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Xie J, Zhang XB, Wen J, Zhang YS, Li HZ. Comparison of clinicopathological features in metastatic upper tract urothelial carcinoma and urothelial bladder cancer. Int Urol Nephrol 2016; 48:481-7. [PMID: 26797856 DOI: 10.1007/s11255-016-1214-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/07/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE To compare the characteristics of primary tumors, sites distribution of metastases and the metastasis-free interval (MFI) between metastatic upper tract urothelial carcinoma (UTUC) and urothelial bladder cancer (UBC), and evaluate the clinicopathological factors associated with MFI. METHODS We retrospectively reviewed 153 metastatic urothelial carcinoma patients consecutively registered at our hospital from 1997 to 2015, including 71 UTUC and 82 UBC, with a median follow-up of 18.3 months. MFI indicators were assessed by univariate and multivariate logistic regression analysis. RESULTS There were significant differences in median age at metastatic disease (p = 0.016), gender (p = 0.018), primary tumor size (p = 0.003), growth pattern (p < 0.001), grade (p < 0.001) and stage (p < 0.001) between metastatic UTUC and UBC. The median MFI of UTUC was dramatically shorter than that of UBC (6.1 vs. 17.4 months, p < 0.001). Univariate analysis revealed pathological stage was the only factor associated with the MFI of UTUC. Multivariate analysis showed that primary tumor grade was an independent inferior predictor for the MFI of UBC (HR 6.384, 95% CI 3.21-12.69, p < 0.001), while recurrence was an independent favorable factor for the MFI of UBC (HR 0.384, 95% CI 0.18-0.82, p = 0.014). CONCLUSIONS Compared to metastatic UBC, the primary tumors of metastatic UTUC were more invasive and the MFI was significantly shorter. Pathological stage was the only factor associated with the MFI in UTUC, while primary tumor grade and recurrence were independent factors for the MFI of UBC.
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Affiliation(s)
- Jing Xie
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Xue-Bin Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Jin Wen
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Yu-Shi Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Han-Zhong Li
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China.
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García-Tello A, Angulo J, Andrés G, Ramón de Fata F, Sánchez-Chapado M, López J. Impact of p53, MIB-1 and PECAM-1 expression on the prognosis of urothelial carcinoma of the renal pelvis. Actas Urol Esp 2014; 38:506-14. [PMID: 24702909 DOI: 10.1016/j.acuro.2014.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 02/24/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Determine whether the overexpression p53, MIB-1 and PECAM-1 of protein levels is of interest in predicting the prognosis of transitional cell carcinoma of the upper urinary tract (TCC-UUT) with the primary seat in the renal pelvis. MATERIAL AND METHOD A univariate and multivariate analysis was conducted for prognosis prediction in a series of 82 patients with TCC-UUT of the renal pelvis who had no metastases at diagnosis (N0/Nx M0) and were treated exclusively with nephroureterectomy. We assessed clinicopathological parameters (age, gender, tumor grade and extent, histological variety, growth pattern, vascular invasion, infiltration of the renal parenchyma, tumor necrosis) and the immunohistochemical expression of p53, MIB-1 (ki-67) and PECAM-1 (CD31) in sections performed with tissue microarray (TMA). RESULTS A total of 47.6% of the patients had high-grade lesions according to the USIP-WHO classification. The growth pattern was flat in 15.85%. The distribution by T category was: 3.7% pTa, 51.2% pT1, 11% pT2, 29.3% pT3 and 4.9% pT4. The mean follow-up was 46.8+38.5 (range, 4-172) months. The median survival was reached at 57 (95% CI 44-63) months. The univariate analysis revealed that survival in these patients is associated with tumor size (P=.028), histological variety (P<.0001), growth pattern (P<.0001), grade (P<.0001), pT (P=.01), vascular invasion (P=.025), necrosis (P=.004) and overexpression of p53 (P=.0006), PECAM-1 (P=.0036) and MIB-1 (P=.0038). The Cox regression model showed that high-grade (HR, 4.2; 95% CI 1.28-13.79; P=.018), flat growth pattern (HR, 2.52; 95% CI 1.05-6.03; P=.038) and p53 overexpression (HR, 2.8; 95% CI 1.22-6.44; P=.015) were independent predictors. CONCLUSION Histological grade, tumor growth pattern and p53 overexpression were established as the primary predictors of prognosis for primary TCC-UUT of the renal pelvis. The independent value of MIB-1 observed in other studies was not reproduced in this study.
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Simonato A, Varca V, Gregori A, Benelli A, Ennas M, Lissiani A, Gacci M, De Stefani S, Rosso M, Benvenuto S, Siena G, Belgrano E, Gaboardi F, Carini M, Bianchi G, Carmignani G. Elective segmental ureterectomy for transitional cell carcinoma of the ureter: long-term follow-up in a series of 73 patients. BJU Int 2012; 110:E744-9. [DOI: 10.1111/j.1464-410x.2012.11554.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Uematsu K, Ogata S, Nakanishi K, Hiroi S, Tominaga S, Aida S, Kawai T. Glucose-regulated protein 78 expression in urothelial carcinoma of the upper urinary tract. BJU Int 2009; 106:873-8. [PMID: 20039870 DOI: 10.1111/j.1464-410x.2009.09144.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine glucose-regulated protein 78 (GRP78; a major molecular chaperone at the endoplasmic reticulum, strongly expressed in several tumours) expression in urothelial carcinoma (UC) of the upper urinary tract (UUT) and to evaluate the diagnostic and progressive importance of GRP78 expression in UC-UUT. PATIENTS AND METHODS We investigated GRP78 expression (using immunohistochemistry) in 126 UC-UUTs to assess its relevance to progression. GRP78 overexpression was recognised in 23 (18.3%) of tumour samples. RESULTS There was no association between GRP78 overexpression and clinicopathological findings, except for an association with low grade in invasive tumours. GRP78 overexpression significantly improved the disease-free survival rate in all patients (according to univariate and multivariate analyses), but did not alter the overall survival rate. CONCLUSION The detection of GRP78 overexpression would appear to provide valuable information for the prognosis of UC-UUT.
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Affiliation(s)
- Kenji Uematsu
- Department of Pathology and Laboratory Medicine, National Defense Medical College, National Defense Medical College Hospital, Tokorozawa, Japan
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5
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Lughezzani G, Sun M, Perrotte P, Shariat SF, Jeldres C, Budäus L, Latour M, Widmer H, Duclos A, Bénard F, McCormack M, Montorsi F, Karakiewicz PI. Gender-related differences in patients with stage I to III upper tract urothelial carcinoma: results from the Surveillance, Epidemiology, and End Results database. Urology 2009; 75:321-7. [PMID: 19962727 DOI: 10.1016/j.urology.2009.09.048] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 09/12/2009] [Accepted: 09/25/2009] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To examine the effect of gender in upper tract urothelial carcinoma (UTUC) stage at nephroureterectomy (NU), as well as on cancer-specific mortality (CSM) after NU in patients with American Joint Committee on Cancer stages I-III UTUC. METHODS Our analyses relied on 2903 (59.9%) males and 1947 (40.1%) females who underwent an NU for pT(1-3)N(0/x)M(0) UTUC between 1988 and 2006, within 17 Surveillance, Epidemiology, and End Results registries. Univariable and multivariable logistic regression models examined the effect of gender on stage and grade distribution at NU. Subsequently, cumulative incidence plots explored the impact of gender on CSM rates, after accounting for other-cause mortality (OCM). Finally, competing-risks regression models tested the independent predictor status of gender in CSM analyses. Covariates consisted of pT stage, pN stage, tumor grade, primary tumor location, type and year of surgery, age, and race. RESULTS Relative to males, females had a higher proportion of pT(3) UTUC (43.1% vs 39%; P = .02) and a higher proportion of grade III/IV UTUC (63.8% vs 59.8%; P = .04) at NU. The female gender represented an independent predictor of pT(3) UTUC at NU (hazard ratio [HR]: 1.15; P = .03). After accounting for OCM, CSM rates in females were higher than those in males (HR: 1.18; P = .03). However, in multivariable competing-risks regression models, no statistically significant differences in survival were recorded between males and females (HR: 1.07; P = .4). CONCLUSIONS Females are more likely to have more advanced pathologic T stage and higher tumor grade at NU than males. After accounting for OCM, stage, grade, and noncancer characteristics, gender no longer affects CSM.
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Affiliation(s)
- Giovanni Lughezzani
- Cancer Prognosis and Health Outcomes Unit, University of Montréal Health Center, Montreal, Quebec, Canada
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Kaufman DS, McDougal WS, Harisinghani MG, Wu CL. Case records of the Massachusetts General Hospital. Case 30-2009. A 77-year-old man with recurrent transitional-cell carcinoma of the ureter. N Engl J Med 2009; 361:1292-9. [PMID: 19776411 DOI: 10.1056/nejmcpc0900642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Donald S Kaufman
- Hematology-Oncology Division, Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, USA
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Fernández MI, Shariat SF, Margulis V, Bolenz C, Montorsi F, Suardi N, Remzi M, Wood CG, Roscigno M, Kikuchi E, Oya M, Zigeuner R, Langner C, Weizer A, Lotan Y, Koppie TM, Raman JD, Karakiewicz P, Karakiewizc P, Bensalah K, Schultz M, Bernier P. Evidence-based sex-related outcomes after radical nephroureterectomy for upper tract urothelial carcinoma: results of large multicenter study. Urology 2008; 73:142-6. [PMID: 18845322 DOI: 10.1016/j.urology.2008.07.042] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2008] [Revised: 06/08/2008] [Accepted: 07/15/2008] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To assess the sex differences in the clinical and pathologic characteristics of upper tract urothelial carcinoma (UTUC) and to determine the effect on prognosis after radical nephroureterectomy (RNU) in a large multicenter series. METHODS The records of 1363 patients who had undergone RNU were reviewed from the UTUC Collaboration database. The median follow-up was 47 months (range 0-250). The pathologic slides were re-evaluated by genitourinary pathologists unaware of the original findings from the slides and the clinical outcomes. The endpoints were freedom from tumor recurrence and disease-specific survival. RESULTS The male-to-female ratio was 2.1:1. The women were older than the men at diagnosis (70 +/- 11 vs 68 +/- 11 years; P < .001). No significant sex-related differences were found in the presence of symptoms at presentation (P = .70), pathologic stage (P = .98), tumor grade (P = .28), tumor architecture (P = .27), presence of lymphovascular invasion (P = .42), presence of concomitant carcinoma in situ (P = .08), or the presence of lymph node metastases (P = .24). Recurrence developed in 379 patients (28%), and 313 patients (23%) died of their disease. Sex was not associated with disease recurrence (P = .07) or disease-specific survival (P = .13). An adjustment for the effects of the pathologic features did not change the lack of association of sex with the clinical outcomes. CONCLUSIONS To our knowledge, this is the largest series analyzing the effect of sex on the outcomes after RNU. No difference was found in the clinicopathologic features or prognosis between women and men treated with RNU for UTUC. The results of this large, international series show that RNU provides durable local control and disease-specific survival for both men and women with UTUC.
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Cho KS, Cho NH, Park SY, Cho SY, Choi YD, Chung BH, Yang SC, Hong SJ. Prognostic impact of peripelvic fat invasion in pT3 renal pelvic transitional cell carcinoma. J Korean Med Sci 2008; 23:434-8. [PMID: 18583879 PMCID: PMC2526530 DOI: 10.3346/jkms.2008.23.3.434] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Renal pelvic transitional cell carcinoma (TCC), which invades beyond muscularis into peripelvic fat or the renal parenchyma, is diagnosed as stage pT3 despite its structural complexity. We evaluated the prognostic impact of peripelvic fat invasion in pT3 renal pelvic TCC. Between 1986 and 2004, the medical records on 128 patients who were surgically treated for renal pelvic TCC were retrospectively reviewed. Sixty patients with pT3 disease were eligible for the main analysis. The prognostic impact of various clinicopathological factors was analyzed using univariate and multivariate analyses. On univariate analysis, sex, age, concomitant bladder tumors, concomitant ureter tumors, lymphadenectomy, adjuvant chemotherapy, tumor grade, multiplicity, renal parenchymal invasion, and carcinoma in situ did not influence the disease-specific survival (p>0.05). By contrast, peripelvic fat invasion, lymph node invasion, and lymphovascular invasion were each significantly associated with disease-specific survival (p<0.05). Multivariate analysis showed that peripelvic fat invasion (p=0.012) and lymph node invasion (p=0.004) were independent prognostic factors. In conclusion, peripelvic fat invasion is a strong prognostic factor in pT3 renal pelvic TCC. Thus, systemic adjuvant therapy should be considered in the presence of peripelvic fat invasion, even if the lymph nodes are not involved.
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Affiliation(s)
- Kang Su Cho
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Hoon Cho
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Yul Park
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Yong Cho
- Department of Urology, Inje University College of Medicine, Goyang, Korea
| | - Young Deuk Choi
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Ha Chung
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Choul Yang
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Joon Hong
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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9
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Cho KS, Cho DS, Choi YD, Hong SJ, Kim SJ, Cho NH. A proposal for a novel staging system in renal pelvicaliceal urothelial carcinomas. Hum Pathol 2007; 38:1639-48. [PMID: 17651786 DOI: 10.1016/j.humpath.2007.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Revised: 03/12/2007] [Accepted: 03/13/2007] [Indexed: 10/23/2022]
Abstract
Renal caliceal urothelial carcinomas, which have characteristic microanatomies in which the tumor directly interfaces to the renal parenchyma without intervening muscle propria, are often overstaged using the existing staging system. Relying on our analysis of 150 renal caliceal and/or pelvic urothelial carcinomas, we propose a novel staging scheme based on the extent of invasion relative to the corticomedullary junction (CMJ). Tumors were classified as category pT2 when renal parenchymal invasion was present within the CMJ and where the renal papillae and medulla were dominant. Tumors going over the CMJ were classified as pT3 with the proposed new scheme. It is very important to exclude pagetoid spread along the collecting ducts/ducts of Bellini to evaluate true invasion into the renal parenchyma. Using this revised staging scheme, 38.5% of tumors that were previously classified as pT3 were reclassified into the pT2 or pT1 groups. On multivariate Cox proportional hazard regression analysis, the extent of CMJ invasion and peripelvic fat invasion were the most significant prognostic indicators (P < .001, HR, 9.308; P = .016, HR, 2.538, respectively). In the new scheme, pT3 tumors showed a tendency to be classified toward the pT4 stage, whereas pT2 tumors were classified closer to the pT1 stage than to the pT3 (pT3 vs pT4, P = .0127; pT3 vs pT2, P < .0001). Renal parenchymal invasion beyond the CMJ has a strong prognostic impact for renal caliceal carcinomas. Using this new staging scheme, we can more precisely evaluate the level of tumor invasion.
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Affiliation(s)
- Kang Su Cho
- Department of Urologic Oncology, Urologic Science Institute, Yonsei University College of Medicine, Seoul 120-752, South Korea.
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Nakanishi K, Ogata S, Matsuo H, Kanai Y, Endou H, Hiroi S, Tominaga S, Aida S, Kasamatsu H, Kawai T. Expression of LAT1 predicts risk of progression of transitional cell carcinoma of the upper urinary tract. Virchows Arch 2007; 451:681-90. [PMID: 17622555 DOI: 10.1007/s00428-007-0457-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Revised: 05/20/2007] [Accepted: 06/15/2007] [Indexed: 12/18/2022]
Abstract
L-type amino acid transporter 1 (LAT1), a neutral amino acid transporter, requires covalent association with the heavy chain of 4F2 cell surface antigen (4F2hc) for its functional form. We investigated the importance of LAT1 and 4F2hc expressions to progression in upper urinary tract cancer. We examined their expressions and their relationships to clinicopathologic parameters and clinical outcome in 124 cases. Positive expressions of LAT1 (protein and messenger ribonucleic acid) and 4F2hc (protein) were recognized in 79.8, 89.5, and 87.9% of tumor samples, respectively. In tumor cells, LAT1 protein was detected either as nodular granules within the cytoplasm or diffusely within the cytoplasm and/or on plasma membrane. In the normal urothelium, its expression was detected as nodular granules within the cytoplasm. A correlation with stage was shown for LAT1 protein expression and for a cooperative expression of LAT1 protein with 4F2hc protein (active form of LAT1 protein). Further, in all tumors, a cooperative expression of LAT1 protein and 4F2hc protein was significantly correlated with both overall and disease-free survival rates in the univariate analysis but not in the multivariate analysis. In conclusion, the detection of the active form of LAT1 protein would appear to be of value in informing the risk of progression in transitional cell carcinoma of the upper urinary tract.
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Affiliation(s)
- Kuniaki Nakanishi
- Department of Pathology and Laboratory Medicine, National Defense Medical College, Tokorozawa, 359-8513, Japan.
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Painter DJ, Timoney AG, Denton K, Alken P, Keeley FX. The modern management of upper urinary tract urothelial cancer: tumour diagnosis, grading and staging. BJU Int 2007; 99:973-7. [PMID: 17437428 DOI: 10.1111/j.1464-410x.2007.06801.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Daniel J Painter
- Bristol Urological Institute, Southmead Hospital, Westbury-on-Trym, Bristol, UK, and Department of Urology, University of Mannheim, Germany
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12
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Ko HL, Tsang YW, Chi KH. Cutaneous metastases from squamous cell carcinoma of the ureter. Med Princ Pract 2007; 16:460-2. [PMID: 17917447 DOI: 10.1159/000107752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Accepted: 03/07/2007] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To present an extremely rare case of squamous cell carcinoma of the ureter with cutaneous metastases. CLINICAL PRESENTATION AND INTERVENTION A case is presented involving a 67-year-old woman presenting with a clinical history of squamous cell carcinoma of the ureter and who had undergone a nephro-ureterectomy with a bladder cuff excision in May 2004. The pathologic report showed squamous differentiation, as well as keratin pearl formation. A large regional cutaneous lesion on the chest wall was found in January 2006, and a biopsy showed metastatic malignant urothelial tumors consisting of squamous cell carcinomas. CONCLUSION This report describes a case of cutaneous metastasis from a squamous cell carcinoma of the ureter that is extremely rare with a generally dismal prognosis.
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Affiliation(s)
- Hui-Ling Ko
- Department of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
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Kwak C, Lee SE, Jeong IG, Ku JH. Adjuvant systemic chemotherapy in the treatment of patients with invasive transitional cell carcinoma of the upper urinary tract. Urology 2006; 68:53-7. [PMID: 16806415 DOI: 10.1016/j.urology.2006.01.053] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Revised: 12/07/2005] [Accepted: 01/13/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the efficacy of adjuvant systemic chemotherapy in conjunction with surgery in patients with invasive transitional cell carcinoma of the upper urinary tract. METHODS From January 1991 to May 2001, 36 men and 7 women had invasive (Stage pT2 or worse), but not metastatic, disease and were the subjects of this study. Their median age was 59 years (range 36 to 72). Of these 43 patients, 32 were scheduled to receive more than four courses of cisplatin-based chemotherapy. The median follow-up period of all the evaluated patients was 30.7 months (range 4.7 to 98.8). RESULTS Recurrence was observed in 12 patients (37.5%) who underwent chemotherapy and 7 (63.6%) who did not (P = 0.170). The disease-free survival was lower in the nonchemotherapy group than in the chemotherapy group (P = 0.0439). During the follow-up period, 9 patients (28.1%) in the chemotherapy group died and 9 patients (81.8%) in the nonchemotherapy group died (P = 0.004). Multivariate Cox proportional hazard model analysis revealed that the use of adjuvant chemotherapy (P = 0.006, relative risk = 9.19) and node-positive status (P = 0.008, relative risk = 8.28) were strongly associated with overall survival. In the chemotherapy group, 24 (75%) had side effects due to the treatment; however, fever and gastrointestinal symptoms were the chief adverse effects and were well tolerated. CONCLUSIONS Our results have indicated that adjuvant systemic chemotherapy may provide therapeutic benefit in patients with invasive transitional cell carcinoma of the upper urinary tract.
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Affiliation(s)
- Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Kangdong Ku, Seoul, South Korea
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14
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Matsumoto A, Tobe T, Kamijima S, Araki K, Naya Y, Igarashi T, Ichikawa T. The usefulness of ureterorenoscopic examination in evaluation of upper tract disease. Int J Urol 2006; 13:509-14. [PMID: 16771717 DOI: 10.1111/j.1442-2042.2006.01352.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The objective of the present study was to clarify the indications, usefulness and limitations of ureterorenoscopy. MATERIAL AND METHODS From January 1998 to June 2004, 72 consecutive patients (48 men and 24 women) with a mean age of 66 years (range, 27-83 years) underwent ureterorenoscopy to diagnose upper urinary tract tumors (UUT). Median follow-up was 24 months (range, 1-73 months). Patients were divided into four subgroups by voided urine cytology and preoperative radiographic findings. Group A (n=11, 15.3%), positive voided urine cytology and positive preoperative radiographic findings; group B (n=5, 6.9%), positive cytology and negative radiographic findings; group C (n=48, 66.7%), negative cytology and positive radiographic findings and group D (n=8, 11.1%), frank hematuria originating from the UUT but negative cytology and negative radiographic findings. We compared the findings of ureterorenoscopic examination and biopsy with the results of retrograde pyelography and cytology of upper tract urine. For each examination, the following diagnostic indices were assessed: sensitivity, specificity, positive-predictive-value (PPV) and negative-predictive-value (NPV) and accuracy. Statistical analysis was performed using McNemar's test. RESULTS For ureterorenoscopy, sensitivity was 94%, specificity 59%, PPV 72%, NPV 92% and accuracy 76%. For biopsy, sensitivity was 77%, specificity 100%, PPV 100%, NPV 80% and accuracy 88%. Accuracy of ureterorenoscopy tended to be superior to that of retrograde pyelography. Ureterorenoscopy was most useful in the group which consisted of 48 patients (66.7%) with negative voided urine cytology and positive preoperative radiographic findings. This group was the only group in which accuracy of ureterorenoscopic biopsy was superior to that of urine cytology, significantly (P=0.03). CONCLUSION Results indicated that ureterorenoscopy is most suitable and gives superior accuracy in patients with positive radiographic findings and negative voiding cytology. Ureterorenoscopic biopsy of the upper urinary tract would provide useful information when considering therapeutic strategies, such as nephron-sparing management.
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Affiliation(s)
- Akihiro Matsumoto
- Department of Urology, Graduate School of Medicine, Chiba University Hospital, Chiba, Japan
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15
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Langner C, Hutterer G, Chromecki T, Rehak P, Zigeuner R. Patterns of invasion and histological growth as prognostic indicators in urothelial carcinoma of the upper urinary tract. Virchows Arch 2006; 448:604-11. [PMID: 16525827 DOI: 10.1007/s00428-006-0150-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Revised: 12/22/2005] [Accepted: 12/22/2005] [Indexed: 10/24/2022]
Abstract
The biological significance of squamous and glandular differentiation and different patterns of invasion in upper urinary tract urothelial carcinoma is unclear. We reviewed 268 cases of consecutive upper urinary tract carcinomas with respect to the presence of squamous and/or glandular differentiation and different patterns of invasion (nodular, trabecular, and infiltrative) and correlated data with patient outcome. Squamous or glandular differentiation occurred in 47/268 (18%) tumors and its presence correlated with high tumor stage (P<0.001) and grade (P<0.001). Invasive patterns were nodular in 49/227 (22%), trabecular in 95/227 (42%), and infiltrative in 83/227 (37%) tumors. The nodular pattern prevailed in low stage (P<0.001) and low-grade (P<0.001) tumors, whereas the infiltrative pattern prevailed in high stage (P<0.001) and high-grade (P<0.001) tumors. Multivariate analysis proved that tumor stage (P<0.001) and the infiltrative pattern (P<0.001) are independent predictors of metastasis-free survival, whereas tumor grade and squamous and glandular differentiation lacked independent influence on patient outcome. In conclusion, the infiltrative pattern of invasion significantly correlated with advanced disease and poor patient outcome. In contrast, the presence of squamous and/or glandular invasion did not prove independent influence on patient outcome. The pattern of invasion should be commented upon separately in the pathology report.
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Affiliation(s)
- C Langner
- Institute of Pathology, Medical University Graz, Auenbruggerplatz 25, Graz, 8036, Austria.
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16
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Langner C, Hutterer G, Chromecki T, Winkelmayer I, Rehak P, Zigeuner R. pT classification, grade, and vascular invasion as prognostic indicators in urothelial carcinoma of the upper urinary tract. Mod Pathol 2006; 19:272-9. [PMID: 16424895 DOI: 10.1038/modpathol.3800529] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Clinicopathologic features predictive of patient outcome in upper urinary tract urothelial carcinoma are not well defined. The aim of this study was to assess the role of pT classification, tumor grade, and vascular invasion in predicting metastasis-free survival. A total of 190 consecutive invasive upper urinary tract urothelial cancers operated between 01/1984 and 12/2004 were re-evaluated with respect to pT classification, tumor grade (according to the three-tiered WHO 1973 and the recent two-tiered grading system following the WHO/ISUP consensus classification), as well as presence of lymph and/or blood vessel invasion. Prognostic impact was analyzed using the Kaplan-Meier method and the Log-Rank test. For multivariate testing, a Cox's proportional hazards regression model was used. pT1 was present in 81 (43%), pT2 in 29 (15%), pT3 in 73 (38%), and pT4 in seven (4%) cases. There were 12 (6%) G1, 96 (51%) G2, and 82 (43%) G3 tumors or 84 (44%) low-grade and 106 (56%) high-grade tumors according to the two-tiered system. The presence of vascular invasion in 72/190 (38%) tumors was associated with high pT classification (P<0.001) and high tumor grade (P<0.001). Disease progression occurred in 39% of patients, with 5- and 10-year metastasis-free survival rates of 56 and 45%, respectively. On univariate analysis, all investigated parameters showed prognostic significance. The negative influence of vascular invasion on patient outcome was strikingly strong in high pT classification and high-grade cancers. On multivariate analysis, pT classification (P<0.001) and vascular invasion (P<0.001) proved to be independent prognostic factors, whereas tumor grade according to the two-tiered system missed statistical significance (P=0.06). In conclusion, pT classification and vascular invasion are independent prognostic factors with respect to metastasis-free survival and should be used to guide adjuvant therapy strategies in affected patients. Presence (or absence) of vascular invasion should be commented upon separately in the pathology report.
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Affiliation(s)
- Cord Langner
- Institute of Pathology, Medical University Graz, Graz, Austria.
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17
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Kamijima S, Tobe T, Suyama T, Ueda T, Igarashi T, Ichikawa T, Ito H. The prognostic value of p53, Ki-67 and matrix metalloproteinases MMP-2 and MMP-9 in transitional cell carcinoma of the renal pelvis and ureter. Int J Urol 2005; 12:941-7. [PMID: 16351648 DOI: 10.1111/j.1442-2042.2005.01159.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate the prognostic and predictive relevance of p53 protein, Ki-67 antigen, MMP-2 and MMP-9 in patients with transitional cell carcinoma (TCC) of the upper urinary tract. METHODS The expression of p53 protein, Ki-67 antigen, MMP-2 and MMP-9 was examined by immunohistochemistry in 69 patients with TCC of the upper urinary tract. Correlation of p53, Ki-67, MMP-2 and MMP-9 over-expression with conventional pathological parameters and patient survival was examined. RESULTS p53 over-expression was significantly correlated with histological grade (P < 0.05), but not with pathological stage, vascular invasion, lymphatic invasion or lymph node metastasis. Ki-67 over-expression was significantly correlated with stage, grade, lymphatic invasion and vascular invasion (P < 0.05). In survival analyses, Ki-67 over-expression was a significant prognostic factor in the univariate analysis (P < 0.05), but it did not have a significant impact on survival in the multivariate analysis. Ki-67 labeling index was a significant prognostic factor in patients with a low p53 labeling index, but not in patients with a high p53 labeling index. CONCLUSION Ki-67 over-expression is of prognostic value in TCC of the upper urinary tract, while p53, MMP-2 and MMP-9 are of limited value.
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Affiliation(s)
- Shuichi Kamijima
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
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18
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Nakanishi K, Hiroi S, Tominaga S, Aida S, Kasamatsu H, Matsuyama S, Matsuyama T, Kawai T. Expression of Hypoxia-Inducible Factor-1α Protein Predicts Survival in Patients with Transitional Cell Carcinoma of the Upper Urinary Tract. Clin Cancer Res 2005; 11:2583-90. [PMID: 15814637 DOI: 10.1158/1078-0432.ccr-04-1685] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypoxia-inducible factor-1 (HIF-1), identified as one of the transcription factors, has been found to play an essential role in oxygen homeostasis. HIF-1 is a heterodimer composed of HIF-1alpha and HIF-1beta. Increased levels of HIF-1alpha have been reported during the carcinogenesis and progress of several tumors. We investigated the prognostic importance of HIF-1alpha expression in transitional cell carcinoma of the upper urinary tract. In 127 cases of transitional cell carcinoma of the upper urinary tract, we examined its expression (using immunohistochemistry and in situ hybridization), and also its relation to the expression of p53 oncoprotein, as well as to proliferating cell nuclear antigen (PCNA) immunoreactivity, microvessel density, clinicopathologic parameters, and clinical outcome. A positive expression of HIF-1alpha protein was recognized in 55.1% of samples, the expression being apparent within the nucleus in tumor cells. HIF-1alpha protein expression correlated with grade, growth pattern, p53 oncoprotein expression, and PCNA index, but not with stage. Furthermore, a significant correlation was found between HIF-1alpha protein expression and both overall and disease-free survival rates in the univariate and multivariate analyses (in all tumors and in invasive tumors). A positive expression of HIF-1alpha mRNA was recognized in 69.6% of 125 samples which were available, the expression being apparent within the cytoplasm in tumor cells. The positive expression of HIF-1alpha mRNA by in situ hybridization correlated significantly with HIF-1alpha protein expression by immunohistochemistry. HIF-1alpha mRNA expression only correlated with pattern of growth (P = 0.0078). In conclusion, the detection of HIF-1alpha protein would seem to be of value in informing the prognosis of transitional cell carcinoma of the upper urinary tract.
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Affiliation(s)
- Kuniaki Nakanishi
- Department of Pathology, National Defense Medical College, Tokorozawa, Japan.
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19
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Czito B, Zietman A, Kaufman D, Skowronski U, Shipley W. Adjuvant radiotherapy with and without concurrent chemotherapy for locally advanced transitional cell carcinoma of the renal pelvis and ureter. J Urol 2004; 172:1271-5. [PMID: 15371822 DOI: 10.1097/01.ju.0000137910.38441.8a] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE Transitional cell carcinoma of the upper urinary tract is a relatively uncommon malignancy. The role of adjuvant radiation therapy and chemotherapy is not well defined. We retrospectively reviewed the records of 31 patients who underwent surgery followed by adjuvant radiotherapy with or without concurrent chemotherapy to determine overall outcome as well as impact of concurrent chemotherapy administration. MATERIALS AND METHODS Between 1970 and 1997, 31 patients with nonmetastatic transitional cell carcinoma of the upper urinary tract (renal pelvis in 13, ureter in 15, and renal pelvis and ureter in 3) were treated with radiotherapy following attempted curative resection. Most patients (28 of 31) had T3/4 and/or N+ disease. The median radiation dose was 46.9 Gy. Nine patients received methotrexate, cisplatin and vinblastine chemotherapy for 2 to 4 cycles, followed by concurrent cisplatin with radiation. RESULTS Median followup was 2.6 years in all patients and 8.5 years in survivors. Median survival in all patients was 2.4 years. Of the patients 16 (52%) experienced disease relapse, including 9 (29%) with distant metastases alone. Seven patients (23%) experienced locoregional failure with distant metastases developing in all except 1 within 8 months of locoregional failure diagnosis. Five-year actuarial overall survival, disease specific survival, locoregional control and metastasis-free survival rates were 39%, 52%, 67% and 48%, respectively. On univariate analysis patients had improved 5-year actuarial overall and disease specific survival with the administration of concurrent chemotherapy (27% vs 67%, p = 0.01 and 41% vs 76%, p = 0.06, respectively). CONCLUSIONS Our series suggests that the addition of concurrent cisplatin to adjuvant radiotherapy improves the ultimate outcome in patients with resected, locally advanced upper tract urothelial malignancies. This regimen should be considered in patients with T3/4 and/or node positive upper tract transitional cell carcinoma.
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MESH Headings
- Actuarial Analysis
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/pathology
- Carcinoma, Transitional Cell/radiotherapy
- Carcinoma, Transitional Cell/surgery
- Chemotherapy, Adjuvant
- Cisplatin/therapeutic use
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Kidney Neoplasms/drug therapy
- Kidney Neoplasms/pathology
- Kidney Neoplasms/radiotherapy
- Kidney Neoplasms/surgery
- Kidney Pelvis/pathology
- Male
- Middle Aged
- Neoplasm Metastasis/pathology
- Neoplasm Recurrence, Local/pathology
- Neoplasm Staging
- Neoplasm, Residual/drug therapy
- Neoplasm, Residual/pathology
- Neoplasm, Residual/radiotherapy
- Neoplasm, Residual/surgery
- Outcome and Process Assessment, Health Care
- Radiation-Sensitizing Agents/therapeutic use
- Radiotherapy, Adjuvant
- Survival Rate
- Ureter/pathology
- Ureter/surgery
- Ureteral Neoplasms/drug therapy
- Ureteral Neoplasms/pathology
- Ureteral Neoplasms/radiotherapy
- Ureteral Neoplasms/surgery
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Affiliation(s)
- Brian Czito
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.
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20
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Abstract
Transitional cell carcinoma (TCC) of ureter and renal pelvis is relatively uncommon. Smoking, occupational carcinogens, analgesic abuse, Balkan nephropathy are the risk factors. Cytogenetic studies revealed that the most frequent aberration is the partial or complete loss of chromosome 9. Approximately 20-50% of patients with upper urinary tract (UUT) TCC have bladder cancer at some point on their course, whereas the incidence of UUT TCC after primary bladder cancer is 0.7-4%. Excretory urography and retrograde pyelography are the conventional diagnostic tools; however, ureteropyeloscopy combined with cytology and biopsy is more accurate. Grade and stage of the disease have the most significant impact on survival. Nephroureterectomy with bladder cuff excision has been the mainstay of treatment. Local resection may be appropriate for distal ureteral lesions especially when the disease is low grade and stage. Advances in endourology have made it possible to treat many tumors conservatively. Ureteroscopic and to a certain extent percutaneous surgical approaches are widely used today especially in patients with low grade, low stage disease. Endoscopic close surveillance is mandatory for these patients. Adjuvant topical therapies appear to be safe but confirmation of any benefits awaits the results of further large studies. More recently, laparoscopic techniques have become a viable alternative to open surgery, but long term cancer control data are lacking. Aggressive surgical resection does not affect the outcome of patients with advanced disease. Adjuvant radiotherapy is ineffective, and systemic chemotherapy results in a low complete response rate for patients with metastases.
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Affiliation(s)
- Ziya Kirkali
- Department of Urology, Dokuz Eylul University School of Medicine, Inciralti, Izmir 35340, Turkey.
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21
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Yoshimura K, Arai Y, Fujimoto H, Nishiyama H, Ogura K, Okino T, Ogawa O. Prognostic impact of extensive parenchymal invasion pattern in pT3 renal pelvic transitional cell carcinoma. Cancer 2002; 94:3150-6. [PMID: 12115347 DOI: 10.1002/cncr.10609] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pathologic T3 renal pelvic transitional cell carcinoma exhibits various patterns of invasion. The authors investigated the prognostic impact of three patterns of invasion of pT3 renal pelvic transitional cell carcinoma. METHODS Of 212 patients who underwent surgery for renal pelvic transitional cell carcinoma, 70 with pT3 disease were eligible for the main analyses. The candidate predictors of prognosis included patient age, gender, lesion laterality, tumor grade, perioperative cisplatin-based systemic chemotherapy, lymph node involvement, vascular involvement, and patterns of invasion. Invasion patterns were classified as fat invasion, ductal involvement, or parenchymal invasion. RESULTS Mean postoperative followup was 33.5 months (range, 1-136 months). On univariate analysis, gender, lymph node involvement, vascular involvement, and extensive parenchymal invasion each had a significant impact on the cause specific survival rate. A multivariate analysis using Cox stepwise regression revealed that extensive parenchymal involvement was the strongest prognostic predictor (P = 0.0004, hazard ratio = 5.59). Lymph node involvement (P = 0.0175, hazard ratio = 3.14) and gender (P = 0.0361, hazard ratio = 2.42) were other weaker predictors. Statistically, pT3 disease without extensive parenchymal invasion had a prognosis similar to that of lower stage disease, and pT3 disease with extensive parenchymal invasion had a prognosis similar to that of pT4 disease. CONCLUSIONS Extensive parenchymal invasion has a strong prognostic impact in renal pelvic transitional cell carcinoma. pT3 disease should be subclassified into two separate entities, that with and that without extensive parenchymal invasion, in view of prognosis.
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Affiliation(s)
- Koji Yoshimura
- Department of Urology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
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22
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Farley JH, Douglas TH, Mcleod DG, Harrison CR. Ureteral carcinoma presenting as a complex pelvic mass in a post menopausal patient. Gynecol Oncol 1998; 70:134-6. [PMID: 9698491 DOI: 10.1006/gyno.1998.5052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This is a report of a low-grade ureteral carcinoma presenting as a pelvic mass in a postmenopausal woman with a prolonged history of lower back pain. A right complex adnexal mass and right hydroureter and hydronephrosis in an atrophic nonfunctioning right kidney was found during evaluation for the back pain. Operative evaluation revealed a normal uterus and ovaries; however, a 2 x 3-cm mass in the right ureter was found at the level of the uterine arteries. A total abdominal hysterectomy, bilateral salpingo-oophorectomy, and right nephroureterectomy were performed with pathology returning grade I papillary transitional cell carcinoma of the ureter.
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Affiliation(s)
- J H Farley
- Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA
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23
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Abstract
Carcinoma of the upper urinary tract is a relatively rare neoplasm, and few studies have dealt with clinicopathological findings and prognosis in a large number of cases. The purpose of our investigation was to look for a possible relation between E-cadherin (E-CD) immunoreactivity and clinicopathologic findings or clinical outcome in transitional-cell carcinoma of the upper urinary tract (TCC-UUT). To this end, we investigated E-CD immunoreactivity in 154 cases of TCC-UUT. E-CD immunoreactivity was recognized as being of "normal" pattern in 29.2% of samples. The relationship between E-CD immunoreactivity and clinicopathologic findings was significant for stage, grade and pattern of growth. The 5-year disease-free rate for 147 cases and 5-year overall survival rate for 154 cases were 55.7% and 71.5%, respectively. A univariate analysis of survival revealed that stage, grade, pattern of growth and E-CD immunoreactivity all had a significant effect on disease-free and overall survival rates. In the final models of multivariate analysis, however, we found that, for disease-free survival and for overall survival, only stage was a factor for progression or prognosis. Detection of E-CD immunoreactivity appears to be of limited value in deciding the prognosis of TCC-UUT.
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Affiliation(s)
- K Nakanishi
- Division of Environmental Medicine, National Defense Medical College Research Institute, Tokorozawa City, Japan
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24
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Nakanishi K, Kawai T, Torikata C. Immunohistochemical evaluation of p53 oncoprotein in transitional cell carcinoma of the upper urinary tract. Hum Pathol 1996; 27:1336-40. [PMID: 8958308 DOI: 10.1016/s0046-8177(96)90347-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The p53 gene, which is located on human chromosome 17, encodes for a nuclear phosphoprotein and is thought to regulate cell growth and proliferation. Although the immunoreactivity for p53 oncoprotein in transitional cell carcinoma (TCC) of the urinary bladder has been shown to correlate with clinicopathologic findings and prognoses, there have been no such reports on TCC of the upper urinary tract (TCC-UUT). The present study investigated the prognostic value of p53 oncoprotein in TCC-UUT. Formalin-fixed, paraffin-embedded tumor tissues from 149 TCC-UUT patients were analyzed using immunohistochemical staining. Immunohistochemically, p53 oncoprotein was recognized as positive in 26.8% of the samples. The immunoreactivity for p53 oncoprotein was significantly (P < .05) correlated with both stage, grade, and pattern of growth. The 5-year disease-free and overall survival rates were 58.4% and 69.7%, respectively. A univariate analysis of survival showed that stage, grade, pattern of growth, and the immunoreactivity for p53 oncoprotein have a significant effect on disease-free and overall survival rates. In the final models of multivariate analysis, only stage for disease-free survival, and stage and the immunoreactivity for p53 oncoprotein for overall survival were found to be progressive or prognostic factors. Detection of immunoreactivity for p53 oncoprotein appears to be of real value in deciding the prognosis of TCC-UUT.
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Affiliation(s)
- K Nakanishi
- Department of Pathology, National Defense Medical College, Tokorozawa, Japan
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25
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Catton C, Warde P, Gospodarowicz M, Panzarella T, Catton P, McLean M, Milosevic M. Transitional cell carcinoma of the renal pelvis and ureter: Outcome and patterns of relapse in patients treated with postoperative radiation. Urol Oncol 1996; 2:171-6. [DOI: 10.1016/s1078-1439(96)00095-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Sengelov L, Kamby C, von der Maase H. Pattern of Metastases in Relation to Characteristics of Primary Tumor and Treatment in Patients with Disseminated Urothelial Carcinoma. J Urol 1996. [DOI: 10.1016/s0022-5347(01)66562-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Lisa Sengelov
- Departments of Oncology, Herlev University Hospital, Herlev, Copenhagen and Aarhus University Hospital, Aarhus, Denmark
| | - Claus Kamby
- Departments of Oncology, Herlev University Hospital, Herlev, Copenhagen and Aarhus University Hospital, Aarhus, Denmark
| | - Hans von der Maase
- Departments of Oncology, Herlev University Hospital, Herlev, Copenhagen and Aarhus University Hospital, Aarhus, Denmark
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27
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Terrell RB, Cheville JC, See WA, Cohen MB. Histopathological Features and p53 Nuclear Protein Staining as Predictors of Survival and Tumor Recurrence in Patients with Transitional Cell Carcinoma of Renal Pelvis. J Urol 1995. [DOI: 10.1016/s0022-5347(01)66855-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- R. Brenton Terrell
- Departments of Urology and Pathology, University of Iowa College of Medicine, Iowa City, Iowa
| | - John C. Cheville
- Departments of Urology and Pathology, University of Iowa College of Medicine, Iowa City, Iowa
| | - William A. See
- Departments of Urology and Pathology, University of Iowa College of Medicine, Iowa City, Iowa
| | - Michael B. Cohen
- Departments of Urology and Pathology, University of Iowa College of Medicine, Iowa City, Iowa
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28
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Braslis KG, Soloway MS. MANAGEMENT OF URETERAL AND RENAL PELVIC RECURRENCE AFTER CYSTECTOMY. Urol Clin North Am 1994. [DOI: 10.1016/s0094-0143(21)00640-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Kaufman RP, Carson CC. Ureteroscopic management of transitional cell carcinoma of the ureter using the neodymium:YAG laser. Lasers Surg Med 1993; 13:625-8. [PMID: 8295471 DOI: 10.1002/lsm.1900130606] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Ureteroscopy offers an extension of endoscopic diagnosis and treatment to upper urinary tract malignancy. Combination of ureteroscopy and the Nd:YAG laser permits accurate and effective treatment of ureteral neoplasms. Nine highly selected patients, six males and three females, were treated with low grade papillary transitional cell carcinomas of the ureter with at least 24 months follow-up. Follow-up cytology and IVP have indicated no evidence for disease recurrence between the follow-up periods and minimal morbidity to the ureteroscopy and laser treatment.
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Affiliation(s)
- R P Kaufman
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina 27710
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30
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Hasui Y, Nishi S, Kitada S, Osada Y, Asada Y. The prognostic significance of vascular invasion in upper urinary tract transitional cell carcinoma. J Urol 1992; 148:1783-5. [PMID: 1433607 DOI: 10.1016/s0022-5347(17)37028-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The prognostic significance of vascular invasion was evaluated in a retrospective series of 30 patients with upper urinary tract cancer who underwent a potentially curative operation. Vascular invasion was found in 11 patients (36.7%). The incidence of vascular invasion was well correlated with tumor grade and stage. The incidence of metastases postoperatively was significantly higher in the patients with (72.7%) than without (21.1%) vascular invasion (p < 0.01). The survival rate of the patients with vascular invasion was significantly lower than in those without vascular invasion (p < 0.005). In multivariate Cox regression analysis the prognostic value of vascular invasion was independent of tumor stage and grade. These results indicate that vascular invasion should predict a more unfavorable outcome in patients with upper urinary tract cancer as an independent morphological indicator.
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Affiliation(s)
- Y Hasui
- Department of Urology, Miyazaki Medical College, Japan
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31
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Raabe NK, Fosså SD, Bjerkehagen B. Carcinoma of the renal pelvis. Experience of 80 cases. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1992; 26:357-61. [PMID: 1292073 DOI: 10.3109/00365599209181226] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The clinical course and association with other urothelial carcinomas was studied in 80 patients with carcinoma of the renal pelvis. At the time of diagnosis macroscopic haematuria was the most common symptom. Urography and retrograde pyelography gave the most accurate diagnoses. Sixty-eight patients (85%) had transitional cell carcinomas, 39 had a history of another urothelial carcinoma either before or after the diagnosis of the renal tumour, usually in the urinary bladder. A previous urothelial carcinoma together with a small renal tumour were predictive of the subsequent development of another urothelial tumour. Regular cystoscopy is recommended during follow-up because of the short observed interval between the development of carcinoma of the renal pelvis and a subsequent urothelial malignancy. The overall five-year survival was 20%. Survival did not depend on the operation, but was significantly related to the extent of locoregional or distant metastases at the time of diagnosis. Patients with such renal tumours that were preceded by or associated with other urothelial carcinomas had a more favourable median survival (42 months) than patients whose renal tumour was their first urothelial carcinoma (19 months).
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MESH Headings
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Adult
- Aged
- Carcinoma/mortality
- Carcinoma/pathology
- Carcinoma/surgery
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Carcinoma, Transitional Cell/mortality
- Carcinoma, Transitional Cell/pathology
- Carcinoma, Transitional Cell/surgery
- Female
- Follow-Up Studies
- Humans
- Kidney Neoplasms/mortality
- Kidney Neoplasms/pathology
- Kidney Neoplasms/surgery
- Kidney Pelvis/pathology
- Male
- Middle Aged
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Neoplasm Staging
- Neoplasms, Second Primary/mortality
- Neoplasms, Second Primary/pathology
- Neoplasms, Second Primary/surgery
- Nephrectomy
- Survival Rate
- Urethral Neoplasms/mortality
- Urethral Neoplasms/pathology
- Urethral Neoplasms/surgery
- Urinary Bladder Neoplasms/mortality
- Urinary Bladder Neoplasms/pathology
- Urinary Bladder Neoplasms/surgery
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Affiliation(s)
- N K Raabe
- Department of Clinical Oncology and Radiotherapy, Ullevål Sykehus, Oslo, Norway
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