Upper urinary tract urothelial cell carcinoma: location as a predictive factor for concomitant bladder carcinoma

Abstract

To investigate the existence of predictive factors for concomitant, primary UUT-UCC and BC. Upper urinary tract urothelial cell carcinoma (UUT-UCC) is a pan-urothelial disease of the transitional epithelial cells. Although several studies have shown the association of bladder recurrence following UUT-UCC, little is known on the incidence of concomitant UUT-UCC and bladder cancer (BC) without previous BC. A retrospective review of 673 patients diagnosed and treated for UUT-UCC was performed. Patients with history of BC were excluded. We investigated age, sex, location of the upper tract tumor (calyx, renal pelvis, upper ureter, mid-ureter, lower ureter), multifocality, clinical symptoms, tumor grade and pathological stage. Contingency tables and chi-square test were used for categorical variables and analysis of variance (ANOVA) for quantitative variables. 450 patients eligible for inclusion were identified. Of these, 76 (17%) presented concomitant primary UUT-UCC and BC. Location of primary UUT-UCC was in calyx and/or renal pelvis in 25 patients (34%), upper ureter 8 (11%) and lower ureter 37 (49%). In 6 patients (8%), data were missing. Concomitant BC was found in 10, 18, and 33% of patients with primary caliceal/renal pelvis, upper ureter and lower ureter UUT-UCC, respectively. On multivariate analysis, location of UUT-UCC was the only predictive factor for concomitant bladder tumor (OR: 1.7; 95% CI, 1.007-2.906 p=0.047). Our findings suggest that the possibility of concomitant BC in primary diagnosed patient with UUT-UCC is as high as 33% and mainly depends on upper tract tumor location.