (HR 1.49, CI 1.00; 2.20, p=0.048). Treatment specific risk factors included positive surgical margins (HR 3.36, CI 1.36; 8.33, p=0.009) and transurethral resection for bladder cuff management (HR 2.73, CI 1.10; 6.76, p=0.031). CONCLUSIONS: IVR after minimally invasive RNU for UTUC is a relatively common event. Risk factors include a ureteroscopic biopsy, transurethral resection of the bladder cuff, and positive surgical margins. When possible, avoidance of transurethral resection of the bladder cuff and alternative strategies for obtaining biopsy tissue sample should be considered.