Impact of upper tract urothelial carcinoma on patients with non-muscle-invasive bladder cancer undergoing intravesical chemotherapy

Background: This study was designed to evaluate the impact of upper tract urothelial carcinoma (UTUC) history on prognosis in patients with non-muscle-invasive bladder cancer (NMIBC) receiving intravesical chemotherapy. Methods: We conducted a single center, retrospective, cohort study of 444 NMIBC patients who received intravesical chemotherapy after transurethral resection of the bladder cancer (TURBT) at Peking University People's Hospital from 2000 to 2015. Patients were divided into UTUC-NMIBC group (with UTUC history) and primary NMIBC group (without UTUC history) by presence of previous UTUC. Demographic, clinical and pathologic factors were analyzed. Kaplan–Meier curves and the log-rank test were used to depict and compare recurrence-free survival (RFS) and progression-free survival (PFS) between the two groups. Multivariable Cox regression models were constructed to determine the variables associated with RFS and PFS. Results: Compared to the primary NMIBC group (n = 410), the UTUC-NMIBC group (n = 34) had an older median age [72.0 (65.0–81.0) vs 66.0 (58–75) years; P = 0.007], a higher incidence of multiple tumors (52.9% vs 33.9%; P = 0.026) and a higher recurrence rate (52.9% vs 30.7%; P = 0.008) and worse RFS (P < 0.001). In multivariate analysis, UTUC history was an independent risk factor for recurrence (hazard ratio = 2.242; P = 0.001), but not for progression. Interestingly, subgroup analysis indicated patients with recent UTUC history (≤ 24 months between UTUC and NMIBC diagnoses) were associated with increased recurrence rates (73.7% vs 26.7%; P = 0.014) . Conclusion: Presence of UTUC history was an independent risk factor for recurrence in patients with NMIBC who received intravesical chemotherapy, especially in those with a shorter interval between UTUC and NMIBC diagnoses.