Chronic kidney disease stages, intravesical therapy regimens, and regular cystoscopic follow-up may also impact the survival of urinary tract urothelial carcinoma patients.

We read with interest the article by Zeng et al. (1) who evaluated the impact of subsequent bladder urothelial carcinoma developed by different stages on cancer-specific-survival (CSS) after radical nephroureterectomy (RNU) in patients of upper urinary tract urothelial carcinoma (UTUC) treated in United States during 2004–2018. Based on the large-scale cohort with more than 8,000 patients, they identified that the UTUC patients with previous or simultaneous bladder cancer, intravesical recurrence (IVR) with muscle-invasive bladder cancer (MIBC), and shorter interval between UTUC and IVR were significantly associated with worse CSS. Though the study is of retrospective nature, the findings provided meaningful information regarding the oncological outcomes among UTUC patients treated by RNU. However, we can find the disease characteristics of UTUC differs from Chinese population in terms of the distribution of the primary UTUC tumor site and gender dominance (2). Higher ureteral location of UTUC and which is female predominant has been reported by the study reported from South Taiwan (2). As we know, the speculated pathomechanisms of UTUC might be different, and results in distinct pathologic characteristics. Chinese herbs which contain aristolochic acid (AA) has been identified as carcinogen for UTUC (3) in China, while smoking is the major risk factor in the Western countries (4). We can expect the oncological outcomes might be different between China and other countries, so it is warranted to conduct a study to examine the specific prognostic factors for Chinese UTUC patients. In addition, we have a few points of concern that we would like to raise apart from the limitations addressed the authors.

First, chronic kidney disease stage and dialysis history are not available in this study, which has been identified as one of the important risk factors for survival outcomes and IVR (5). Second, the regimens of intravesical chemotherapy are not clear. Third, among patients with subsequent MIBC, how many patients did not receive regular cystoscopy examination, which might early diagnose NMIBC and prevent the progression to MIBC. We believe that addressing the points we have highlighted would provide greater application for our readers.

The article’s supplementary files as