Presentation Authors: Tadatsugu Anno*, Eiji Kikuchi, Koichiro Ogihara, Mototsugu Oya, Tokyo, Japan
Introduction: It is not fully known whether the location of a urothelial carcinoma in the urinary tract can result in a different clinical outcome. As tumor stage is thought to be the most important prognostic indicator for survival, we compared the prognostic differences in tumor location of urothelial carcinoma (bladder urothelial carcinoma, BUC vs renal pelvis urothelial carcinoma, PUC vs ureter urothelial carcinoma, UUC).
Methods: We identified 449 patients who underwent total cystectomy for BUC or radical nephroureterectomy for PUC and UUC at our 4 institutions. Among them, 125 patients had pT2 tumors (BUC in 69, PUC in 20, UUC in 36) and 324 patients had pT3/4 tumors (BUC in 139, PUC in 113, UUC in 72. We evaluated the oncological outcome of tumor recurrence and cancer death in these three groups.
Results: In patients with a pT2 tumor, 33.3% received neoadjuvant and/or adjuvant chemotherapy for BUC, which was significantly higher than 5.0% for PUC, and 14.7% for UUC. A history of smoking was present in 66.2% of BUC patients, 50.0% of PUC patients, and 71.9% of UUC patients, with no statistical significance (NS). Of the patients with a pT2 tumor, the 5-year recurrence free survival (RFS) for BUC was 64.5%, which was not significantly different to that for PUC (69.4%) and UUC (82.7%) and the 5-year cancer specific survival (CSS) for BUC was 74.9%, which was not significantly different to that for PUC (80.0%) and UUC (83.7%). In patients with a pT3/4 tumor, 44.9% received neoadjuvant and/or adjuvant chemotherapy for BUC, which was significantly higher than 32.4% for PUC, and 28.1% for UUC. A history of smoking was present in 64.2% of BUC patients, 59.1% of PUC patients, and 50.0% of UUC (NS). Of the patients with a pT3/4 tumor, the 5-year RFS for BUC was 32.4%, which was significantly lower than that for PUC (58.2%, p=0.001) and UUC (49.7%, p=0.011) and the 5-year CSS for BUC was 44.0%, which was significantly lower than that for PUC (72.3%, p=0.001) and UUC (61.8%, p=0.045). Multivariate Cox regression analysis revealed BUC was independently associated with worse RFS (hazard ratio: HR of 1.800, p=0.006 vs PUC, HR of 1.635, p=0.039 vs UUC) and OS (HR of 2.167, p=0.003 vs PUC).
Conclusions: Higher staged BUC might have worse tumor biology and sensitivity for systemic chemotherapy as compared to upper tract urothelial carcinoma.