MP40-05: Risk factors of subsequent upper urinary tract carcinoma treated with intravesical bacillus Calmette-Guerin therapy for non-muscle-invasive bladder cancer: from multiple Japanese hospitals.

Kazuyuki Numakura*, Akita, Japan, Makito Miyake, Nara, Japan, Yuya Sekine, Yumina Muto, Mizuki Kobayashi, Akita, Japan, Rikiya Taoka, Kagawa, Japan, Takashi Kobayasi, Kyoto, Japan, Takahiro Kojima, Tsukuba, Japan, Hiroshi Kitamura, Toyama, Japan, Hiroyuki Nishiyama, Tsukuba, Japan, Kiyohide Fujimoto, Nara, Japan, Tomonori Habuchi, Akita, Japan

Introduction: Patients with urothelial cancer experience frequent asynchronous and multi-locational recurrence. An upper urinary tract urothelial carcinoma (UTUC) is rare after intravesical bacillus Calmette-Guerin (BCG) therapy, and its incidence, clinical impacts, and risk factors have not been fully understood. Our study aimed to elucidate the clinical impact of UTUC after intravesical BCG therapy.

Methods: This retrospective cohort study used data collected between December 2017 and January 2000 from multiple Japanese hospitals (JUOG-UC 1901). Research involving human participants was approved by the Ethics board of all hospitals. A total of 3,226 patients diagnosed with non-muscle-invasive bladder cancer (NMIBC) and treated with intravesical BCG therapy were enrolled. We evaluated the impact of UTUC by comparing the intravesical recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS) rates. The predictor of UTUC after BCG was assessed by multivariate logistic regression analysis.

Results: The median follow-up period from BCG treatment after transurethral resection of the bladder tumor (TURBT) was 48.0 months (IQR: 26.0–76.0). UTUC was detected in 175 (5.4%) patients during follow-up. Patients with UTUC had worse survival rates than those without UTUC: RFS (70.5 m vs 147.3 m, p < 0.001), CSS (168.3 m vs 227.4 m, p <0.001), and OS (156.0 vs 189.6, p = 0.019) (Figure 1). Multivariate analyses revealed that tumor multiplicity (OR, 1.681; 95% CI, 1.005–2.812; p = 0.048), Connaught strain (OR, 2.211; 95% CI, 1.380–3.543; p = 0.001), and intravesical recurrence (OR, 5.097; 95% CI, 3.225–8.056; p < 0.001) were associated with UTUC after BCG therapy (Table 1).

Conclusions: Patients with recurrent UTUC showed worse survival rates in terms of RFS, CSS, and OS than those without UTUC. Multiple primary bladder tumors, Connaught strain, and intravesical recurrence after BCG may be predictive factors for UTUC recurrence.

Source of Funding: none