Upper Urinary Tract Tcc Recurrence Rate Following Radical Cystectomy for Bladder Cancer

UPPER URINARY TRACT TCC RECURRENCE RATE FOLLOWING RADICAL CYSTECTOMY FOR BLADDER CANCER: A META-ANALYSIS ON 13185 PATIENTS

INTRODUCTION

Patients who underwent radical cystectomy for urothelial cancer are at risk for transitional cell carcinoma (TCC)recurrence on the upper urinary tract (UUT). Previous studies identified several risk factors for TCCrecurrence, although predictive value of each factor remains controversial. Both European and American urologicalguidelines lackthese topics, referring only to isolated works with large casuistic.

MATERIALS AND METHODS

A bibliographic search covering the period from January 1970 to July 2010 was conducted on PubMed, MEDLINEendamebas. This analysis is based on the 27 studies that fulfilled the predefined inclusion criteria. Data wereanalyzed into ways: a fixed effect logistic regression approach and a classical meta-analysis.

RESULTS

A total of 13185 patients were included. Follow-up has been described in twenty-two studies and the length rangewasbetween 0.36 and 349.2 months. The overall prevalence of recurrence of the upper urinary tract after cystectomy hadarange from 0.75 to 6.4%. TCC recurrence evidence appeared after 0.4 to 164 months. The presentation was inanadvanced (64.6%) or in a metastatic way (35.6%). Both the situations had a poor survival rates.Patients affected by alow grade disease compared to higher ones show a strong significant difference in TCCrecurrence. The same differenceis reported between patients with CIS or superficial disease compared with muscleinvasive disease. Patients with ahistory of CIS did not have a statistically significant recurrence rates difference aspatients presented with solitarybladder TCC lesion and between the different types of diversion adopted.In 24 studies follow-up has been carried out through periodic radiological assessment of the upper urinary tract, and in20 with urinary cytology. In 14 studies 166 recurrences were reported. In 63 (63/166; 38%) patients the upper urinarytract recurrence was diagnosed thanks tofollow-up. The other recurrences (62%) were diagnosed after symptomsappearance. Among the 5537 that underwent the follow up pathway with a urinary cytological examination, recurrenceswere diagnosed in 1.8‰, this rate came up to 7.6‰ with a follow up with a periodic upper urinary tract imaging.

CONCLUSIONS

The recurrence values could appear low considering the pan-urothelial field defect theory, butthese values reflect themortality related to the initial bladder cancer. A group of patients athigh risk does exist thus considering theiranamnesis and their definitive pathologicalexamination taken from cystectomy specimens. An extensive regularfollow-up with cytologyand upper urinary tract imaging gives insufficient benefits. Periodic CT scan withpielographicstudy combines the upper urinary tract imaging with the identification of anysecondaryparenchymal, osseous or lymph-nodal metastatic lesion.