Surveillance guidelines based on recurrence patterns for upper tract urothelial carcinoma

Area of Science:

• Urology
• Oncology
• Medical Surveillance

Background:

• Upper tract urothelial carcinoma (UTUC) is rare, comprising 5% of all urothelial tumours.
• Limited evidence exists for optimal postoperative surveillance strategies following radical nephroureterectomy (RNU).

Purpose of the Study:

• To develop a post-RNU surveillance protocol based on recurrence patterns.
• To establish evidence-based guidelines for monitoring UTUC patients after surgery.

Main Methods:

• Retrospective analysis of clinical and pathological data from 1029 patients undergoing RNU.
• Multivariable modeling to identify prognostic factors and define risk categories.
• Development of risk-based surveillance guidelines informed by recurrence data.

Main Results:

• Nearly 50% of patients (49.9%) experienced recurrence, with significant proportions in the urothelium (25.9%) and loco-regional/distant sites (23.9%).
• Three risk groups were identified: low (pTa-T1, pN0, no adverse features), intermediate (pTa-T1, pN0, with adverse features), and high (≥pT2 and/or nodal involvement).
• Recurrence-free rates at three years varied significantly across risk groups, highlighting distinct patterns for urothelial and loco-regional/distant recurrences.

Conclusions:

• An evidence-based, risk-adapted surveillance protocol for post-RNU patients has been proposed.
• The protocol leverages identified recurrence patterns and prognostic factors to guide patient monitoring.