Risk of Intravesical Recurrence After Ureteroscopic Biopsy for Upper Tract Urothelial Carcinoma: Does the Location Matter?

Introduction: To investigate whether ureteroscopic biopsy (URS-Bx) for upper tract urothelial carcinoma (UTUC) before radical nephroureterectomy affects intravesical recurrence (IVR). Patients and Methods: Of the 515 patients receiving radical nephroureterectomy for UTUC between 1998 and 2012, 387 patients were included for the analysis. URS-Bx was performed in 69 patients (17.8%). Patients were stratified according to tumor location, and the impact of URS-Bx on IVR was evaluated after adjusting for other clinicopathologic variables. Results: IVR occurred in 163 patients (42.1%). The postoperative 5-year IVR-free survival was not significantly different according to URS-Bx in the overall patient group (54.0% vs 39.3%, p=0.056). In patients with renal pelvic tumor, IVR-free probability was lower in patients with URS-Bx than in patients without URS-Bx (39.6% vs 62.2%, p=0.012), although IVR-free survival in patients with ureteral tumor was equivalent (36.7% vs 45.8%, p=0.946). In multivariate analysis, previous bladder tumors (hazard ratio [HR], 1.65; p=0.016) were a significant risk factor for IVR in all patients and ureteral tumor location (HR, 1.35; p=0.071) was associated with IVR, although statistical significance was not achieved. In patients with renal pelvic tumor, URS-Bx HR, 1.98; p=0.020 was the only risk factor for IVR. However, URS-Bx was not associated with IVR in patients with ureteral tumor, although previous bladder tumor HR, 1.74; p=0.028 was a risk factor for IVR. Conclusion: URS-Bx is a significant risk factor for IVR in patients with renal pelvic tumor and should be performed after sufficient consideration in these patients if other examinations are uncertain.