Bladder cancer worsens prognosis in upper urinary tract urothelial carcinoma

A significant association exists between bladder cancer and worse clinical outcomes following radical nephroureterectomy of upper urinary tract urothelial carcinoma, a study has found.

The authors retrospectively collected data on 2,668 patients who underwent radical nephroureterectomy of nonmetastatic upper urinary tract urothelial carcinoma in 1995 to 2009. They assessed the impact of bladder cancer on overall mortality and the factors predictive of subsequent bladder cancer.

Of the patients, 631 (23.7 percent) had previous or simultaneous bladder cancer. These patients had significantly shorter overall survival than those without previous or simultaneous bladder cancer (hazard ratio [HR], 1.29, 95 percent confidence interval [CI], 1.09–1.53; p=0.0026).

About a third (683 of 2,037; 33.5 percent) of patients without previous or simultaneous bladder cancer subsequently had the disease following radical nephroureterectomy.

Of the patients with pT0-2 disease, those with subsequent bladder cancer had significantly shorter overall survival than those without (HR, 1.81, 95 percent CI, 1.23–2.67; p=0.0025). On the other hand, subsequent bladder cancer did not result in worse overall survival in patients with pT3-4 disease.

Multivariable analyses revealed the following independent predictors of subsequent bladder cancer: gender, preoperative urine cytology and clinical node status in the preoperative setting, and gender, adjuvant chemotherapy and pathological node status in the postoperative setting.

“Preventing subsequent bladder cancer in patients with pT0-2 upper urinary tract urothelial carcinoma may lead to better prognosis in those who undergo radical nephroureterectomy,” the authors said.