Abstract

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP48)1 Sep 2021MP48-09 UPPER TRACT UROTHELIAL CARCINOMA FOLLOWING RADICAL CYSTECTOMY: A RISK-ADAPTED SCORING MODEL FOR STRATIFYING SURVEILLANCE INTENSITY Tanner Miest, Abhinav Khanna, Vidit Sharma, Patrick Hensley, Rebecca Campbell, Prabin Thapa, Andrew Zganjar, Matthew Tollefson, Houston Thompson, Igor Frank, Jeffrey Karnes, Aaron Potretzke, Surena Matin, Prithvi Murthy, Georges-Pascal Haber, Byron Lee, and Stephen Boorjian Tanner MiestTanner Miest More articles by this author , Abhinav KhannaAbhinav Khanna More articles by this author , Vidit SharmaVidit Sharma More articles by this author , Patrick HensleyPatrick Hensley More articles by this author , Rebecca CampbellRebecca Campbell More articles by this author , Prabin ThapaPrabin Thapa More articles by this author , Andrew ZganjarAndrew Zganjar More articles by this author , Matthew TollefsonMatthew Tollefson More articles by this author , Houston ThompsonHouston Thompson More articles by this author , Igor FrankIgor Frank More articles by this author , Jeffrey KarnesJeffrey Karnes More articles by this author , Aaron PotretzkeAaron Potretzke More articles by this author , Surena MatinSurena Matin More articles by this author , Prithvi MurthyPrithvi Murthy More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber More articles by this author , Byron LeeByron Lee More articles by this author , and Stephen BoorjianStephen Boorjian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002074.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Metachronous upper tract urothelial carcinoma (UTUC) is diagnosed in approximately 5% of patients following radical cystectomy (RC) for urothelial carcinoma of the bladder. Balancing the potential oncologic benefit of early diagnosis with the costs and anxiety from surveillance, we sought to develop and validate an UTUC recurrence risk score to optimize UT surveillance after RC. METHODS: A multi-institutional retrospective review was performed of patients undergoing RC for urothelial carcinoma. Clinicopathologic variables were evaluated using multivariable cox proportional hazard models to develop and validate a subsequent UTUC diagnosis risk score using two independent institutional registries as training and validation cohorts. RESULTS: Between 1980 and 2019, 3170 patients in the training cohort and 959 patients in the validation cohort underwent RC for bladder urothelial carcinoma. At a median follow-up after RC of 4.6 years (IQR 2.1-8.7), 167/4129 (4.0%) patients were diagnosed with UTUC. Four factors were significantly associated with metachronous UTUC on multivariable Cox regression in the training cohort: any positive margin (hazard ratio [HR] 2.35, 95% confidence interval [CI] 1.62-3.41, p<0.01), history of BCG (HR 2.24, 95% CI 1.60-3.14, p<0.01), CIS at RC (HR 2.07, 95% CI 1.42-3.03, p<0.01), and pre-RC hydronephrosis (HR 1.49, 95% CI 1.021-2.17, p=0.04). These factors had similar discriminative capacity in the training and validation cohorts (C-stat 0.70 and 0.72, respectively). An UTUC risk score was developed by ascribing 2 points to positive margins, history of BCG, and CIS, and 1 point to hydronephrosis. The model-derived risk score stratified patients into low (0 points), intermediate (1-3 points), and high risk (4+ points) for subsequent UTUC diagnosis, with 5-year UTUC free survivals of 99%, 96%, 89% for low, intermediate and high risk groups in the training cohort, and 98%, 96%, and 92% in the validation cohort, respectively (Figure 1). CONCLUSIONS: We developed and validated a post-RC UTUC risk score using two independent institutional cohorts. Further study is warranted to optimize guideline recommended UTUC surveillance protocols after RC in concordance with our risk score. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e866-e867 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tanner Miest More articles by this author Abhinav Khanna More articles by this author Vidit Sharma More articles by this author Patrick Hensley More articles by this author Rebecca Campbell More articles by this author Prabin Thapa More articles by this author Andrew Zganjar More articles by this author Matthew Tollefson More articles by this author Houston Thompson More articles by this author Igor Frank More articles by this author Jeffrey Karnes More articles by this author Aaron Potretzke More articles by this author Surena Matin More articles by this author Prithvi Murthy More articles by this author Georges-Pascal Haber More articles by this author Byron Lee More articles by this author Stephen Boorjian More articles by this author Expand All Advertisement Loading ...

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