Subsequent Upper Urinary Tract Carcinoma Related to Worse Survival in Patients Treated with BCG

SIMPLE SUMMARY: This retrospective cohort study aimed to understand the incidence, clinical impact, and risk factors associated with upper urinary tract urothelial carcinoma (UTUC) after intravesical Bacillus Calmette-Guerin (BCG) therapy. The study included 3226 patients diagnosed with non-muscle-invasive bladder cancer (NMIBC) and treated with intravesical BCG therapy between January 2000 and December 2019. Of these patients, 6.1% were diagnosed with UTUC during the follow-up period, and those with UTUC had worse survival rates compared to those without UTUC. Tumor multiplicity, treatment for Connaught strain, and intravesical recurrence after BCG therapy were associated with subsequent UTUC diagnosis. The study suggests that patients with these risk factors may require closer monitoring for UTUC after BCG therapy. ABSTRACT: Upper urinary tract urothelial carcinoma (UTUC) after intravesical bacillus Calmette-Guerin (BCG) therapy is rare, and its incidence, clinical impact, and risk factors are not fully understood. To elucidate the clinical implications of UTUC after intravesical BCG therapy, this retrospective cohort study used data collected between January 2000 and December 2019. A total of 3226 patients diagnosed with non-muscle-invasive bladder cancer (NMIBC) and treated with intravesical BCG therapy were enrolled (JUOG-UC 1901). UTUC impact was evaluated by comparing intravesical recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) rates. The predictors of UTUC after BCG treatment were assessed. Of these patients, 2873 with a medical history that checked UTUC were analyzed. UTUC was detected in 175 patients (6.1%) during the follow-up period. Patients with UTUC had worse survival rates than those without UTUC. Multivariate analyses revealed that tumor multiplicity (odds ratio [OR], 1.681; 95% confidence interval [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. In conclusion, patients with subsequent UTUC had worse RFS, CSS, and OS than those without UTUC. Multiple bladder tumors, treatment for Connaught strain, and intravesical recurrence after BCG therapy may be predictive factors for subsequent UTUC diagnosis.