Should follow-up cystoscopy be performed in upper-tract urothelial carcinoma patients managed with radical nephroureterectomy after a five-year bladder tumor-free period?

There is a lack of consensus regarding the follow-up schedule for patients with upper-tract urothelial carcinoma (UTUC) who remain bladder recurrence-free for 5 years after radical nephroureterectomy (RNU). In this study, we aimed to identify the risk factors for late recurrence in UTUC patients who remained bladder recurrence-free for at least 5 years post-RNU. Data from a large single-center Chinese institution were retrospectively analyzed. A total of 939 patients who remained recurrence-free for at least 5 years post-RNU were included in this study. To determine the risk factors for late bladder recurrence after RNU, we applied univariate and multivariate analyses using the Fine-Gray model, considering death as a competing risk. During a median follow-up of 97 months, 45 (4.8%) developed bladder recurrence, 207 (22%) died, and 61 (6.5%) succumbed to UTUC. The cumulative risk of bladder recurrence was 6.3% at 10 years and 13.9% at 15 years. The peak incidence of late bladder recurrence was observed between 70 and 90 months post-RNU. Univariate analysis revealed that Chronic Kidney Disease (CKD) stage 5 was significantly associated with late bladder recurrence.Multivariate analysis revealed that CKD stage 5 and tumor diameter less than 3 cm were independent risk factors for late bladder recurrence. These findings indicate that late bladder recurrence is uncommon and patients with CKD stage 5 or tumor diameter less than 3 cm are at a higher risk of late bladder recurrence, warranting prolonged cystoscopic surveillance for for 5 to 10 years post-RNU.