Upper-tract tumors after an initial diagnosis of bladder cancer: Argument for long-term surveillance

Purpose: To determine the relative risk (RR) of upper-tract tumors (UTT) af ter bladder cancer, stratified by bladder tumor characteristics, demographi c factors, and follow-up duration, in order to develop an improved risk-bas ed surveillance strategy. Patients and Methods: The 1973 to 1996 Surveillance, Epidemiology, and End Results (SEER) database was used to determine the observed and expected num ber of UTT after bladder cancer. The RR with 95% confidence intervals (CI) were calculated, stratifying by race, sex, stage, grade, histology, and fol low-up duration. The tumor characteristics and clinical outcome were compar ed in patients with UTT after bladder cancer and those with de novo UTT. Results: A total of 94,591 patients had a first diagnosis of bladder cancer , of whom 91,245 had follow-up (median, 4.1 years), with no antecedent or s ynchronous UTT. UTT developed subsequently in 657 of 91,245 (0.7%), with 12 .80 expected cases (RR = 51.3; 95% CI, 47.5 to 55.4). The respective RRs fo r UTT for white men and women were 64.2 (95% CI, 55.1 to 74.3) and 75.4 (95 % CI, 57.7 to 96.9) at less than 2 years, 44.3 (95% CI, 36.7 to 53.0) and 4 0.5 (95% CI, 27.9 to 56.8) at 2 to 5 years, 50.8 (95% CI, 42.2 to 60.7) and 42.1 (95% CI, 28.8 to 59.4) at 5 to 10 years, and 43.2 (95% CI, 32.6 to 56 .1) and 22.2 (95% CI, 10.1 to 42.2) at greater than or equal to 10 years. S imilar RRs were seen among different strata of race, stage, grade, and hist ology. Patients with UTT after bladder cancer had lower stage and improved disease-specific survival compared with those with de novo UTT. Conclusion: The incidence of UTT is stable on longterm follow-up, with no s ignificant risk factors identified. These findings suggest that upper-tract surveillance remain rigorous on extended follow-up of bladder cancer patie nts. J Clin Oncol 19:94-100. (C) 2001 by American Society of Clinical Oncol ogy.