Should follow-up cystoscopy be performed in upper-tract urothelial carcinoma patients managed with radical nephroureterectomy after a five-year bladder tumor-free period?

Objectives: There is disagreement on the follow-up schedule after a 5-year bladder recurrence-free period in patients with upper-tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). In this study, we aimed to clarify the risk factors for the late recurrence in UTUC patients who remained bladder recurrence-free for more than 5 years. Methods: Data from a large single-center Chinese institution were retrospectively reviewed. Among the patients with UTUC who were treated with RNU between 1999 and 2018, those who had no recurrence for more than 5 years were included in this study. The Kaplan–Meier method and Cox hazards model were used to estimate recurrence-free survival. Results: In total, 1028 patients were enrolled in this study. Of these patients, 57 patients (5.5%) experienced late recurrence. The median follow-up time was 96 years (interquartile range 6.9–11.3 years). A prior history of bladder cancer (BCa) before RNU,synchronous T1 BCa, a prior history of kidney transplantation and carcinoma in situ (CIS) were significant predictors for late recurrence, although other clinical factors including tumor grade, pathologic stage and tumor multiplicity were not associated with late recurrence. Conclusions: Late recurrence after a prolonged intravesical tumor-free period is not uncommon and can not be fully predicted by the current risk stratification system. Patients with high-risk factors including previous and synchronous BCa, CIS variants and a previous kidney transplantation require more extensive cystoscopy follow-up for 5 to 10 years after RNU to ensure effective surveillance and timely management of potential recurrences.