Abstract
Tumor multifocality and location are prognostic factors for upper tract urothelial carcinoma (UTUC). However, confounding effects can appear when these two factors are analyzed together. Therefore, we aimed to investigate the impact of tumor distribution on the outcomes of multifocal UTUC after radical nephroureterectomy. From the 2780 UTUC patients in the Taiwan UTUC Collaboration Group, 685 UTUC cases with multifocal tumors (defined as more than one tumor lesion in unilateral upper urinary tract) were retrospectively included and divided into three groups: multiple renal pelvic tumors, multiple ureteral tumors, and synchronous renal pelvic and ureteral tumors included 164, 152, and 369 patients, respectively. We found the prevalence of carcinoma in situ was the highest in the synchronous group. In multivariate survival analyses, tumor distribution showed no difference in cancer-specific and disease-free survival, but there was a significant difference in bladder recurrence-free survival. The synchronous group had the highest bladder recurrence rate. In summary, tumor distribution did not influence the cancer-specific outcomes of multifocal UTUC, but synchronous lesions led to a higher rate of bladder recurrence than multiple renal pelvic tumors. We believe that the distribution of tumors reflects the degree of malignant involvement within the urinary tract, but has little significance for survival or disease progression.
Highlights
Tumor multifocality and location are prognostic factors for upper tract urothelial carcinoma (UTUC)
Tumor distribution did not influence the cancer-specific outcomes of multifocal UTUC, but synchronous lesions led to a higher rate of bladder recurrence than multiple renal pelvic tumors
Whether the prognosis of the two tumors is different has been a matter of debate, but recent studies agree that renal pelvic tumors (RPTs) are associated with better o utcomes[3,5,6,8,9]
Summary
Tumor multifocality and location are prognostic factors for upper tract urothelial carcinoma (UTUC). Tumor distribution did not influence the cancer-specific outcomes of multifocal UTUC, but synchronous lesions led to a higher rate of bladder recurrence than multiple renal pelvic tumors. Upper tract urothelial carcinoma (UTUC) comprises renal pelvic tumors (RPTs) and ureteral tumors (UTs). It is a relatively rare but aggressive urological cancer with a poor p rognosis[1,2]. The differences between RPTs and UTs have been validated, and tumor location is considered a profound factor for the evaluation of UTUC. In addition to the differences in the disease features of RPTs and UTs, the existence of two localities within a single cancer entity results in heterogeneity of tumor multifocality. Inappropriate grouping may mask the true impact of tumor location and multifocality on prognosis
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