Routine surveillance of upper urinary tract imaging for diagnosing upper urinary tract urothelial cancer recurrence in patients with non-muscle invasive bladder cancer having a tumor size ≥30 mm and carcinoma in situ.

Abstract Background Although routine surveillance imaging to examine upper urinary tract urothelial cancer recurrence during follow-up of non-muscle invasive bladder cancer is recommended, its necessity remains invalidated. We performed a single-institute long-term follow-up cohort study to identify risk factors for upper urinary tract urothelial cancer recurrence after non-muscle invasive bladder cancer treatment, as well as the clinical impact of routine surveillance imaging. Methods and materials A retrospective chart review of 864 patients with primary non-muscle invasive bladder cancer who underwent initial transurethral resection of bladder tumor between 1980 and 2020 was conducted. Oncological outcomes included upper urinary tract urothelial cancer recurrence-free survival and overall survival. Moreover, we examined the opportunities to diagnose its recurrence. Results Of 864 patients, 19 (2.2%) experienced upper urinary tract urothelial cancer recurrence. On multivariate Fine-Gray proportional regression analyses, a tumor size ≥ 30 mm and carcinoma in situ were independently associated with short upper urinary tract urothelial cancer recurrence-free survival. Recurrence was associated with shorter overall survival. Among the aforementioned 19 patients, recurrence was detected through routine imaging in 12 (63.2%), cystoscopy in two (10.5%), urine cytology in two (10.5%), presence of gross hematuria in one (5.3%), and unknown methods in two (10.5%). Conclusion Most patients experiencing upper urinary tract urothelial cancer recurrence were diagnosed by routine surveillance imaging, suggesting its clinical importance, especially for patients with non-muscle invasive bladder cancer accompanied by a tumor size ≥ 30 mm and carcinoma in situ.