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Xu B, Zhang JE, Ye L, Yuan CW. Evaluation of the diagnostic efficiency of voided urine fluorescence in situ hybridization for predicting the pathology of preoperative "low-risk" upper tract urothelial carcinoma. Front Oncol 2023; 13:1225428. [PMID: 37576882 PMCID: PMC10412927 DOI: 10.3389/fonc.2023.1225428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/03/2023] [Indexed: 08/15/2023] Open
Abstract
Objectives To evaluate the clinical utility of voided urine fluorescence in situ hybridization (FISH) for predicting the pathology of preoperative "low-risk" upper tract urothelial carcinoma (UTUC). Methods Information of patients preoperatively diagnosed with "low-risk" UTUC receiving radical nephroureterectomy (RNU) between May 2014 and October 2019 were retrospectively collected. All of the patients accepted the FISH test and then were divided into two groups according to the results of FISH. The diagnostic value of FISH was assessed through the receiver operating characteristics (ROC) curve and area under the curve. Logistic regression analysis was applied to examine FISH as a predictive factor of tumor final stage and grade of preoperative "low-risk" UTUC. Results In total, 129 patients were included. Of them, 70 (54.2%) were marked with positive FISH result. The difference at final pathology in tumor stage and tumor grade between these two groups of FISH (-) and FISH (+) had significantly statistical significance (p<0.001). Regarding to the tumor stage at final pathology, the sensitivity, specificity, positive predictive value and negative predictive value of FISH were 70.7 (58.9-80.3)68.5 (54.3-80.1)75.7 (63.7-84.8) and 62.7 (49.1-74.7), respectively. Regarding to the tumor grade at final pathology, the sensitivity, specificity, positive predictive value and negative predictive value of FISH were 64.7 (53.5-74.6), 65.9 (50.0-79.1), 78.6 (66.8-87.1) and 49.1 (36.5-62.3), respectively. The results of logistic regression analysis indicated that FISH could predict the pathologic characteristics of preoperative "low-risk" UTUC independently. Conclusions FISH was qualified with relatively high diagnostic estimates for predicting tumor stage and grade of preoperative "low-risk" UTUC, and could be an independent predictive factor in clinical practice. For preoperative "low-risk" UTUC patients but with positive FISH result, choosing nephron-sparing surgery may require special caution.
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Affiliation(s)
- Ben Xu
- Department of Urology, Peking University First Hospital, Beijing, China
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Paciotti M, Alkhatib KY, Nguyen DD, Yim K, Lipsitz SR, Mossanen M, Casale P, Pierorazio PM, Kibel AS, Trinh QD, Buffi NM, Lughezzani G, Cole AP. Is Segmental Ureterectomy Associated with Inferior Survival for Localized Upper-Tract Urothelial Carcinoma of the Ureter Compared to Radical Nephroureterectomy? Cancers (Basel) 2023; 15:cancers15051373. [PMID: 36900166 PMCID: PMC10000204 DOI: 10.3390/cancers15051373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023] Open
Abstract
Segmental ureterectomy (SU) is an alternative to radical nephroureterectomy (RNU) in the treatment of upper-tract urothelial carcinoma (UTUC) of the ureter. SU generally preserves renal function, at the expense of less intensive cancer control. We aim to assess whether SU is associated with inferior survival compared to RNU. Using the National Cancer Database (NCDB), we identified patients diagnosed with localized UTUC of the ureter between 2004-2015. We used a propensity-score-overlap-weighted (PSOW) multivariable survival model to compare survival following SU vs. RNU. PSOW-adjusted Kaplan-Meier curves were generated and we performed a non-inferiority test of overall survival. A population of 13,061 individuals with UTUC of the ureter receiving either SU or RNU was identified; of these, 9016 underwent RNU and 4045 SU. Factors associated with decreased likelihood of receiving SU were female gender (OR, 0.81; 95% CI, 0.75-0.88; p < 0.001), advanced clinical T stage (cT4) (OR, 0.51; 95% CI, 0.30-0.88; p = 0.015), and high-grade tumor (OR, 0.76; 95% CI, 0.67-0.86; p < 0.001). Age greater than 79 years was associated with increased probability of undergoing SU (OR, 1.18; 95% CI, 1.00-1.38; p = 0.047). There was no statistically significant difference in OS between SU and RNU (HR, 0.98; 95% CI, 0.93-1.04; p = 0.538). SU was not inferior to RNU in PSOW-adjusted Cox regression analysis (p < 0.001 for non-inferiority). In weighted cohorts of individuals with UTUC of the ureter, the use of SU was not associated with inferior survival compared to RNU. Urologists should continue to utilize SU in appropriately selected patients.
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Affiliation(s)
- Marco Paciotti
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02120, USA
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Khalid Y. Alkhatib
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02120, USA
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Division of Urology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David-Dan Nguyen
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02120, USA
| | - Kendrick Yim
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Stuart R. Lipsitz
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02120, USA
| | - Matthew Mossanen
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | | | - Adam S. Kibel
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02120, USA
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Nicoló Maria Buffi
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Giovanni Lughezzani
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
- Correspondence: ; Tel.: +39-(028)-224-7356
| | - Alexander P. Cole
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02120, USA
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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3
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Alhalabi O, Campbell MT, Xiao L, Adriazola AC, Wilson NR, Siefker‐Radtke AO, Corn PG, Zurita A, Jonasch E, Gao J, Adibi M, Kamat AM, Navai N, Pisters LL, Dinney C, Matin SF, Shah AY. Multimodal kidney‐preserving approach in localised and locally advanced high‐risk upper tract urothelial carcinoma. BJUI COMPASS 2021; 3:37-44. [PMID: 35475152 PMCID: PMC8988842 DOI: 10.1002/bco2.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/11/2021] [Accepted: 08/25/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives Multimodal kidney‐preserving (MKP) strategies may be an option for patients with localised or locally advanced high‐risk upper tract urothelial carcinoma (UTUC) who have a relative contraindication for nephroureterectomy (NU). Materials and methods We studied patients with UTUC who were managed with MKP strategies, consisting of systemic anticancer therapy, with or without local/topical strategies after endoscopic control of intraluminal tumours. Primary end points were overall survival (OS) and progression‐free survival (PFS). Results Fourteen patients received MKP treatment between August 2013 and April 2020. Median baseline estimated glomerular filtration rate was 43 mL/min/1.73m2. MKP was mainly pursued to avoid dialysis (10/14, 71%), followed by low performance status and/or comorbidities (2/14, 14%). All patients had received systemic therapy: chemotherapy (64%) and immunotherapy (36%). Endoscopic control and/or laser ablation was feasible in 7 (50%) patients. Calculated overall risk of non‐organ confined disease was 35%. Predicted 2‐year and 5‐year relapse‐free probability (RFP) was 74% (24–92%) and 62% (10–85%), respectively. Median follow‐up was 31 months (95% CI: 22.6, NE), median OS was 48.1 months (95% CI: 48.1, NE) and 2‐year OS probability was 0.89 (95% CI: 0.71, 1). Median metastases‐free survival was 48.1 months (95% CI: 26.8, NE), median PFS was 22.4 months (95% CI: 15.6, NE) and 2‐year PFS probability was 0.48 (0.26, 0.89). Conclusion Management of high‐risk localised or locally advanced UTUC with MKP strategies was associated with good tolerance, preservation of renal function, and comparable PFS and OS to predicted in vulnerable patients. Prospective studies with more patients are needed to evaluate these possible benefits relative to current standards.
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Affiliation(s)
- Omar Alhalabi
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine University of Texas MD Anderson Cancer Center Houston TX USA
| | - Matthew T. Campbell
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine University of Texas MD Anderson Cancer Center Houston TX USA
| | - Lianchun Xiao
- Department of Biostatistics, Division of Cancer Medicine University of Texas MD Anderson Cancer Center Houston TX USA
| | - Ana C. Adriazola
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine University of Texas MD Anderson Cancer Center Houston TX USA
| | - Nathaniel R. Wilson
- Department of Internal Medicine University of Texas Health Science Center at Houston Houston TX USA
| | - Arlene O. Siefker‐Radtke
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine University of Texas MD Anderson Cancer Center Houston TX USA
| | - Paul G. Corn
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine University of Texas MD Anderson Cancer Center Houston TX USA
| | - Amado Zurita
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine University of Texas MD Anderson Cancer Center Houston TX USA
| | - Eric Jonasch
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine University of Texas MD Anderson Cancer Center Houston TX USA
| | - Jianjun Gao
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine University of Texas MD Anderson Cancer Center Houston TX USA
| | - Mehrad Adibi
- Department of Urology, Division of Surgery University of Texas MD Anderson Cancer Center Houston TX USA
| | - Ashish M. Kamat
- Department of Urology, Division of Surgery University of Texas MD Anderson Cancer Center Houston TX USA
| | - Neema Navai
- Department of Urology, Division of Surgery University of Texas MD Anderson Cancer Center Houston TX USA
| | - Louis L. Pisters
- Department of Urology, Division of Surgery University of Texas MD Anderson Cancer Center Houston TX USA
| | - Colin Dinney
- Department of Urology, Division of Surgery University of Texas MD Anderson Cancer Center Houston TX USA
| | - Surena F. Matin
- Department of Urology, Division of Surgery University of Texas MD Anderson Cancer Center Houston TX USA
| | - Amishi Y. Shah
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine University of Texas MD Anderson Cancer Center Houston TX USA
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4
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Pizzighella M, Bruyere F, Peyronnet B, Grafeille V, Brichart N, Mori K, Verhoest G, Bensalah K, Moschini M, Xylinas E, Pradere B. THE MANAGEMENT OF DISTAL URETER DURING RADICAL NEPHROURETERECTOMY DOES NOT INFLUENCE BLADDER RECURRENCE. J Endourol 2021; 36:77-82. [PMID: 34121446 DOI: 10.1089/end.2021.0303] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The bladder cuff management and its surgical approach represent an essential and debated step in radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). The objective of our study was to determine which bladder-cuff management has the best oncological outcomes in terms of bladder recurrence-free survival ( BRFS). METHODS We retrospectively analyzed all patients who underwent an open robot-assisted laparoscopic (RNU) or a combined RNU between March 2012 and March 2019 in three academic hospitals. Bladder-cuff management approaches were divided into two categories: (O-cuff) open bladder cuff and (R-cuff) robot-assisted bladder cuff. We assessed demographic characteristics, distal ureter approach, pathology, and operative details as well as oncological outcomes including BRFS. Survival was analysed using the Kaplan-Meier method and compared using the log-rank test. A multivariable analysis was performed to identify predictive factors of bladder recurrence. RESULTS A total of 117 patients were included with a mean follow-up of 40.4 months. Patients with a history of bladder cancer, RNU with pure laparoscopic approach and endoscopic bladder cuff were excluded. There were 53 (45%) patients in the O-cuff group and 64 (55%) in the R-cuff group. BRFS at 2 years was 73.3% and 72.7% for O-cuff and R-cuff respectively (p=0.9). On multivariable analysis, distal ureter tumor (odds ratio (OR): 6.24, 95% CI: 1.95- 21.5; p < 0.01) was associated with bladder recurrence (BR). CONCLUSION There was no statistically significant difference in BRFS between the O-cuff and R-cuff groups. Nevertheless, we underlined that distal ureter tumor was associated with bladder recurrence. Although we did not find differences regarding the surgical approach, bladder-cuff remains a very important step of RNU and caution should be taken when performed laparoscopically to avoid any tumor spillage. Risk factors for bladder cancer recurrence might be taken into account for the choice of its surgical approach. .
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Affiliation(s)
| | - Franck Bruyere
- CHRU Tours, 26928, urology, 2 bd Tonnellé, Tours, France, 37044;
| | - Benoit Peyronnet
- CHU Rennes, Department of urology, 2 rue Henri Le Guilloux, Rennes, France, 35000;
| | - Vivien Grafeille
- CHU Rennes, 36684, Department of urology, Rennes, Bretagne, France;
| | - Nicolas Brichart
- CHR Orleans, 52817, Department of urology, Orleans, Centre, France;
| | - Keiichiro Mori
- The Jikei University School of Medicine, Urology, Minato, Tokyo, Japan;
| | - Gregory Verhoest
- RENNES Univeristy Hospital, Urology, Henri Le Guillou St, RENNES, France, 35033;
| | - Karim Bensalah
- Rennes University Hospital (France), Urology, 2 rue Henri Le Guillou, Rennes, France, 35000;
| | - Marco Moschini
- Luzerner Kantonsspital, 30748, Luzerner Kantonsspital, Luzern, Switzerland, 6000.,United States;
| | | | - Benjamin Pradere
- CHU Tours, Department of urology, Tours, France.,Medical University of Vienna, 27271, urology, Wien, Wien, Austria;
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Sung HH, Scherr DS, Slaton J, Liu H, Feeny KL, Lingley-Papadopoulos C, Gearheart J, Zara JM, Lerner SP. Phase II multi-center trial of optical coherence tomography as an adjunct to white light cystoscopy for intravesical real time imaging and staging of bladder cancer. Urol Oncol 2021; 39:434.e23-434.e29. [PMID: 33934964 DOI: 10.1016/j.urolonc.2021.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 03/14/2021] [Accepted: 03/29/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Optical coherence tomography (OCT) is a novel imaging modality that provides microstructural information of different tissue layers using near-infrared light. This prospective, multicenter phase II trial aimed to assess the accuracy of OCT-assisted cystoscopy for bladder tumor staging. METHODS Patients with primary or recurrent bladder tumors (Ta,T1) identified by outpatient cystoscopy were included. The primary objective was to assess the accuracy and positive predictive value of for determining tumor stage ≥T1 correlated by histopathology. 72 suspicious lesions from 63 patients were eligible to analyze in the study. All suspected lesions were evaluated with conventional cystoscopy, interpreted in real-time using OCT, and then resected. All results were compared to pathology. A total of 363 OCT images of tumor and normal mucosa in 25 patients were obtained to evaluate diagnostic efficacy of the computer-aided texture analysis algorithm. RESULTS Sensitivity and specificity for predicting invasive tumors (≥ T1, n = 17) were 58.8% and 92.7% for cystoscopy, 64.7% and 100% for OCT-assisted cystoscopy, respectively. Accuracy of cystoscopy and OCT-assisted cystoscopy for predicting invasive tumor was 84.7% and 91.7% (P = 0.063), respectively. Cystoscopy and OCT-assisted cystoscopy correctly predicted T stage in 52/72 and 59/72 cases, respectively (P = 0.016). Cystoscopy missed 2 more invasive tumors than OCT-assisted cystoscopy. Cystoscopy (14.3%, 1/7) and OCT-assisted cystoscopy (28.6%, 2/7) showed relatively low sensitivity in detecting muscle invasion. Computer aided texture analysis demonstrated 75.1% sensitivity, 64.0% specificity, and 74.4% accuracy for differentiating tumor and normal urothelium. CONCLUSION OCT-assisted cystoscopy is a real time noninvasive and simple procedure that enhanced the accuracy of staging bladder tumors and prediction of any tumor invasion. Though the study did not meet the prespecified primary endpoint, OCT imaging is a promising adjunct to cystoscopy that may supplement intraoperative decision-making during transurethral resection of bladder tumors and additional prospective studies are warranted.
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Affiliation(s)
- Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Scott Department of Urology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX
| | - Douglas S Scherr
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY
| | - Joel Slaton
- Department of Urology, University of Minnesota, Minneapolis, MIN
| | - Hao Liu
- Department of Biostatistics, Indiana University School of Medicine, Indiana University Simon Cancer Center, Indianapolis, IN
| | | | | | - John Gearheart
- School of Engineering & Applied Science, The George Washington University, Washington, DC
| | - Jason M Zara
- School of Engineering & Applied Science, The George Washington University, Washington, DC
| | - Seth P Lerner
- Scott Department of Urology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX.
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6
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Risk Stratification of Upper Tract Urothelial Carcinoma for Kidney-Sparing Surgery. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Benamran D, Seisen T, Naoum E, Vaessen C, Parra J, Mozer P, Shariat SF, Rouprêt M. Risk stratification for upper tract urinary carcinoma. Transl Androl Urol 2020; 9:1799-1808. [PMID: 32944543 PMCID: PMC7475669 DOI: 10.21037/tau.2019.12.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Upper tract urinary carcinoma (UTUC) is a heterogeneous group of rare tumors. The aim of this article is to critically review current therapeutic strategies and to propose a change in the risk-stratification of the disease. A non-systematic review of the literature was performed using the Medline database with the search terms: “upper tract urothelial carcinoma” together with “prognostic factor”, “risk stratification”, “risk factor”, “recurrence”, “predictive tool”, “nomograms” and “treatment”. Preoperative risk factors can be viewed as patient-related risk factors (gender, age, ethnicity, body mass index, smoking status, or genetic factors), or tumor-related risk factors (stage, grade, size, architecture, multifocality, ureteric obstruction). Several biomarkers, available either in blood, urine, or the tumor itself have also been proposed. However, many of these prognostic factors lack accuracy and validation in predicting oncological outcomes, despite their use in predictive tools. After risk stratification, kidney-sparing strategies should be considered (endoscopic management and segmental ureterectomy) and could benefit from new diagnostic tools and technical improvements in in situ adjuvant endocavitary instillations. Radical nephroureterectomy remains the first choice therapy for high-grade disease and will probably be associated with other treatments in the future (lymphadenectomy, perioperative chemotherapy, or immunotherapy). In view of the major recent improvements in UTUC treatment strategies, a new classification should be proposed, including low-, intermediate-, high- and very high-risk disease. Subgroup analysis of good quality trials and better understanding of UTUC risk factors will help validate this new approach toward more personalized medicine.
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Affiliation(s)
- Daniel Benamran
- Division of Urology, Geneva University Hospitals, Geneva, Switzerland.,Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Urology Department, Hôpital Pitié-Salpêtrière, F-75013 Paris, France
| | - Thomas Seisen
- Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Urology Department, Hôpital Pitié-Salpêtrière, F-75013 Paris, France
| | - Elias Naoum
- Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Urology Department, Hôpital Pitié-Salpêtrière, F-75013 Paris, France
| | - Christophe Vaessen
- Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Urology Department, Hôpital Pitié-Salpêtrière, F-75013 Paris, France
| | - Jérome Parra
- Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Urology Department, Hôpital Pitié-Salpêtrière, F-75013 Paris, France
| | - Pierre Mozer
- Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Urology Department, Hôpital Pitié-Salpêtrière, F-75013 Paris, France
| | | | - Morgan Rouprêt
- Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Urology Department, Hôpital Pitié-Salpêtrière, F-75013 Paris, France
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8
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[Upper urinary tract urothelial cell carcinoma]. Urologe A 2020; 59:1265-1274. [PMID: 32936335 DOI: 10.1007/s00120-020-01323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Upper urinary tract urothelial cell carcinoma (UTUC) is a rare entity. The incidence in Germany is approximately 2/100,000 with a ratio between women and men of 1:2.5. Most clinical signs are nonspecific, which is why early diagnosis is rarely successful. Computed tomography urography in combination with diagnostic ureterorenoscopy is currently the gold standard in the diagnostics of UTUC. Regarding surgical treatment, radical nephroureterectomy (RNU) with resection of a bladder cuff remains the method of choice, although the radical approach is developing towards laparoscopic/robotic or endourological procedures with preservation of kidney tissue. Due to the high recurrence rate (22-47%) of urothelial carcinoma inside the bladder, close follow-up after RNU is mandatory.
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9
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Segmental ureterectomy vs. radical nephroureterectomy for ureteral carcinoma in patients with a preoperative glomerular filtration rate less than 90 ml/min/1.73 m2: A multicenter study. Urol Oncol 2020; 38:601.e11-601.e16. [DOI: 10.1016/j.urolonc.2020.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 02/26/2020] [Accepted: 03/05/2020] [Indexed: 11/17/2022]
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10
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Segmental Ureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-analysis of Comparative Studies. Clin Genitourin Cancer 2020; 18:e10-e20. [DOI: 10.1016/j.clgc.2019.10.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/05/2019] [Accepted: 10/06/2019] [Indexed: 01/17/2023]
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11
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Veccia A, Antonelli A, Francavilla S, Simeone C, Guruli G, Zargar H, Perdoná S, Ferro M, Carrieri G, Hampton LJ, Porpiglia F, Autorino R. Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87,000 cases. World J Urol 2019; 38:845-852. [PMID: 31773242 DOI: 10.1007/s00345-019-03020-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 11/10/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To perform a systematic review and meta-analysis of the literature inherent robotic nephroureterectomy (RNU) and to compare its outcomes with those of other nephroureterectomy (NU) techniques. METHODS A systematic literature search was performed up to April 2019 using PubMed, Embase®, and Web of Science. The Preferred Reporting Items for Systematic Review and Meta-analysis Statement was followed for study selection. The following data were extracted for each study: baseline features, surgical outcomes, oncological outcomes, and survival outcomes. Stata® 15.0 was used for statistical analysis. RESULTS Literature search identified 80 studies eligible for the meta-analysis and overall 87,291 patients were included in the analysis: open NU (ONU; n = 45,601), hand-assisted laparoscopic NU (HALNU; n = 442), laparoscopic NU (LNU n = 31,093), and RNU (n = 10,155). RNU was more likely to be performed in those patients with multifocal tumor location (proportion: 0.19; 95% CI 0.14, 0.24) and high-grade disease (proportion: 0.70; 95% CI 0.53, 0.68). The lowest EBL was recorded in the RNU group (weighted mean (WM) 163.31 mL; 95% CI 88.94, 237.68), whereas the highest was in the ONU group (414.99 mL; 95% CI 378.52, 451.46). Operative time was shorter for ONU (224.98 mL; 95% CI 212.26, 237.69). RNU had lower rate of intraoperative complications (0.02; 95% CI 0.01, 0.05). ONU showed higher odds of transfusions (0.20; 95% CI 0.15, 0.25). LOS was statistically significantly shorter for the RNU group (5.35 days; 95% CI 4.97, 5.82). HALNU seemed to present lower risk of PSM (0.02; 95% CI - 0.01, 0.05), and lower risk of recurrence (0.22; 95% CI 0.15, 0.30), metastasis (0.07; 95% CI 0.05, 0.10), and cancer-related death (0.03; 95% CI 0.01, 0.06). ONU showed the lowest 5 years cancer specific survival (proportion: 0.77; 95% CI 0.74, 0.80). No correlation was found between the surgical technique and recurrence-free and cancer-specific survival. CONCLUSIONS Evidence regarding RNU for the treatment of UTUC is increasing but it remains quite sparse and of low quality. Despite this, RNU seems to be safe, and to offer the advantages of a minimally invasive approach without impairing the oncological outcomes. Nevertheless, ONU, HALNU, and LNU still represent a valid, and commonly used surgical treatment option. As RNU becomes more popular, and concerns related to its use remain, the best surgical technique for NU remains to be determined.
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Affiliation(s)
- Alessandro Veccia
- Division of Urology, VCU Health System, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA.,Urology Unit, ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Alessandro Antonelli
- Urology Unit, ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Simone Francavilla
- Urology Unit, ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Claudio Simeone
- Urology Unit, ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Georgi Guruli
- Division of Urology, VCU Health System, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA
| | - Homayoun Zargar
- Department of Surgery, Department of Urology, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
| | - Sisto Perdoná
- Uro-Gynecological Department, Fondazione "G. Pascale" IRCCS, Naples, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Lance J Hampton
- Division of Urology, VCU Health System, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA
| | | | - Riccardo Autorino
- Division of Urology, VCU Health System, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA.
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12
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Attalla K, Patnaik S, Vellos T, Mehrazin R. Management of distal ureter and bladder cuff at the time of nephroureterectomy: surgical techniques and predictors of outcome. Future Oncol 2019; 15:2385-2393. [PMID: 31237445 DOI: 10.2217/fon-2019-0064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Open radical nephroureterectomy (NU) with removal of the ureter and bladder cuff is the 'gold standard' in the treatment of high-grade urothelial cancers of the upper urinary tract. A salient issue is the management of the distal ureter and bladder cuff at time of surgery. Which technique confers superior oncologic benefit is of particular interest since this disease process is notoriously plagued with high intravesical recurrence rates. Although open radical NU is the 'gold standard', the maturation of minimally invasive surgery formidably challenges approaches considered 'gold standard'. We thus sought to critically review the literature comparing perioperative and oncologic outcomes in the approaches used to manage the distal ureter and bladder cuff in patients undergoing radical NU.
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Affiliation(s)
- Kyrollis Attalla
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Shyam Patnaik
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ted Vellos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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13
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Kardoust Parizi M, Glybochko PV, Enikeev D, Rouprêt M, Fajkovic H, Seebacher V, Shariat SF. Risk stratification of upper tract urothelial carcinoma: A Review of the Current Literature. Expert Rev Anticancer Ther 2019; 19:503-513. [DOI: 10.1080/14737140.2019.1621753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Mehdi Kardoust Parizi
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Teheran, Iran
| | - Petr V. Glybochko
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Morgan Rouprêt
- Sorbonne Université, GRC no. 5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Harun Fajkovic
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Veronika Seebacher
- Department for Gynecology and Gynecologic Oncology, Gynecologic Cancer Unit, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - Shahrokh F. Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
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14
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Robotic radical nephroureterectomy and segmental ureterectomy for upper tract urothelial carcinoma: a multi-institutional experience. World J Urol 2019; 37:2303-2311. [PMID: 31062121 DOI: 10.1007/s00345-019-02790-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 04/26/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To report a multi-institutional experience on robotic radical nephroureterectomy (RNU) and segmental ureterectomy (SU) for upper tract urothelial carcinoma (UTUC). METHODS Data were prospectively collected from patients with non-metastatic UTUC undergoing robotic SU or RNU at three referral centers between 2015 and 2018. Transperitoneal, single-docking robotic RNU followed established principles. Bladder cuff excision (BCE) was performed with robotic or open approach. Techniques for SU included: ureteral resection and primary uretero-ureterostomy; partial pyelectomy and modified pyeloplasty; ureteral resection with BCE and direct- or psoas hitch-ureteroneocystostomy. We retrospectively evaluated the technical feasibility, and peri-operative and oncologic outcomes after robotic RNU/SU. RESULTS 81 patients were included. No case required conversion to open surgery. Early major (Clavien-Dindo grade > 2) complications were reported in six (7.4%) patients (two after SU, four after RNU). Three patients experienced late major complications (one after SU, two after RNU). Median ΔeGFR at 3 months was - 1 ml/min/1.73 m2 after SU and - 15 ml/min/1.73 m2 after RNU. Positive surgical margins were recorded in five patients (one after SU, four after RNU). Median follow-up was 21 months and 22 months in the SU and RNU groups, respectively. Three (20%) patients had ipsilateral upper tract recurrence after SU, while five (7.5%) developed metastases after RNU. No case of port-site metastases or peritoneal carcinomatosis was reported. At last follow-up, 67 (82.7%) patients were alive without evidence of disease. CONCLUSION Robotic SU and RNU are technically feasible and achieved promising peri-operative and oncologic outcomes in selected patients with non-metastatic UTUC.
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15
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Abrate A, Sessa F, Sebastianelli A, Preto M, Olivero A, Varca V, Benelli A, Campi R, Sessa M, Pavone C, Serretta V, Vella M, Brunocilla E, Serni S, Trombetta C, Terrone C, Gregori A, Lissiani A, Gontero P, Schiavina R, Gacci M, Simonato A. Segmental resection of distal ureter with termino-terminal ureteric anastomosis vs bladder cuff removal and ureteric re-implantation for upper tract urothelial carcinoma: results of a multicentre study. BJU Int 2019; 124:116-123. [DOI: 10.1111/bju.14697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alberto Abrate
- Section of Urology; Department of Surgical, Oncological and Oral Sciences; University of Palermo; Palermo Italy
| | - Francesco Sessa
- Department of Minimally-Invasive and Robotic Urologic Surgery and Kidney Transplantation; Careggi Hospital; University of Florence; Florence Italy
| | - Arcangelo Sebastianelli
- Department of Minimally-Invasive and Robotic Urologic Surgery and Kidney Transplantation; Careggi Hospital; University of Florence; Florence Italy
| | - Mirko Preto
- Division of Urology; Department of Surgical Science; AOU Città della Salute e della Scienza di Torino - Presidio Molinette; University of Turin; Turin Italy
| | - Alberto Olivero
- Department of Urology; IRCCS AOU San Martino; University of Genoa; Genoa Italy
| | - Virginia Varca
- Department of Urology; ASST Rhodense, G. Salvini Hospital; Garbagnate Milanese, Milan Italy
| | - Andrea Benelli
- Department of Urology; ASST Rhodense, G. Salvini Hospital; Garbagnate Milanese, Milan Italy
| | - Riccardo Campi
- Department of Minimally-Invasive and Robotic Urologic Surgery and Kidney Transplantation; Careggi Hospital; University of Florence; Florence Italy
| | - Maurizio Sessa
- Department of Experimental Medicine; University of Campania ‘L. Vanvitelli’; Naples Italy
- Department of Drug Design and Pharmacology; University of Copenhagen; Copenhagen Denmark
| | - Carlo Pavone
- Section of Urology; Department of Surgical, Oncological and Oral Sciences; University of Palermo; Palermo Italy
| | - Vincenzo Serretta
- Section of Urology; Department of Surgical, Oncological and Oral Sciences; University of Palermo; Palermo Italy
| | - Marco Vella
- Section of Urology; Department of Surgical, Oncological and Oral Sciences; University of Palermo; Palermo Italy
| | - Eugenio Brunocilla
- Department of Urology; St. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Sergio Serni
- Department of Minimally-Invasive and Robotic Urologic Surgery and Kidney Transplantation; Careggi Hospital; University of Florence; Florence Italy
| | | | - Carlo Terrone
- Department of Urology; IRCCS AOU San Martino; University of Genoa; Genoa Italy
| | - Andrea Gregori
- Department of Urology; ASST Rhodense, G. Salvini Hospital; Garbagnate Milanese, Milan Italy
| | | | - Paolo Gontero
- Division of Urology; Department of Surgical Science; AOU Città della Salute e della Scienza di Torino - Presidio Molinette; University of Turin; Turin Italy
| | - Riccardo Schiavina
- Department of Urology; St. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Mauro Gacci
- Department of Minimally-Invasive and Robotic Urologic Surgery and Kidney Transplantation; Careggi Hospital; University of Florence; Florence Italy
| | - Alchiede Simonato
- Section of Urology; Department of Surgical, Oncological and Oral Sciences; University of Palermo; Palermo Italy
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16
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Cimadamore A, Scarpelli M, Santoni M, Cheng L, Lopez-Beltran A, Montironi R. Upper urinary tract urothelial carcinoma and its variants: transition from morphology to personalized molecular characterization in diagnosis, prognosis, and therapy. Expert Rev Mol Diagn 2018; 18:1021-1028. [PMID: 30452305 DOI: 10.1080/14737159.2018.1549490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Upper tract urothelial carcinoma (UTUC) accounts for 5% of urothelial carcinomas (UCs), the estimated annual incidence being 1-2 cases per 100,000 inhabitants. The aim of this review was to summarize the main morphologic features of UTUC as well as the current status and future role of its molecular characterization in diagnosis, prognosis, and therapy. Areas covered: Several studies on the UTUCs have shown the diagnostic, prognostic, and therapeutic significance of standard pathological features, such as tumor stage, grade, and lymph node metastasis. Investigations have also identified novel factors, in particular, variant histologies, and molecular biomarkers. Based on these, predictive tools have been developed. Expert commentary: The morphology of the UTUC has been considered to be the same as that of Bladder Urothelial carcinoma (BUC). Molecular characterization studies, including genomics, have shown changes in UTUC occurring at differing frequencies in comparison with BUC, the former with unique molecular subtypes and different responses to treatment.
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Affiliation(s)
- Alessia Cimadamore
- a Section of Pathological Anatomy, School of Medicine, United Hospitals , Polytechnic University of the Marche Region , Ancona , Italy
| | - Marina Scarpelli
- a Section of Pathological Anatomy, School of Medicine, United Hospitals , Polytechnic University of the Marche Region , Ancona , Italy
| | | | - Liang Cheng
- c Department of Pathology and Laboratory Medicine , Indiana University School of Medicine , Indianapolis , IN , USA
| | | | - Rodolfo Montironi
- a Section of Pathological Anatomy, School of Medicine, United Hospitals , Polytechnic University of the Marche Region , Ancona , Italy
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17
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Inokuchi J, Kuroiwa K, Kakehi Y, Sugimoto M, Tanigawa T, Fujimoto H, Gotoh M, Masumori N, Ogawa O, Eto M, Ohyama C, Yamaguchi A, Matsuyama H, Ichikawa T, Asano T, Mizusawa J, Eba J, Naito S. Role of lymph node dissection during radical nephroureterectomy for upper urinary tract urothelial cancer: multi-institutional large retrospective study JCOG1110A. World J Urol 2017; 35:1737-1744. [DOI: 10.1007/s00345-017-2049-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/08/2017] [Indexed: 02/06/2023] Open
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18
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Ishihara H, Kondo T, Yoshida K, Omae K, Takagi T, Iizuka J, Tanabe K. Preoperative controlling nutritional status (CONUT) score as a novel predictive biomarker of survival in patients with localized urothelial carcinoma of the upper urinary tract treated with radical nephroureterectomy. Urol Oncol 2017; 35:539.e9-539.e16. [PMID: 28499734 DOI: 10.1016/j.urolonc.2017.04.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/04/2017] [Accepted: 04/15/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the correlation between the controlling nutritional status (CONUT) score and survival of patients with localized urothelial carcinoma of the upper urinary tract treated with radical nephroureterectomy (RNU). METHODS AND MATERIALS We retrospectively enrolled 107 patients. CONUT score was calculated based on the serum albumin concentration, lymphocyte count, and total cholesterol concentration. Patients were classified into 2 groups based on CONUT score. Relapse-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) after RNU were compared between the 2 groups, and predictors of survival were analyzed using Cox proportional hazards regression models. RESULTS For CONUT score, the area under the curve was 0.588 and the optimal cutoff value was 3. Twenty-four patients (22.4%) had high CONUT scores. The patients with high CONUT scores had significantly shorter 5-year RFS, CSS, and OS than did those with low CONUT scores (RFS: 50.1% vs. 66.0%; CSS: 28.1% vs. 71.7%; OS: 26.4% vs. 66.8%; all P<0.05). Results of the multivariable analysis, after adjustment for factors such as pT stage, pN stage, tumor grade, presence of lymphovascular invasion, and C-reactive protein level, revealed that CONUT score was an independent predictor of CSS (hazard ratio [HR] = 5.44, P = 0.0016) and OS (HR = 2.90, P = 0.0214) and showed marginal significance for predicting RFS (HR = 2.26, P = 0.0581). CONCLUSIONS Preoperative CONUT score helps predict survival in patients with localized urothelial carcinoma of the upper urinary tract treated with RNU.
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Affiliation(s)
- Hiroki Ishihara
- Department of Urology, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan; Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
| | - Kazuhiko Yoshida
- Department of Urology, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenji Omae
- Department of Urology, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan; Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan
| | - Toshio Takagi
- Department of Urology, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
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19
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Fahmy O, Schubert T, Khairul-Asri MG, Stenzl A, Gakis G. Total proximal ureter substitution using buccal mucosa. Int J Urol 2017; 24:320-323. [PMID: 28208217 DOI: 10.1111/iju.13307] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/09/2017] [Indexed: 12/14/2022]
Abstract
The surgical treatment of a long proximal ureteral stricture is a challenging situation for reconstructive surgeons. Despite the underlying morbidities, ileal interposition and autotransplantation are the options available to treat complex cases of long segment ureteral stricture. Buccal mucosa has shown excellent results in urethroplasty. However, its use in ureteral reconstruction is infrequent. We report on a 64-year-old female patient with multiple comorbidities and prior abdominal surgeries for Crohn's disease who underwent a successful total substitution of a long segment of the proximal ureter using buccal mucosa. Regular postoperative isotope scans showed improvement in renal function. Based on the pleasant outcome of this case and review of the literature, buccal mucosa might be a viable option with low morbidity in selected cases.
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Affiliation(s)
- Omar Fahmy
- Department of Urology, University of Putra Malaysia, Selangor, Malaysia
| | - Tina Schubert
- Department of Urology, Eberhard-Karls University, Tuebingen, Germany
| | | | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls University, Tuebingen, Germany
| | - Georgios Gakis
- Department of Urology, Eberhard-Karls University, Tuebingen, Germany
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20
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Shariat SF, Mathieu R. Contemporary concepts and controversies in the diagnosis and management of urothelial carcinoma. Transl Androl Urol 2016; 5:633-635. [PMID: 27785419 PMCID: PMC5071187 DOI: 10.21037/tau.2016.08.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Romain Mathieu
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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21
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Gakis G, Black PC, Bochner BH, Boorjian SA, Stenzl A, Thalmann GN, Kassouf W. Systematic Review on the Fate of the Remnant Urothelium after Radical Cystectomy. Eur Urol 2016; 71:545-557. [PMID: 27720534 DOI: 10.1016/j.eururo.2016.09.035] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/22/2016] [Indexed: 01/08/2023]
Abstract
CONTEXT Urothelial carcinoma is considered a pan-urothelial disease. As such, the remnant urothelium in the upper urinary tract and urethra following radical cystectomy (RC) remains at risk for secondary urothelial tumors (SUTs). OBJECTIVE To describe the incidence, diagnosis, treatment, and outcomes of patients with SUTs after RC. EVIDENCE ACQUISITION A systematic search was conducted using PubMed database according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies between 1970 and 2016 reporting on malignant diseases of the urothelium after RC for bladder cancer. The search strategy separated between upper and lower tract urothelial tumors. EVIDENCE SYNTHESIS Of a total of 1069 studies, 57 were considered for evidence synthesis. SUTs occured in approximately 4-10% of patients after RC. Carcinoma in situ of the bladder, a history of nonmuscle invasive bladder cancer, and tumor involvement of the distal ureter are the strongest risk factors for secondary upper tract tumors. Risk factors for secondary urethral tumors represent urothelial malignancy in the prostatic urethra/prostate and bladder neck (in women), nonorthotopic diversions, and positive findings on permanent sections. The majority of patients (84%) with SUTs, presented with urothelial recurrence without evidence of metastasis. Of those, 84.0% were treated with surgery, 10.5% with systemic chemotherapy and/or radiotherapy, and 5.6% with topical chemotherapy and/or immunotherapy. After a median follow-up of 91 mo (range: 26-155), 65.9% of patients died of disease and 21.5% died of other causes. Detection and treatment of SUTs at an asymptomatic stage can reduce the risks of cancer-specfific and overall mortality by 30%. A limitation of the study is that the available data were retrospective. CONCLUSIONS SUTs are rare oncological events and most patients have an adverse prognosis despite absence of distant disease at diagnosis. Therefore, surveillance of the remnant urothelium should be implemented for patients with histological features of panurothelial disease as it may improve timely detection and treatment. PATIENT SUMMARY Secondary tumors of the renal pelvis, ureters, and urethra occur in approximately 4-10% of patients after radical removal of the bladder for bladder cancer. These patients' prognoses are reduced, likely due to delayed diagnosis. Therefore, routine surveillance might be important to detect tumors at an early stage.
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Affiliation(s)
- Georgios Gakis
- Department of Urology, Eberhard-Karls University of Tübingen, Germany.
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Bernard H Bochner
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls University of Tübingen, Germany
| | - George N Thalmann
- Department of Urology, Inselspital Bern, University of Bern, Switzerland
| | - Wassim Kassouf
- Division of Urology, McGill University, Montreal, QC, Canada
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22
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Mbeutcha A, Mathieu R, Rouprêt M, Gust KM, Briganti A, Karakiewicz PI, Shariat SF. Predictive models and prognostic factors for upper tract urothelial carcinoma: a comprehensive review of the literature. Transl Androl Urol 2016; 5:720-734. [PMID: 27785429 PMCID: PMC5071205 DOI: 10.21037/tau.2016.09.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In the context of customized patient care for upper tract urothelial carcinoma (UTUC), decision-making could be facilitated by risk assessment and prediction tools. The aim of this study was to provide a critical overview of existing predictive models and to review emerging promising prognostic factors for UTUC. A literature search of articles published in English from January 2000 to June 2016 was performed using PubMed. Studies on risk group stratification models and predictive tools in UTUC were selected, together with studies on predictive factors and biomarkers associated with advanced-stage UTUC and oncological outcomes after surgery. Various predictive tools have been described for advanced-stage UTUC assessment, disease recurrence and cancer-specific survival (CSS). Most of these models are based on well-established prognostic factors such as tumor stage, grade and lymph node (LN) metastasis, but some also integrate newly described prognostic factors and biomarkers. These new prediction tools seem to reach a high level of accuracy, but they lack external validation and decision-making analysis. The combinations of patient-, pathology- and surgery-related factors together with novel biomarkers have led to promising predictive tools for oncological outcomes in UTUC. However, external validation of these predictive models is a prerequisite before their introduction into daily practice. New models predicting response to therapy are urgently needed to allow accurate and safe individualized management in this heterogeneous disease.
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Affiliation(s)
- Aurélie Mbeutcha
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; ; Department of Urology, University of Nice Sophia-Antipolis, Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Romain Mathieu
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Morgan Rouprêt
- Department of Urology, Pitié-Salpêtrière, APHP, University Paris VI, Paris, France
| | - Kilian M Gust
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Alberto Briganti
- Unit of Urology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Ospedale S. Raffaele, Milan, Italy
| | | | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; ; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; ; Department of Urology, Weill Cornell Medical College, New York, NY, USA
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23
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Mathieu R, Shariat SF. Building bridges in urothelial carcinoma to face common challenges. Transl Androl Urol 2016; 5:745-748. [PMID: 27785431 PMCID: PMC5071182 DOI: 10.21037/tau.2016.08.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Romain Mathieu
- Department of Urology, Medical University Vienna, General Hospital, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Medical University Vienna, General Hospital, Vienna, Austria; ; Department of Urology, Weill Cornell Medical College, New York, NY, USA; ; Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA; ; Karl Landsteiner Institute, Vienna, Austria
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24
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Khene ZE, Mathieu R, Kammerer-Jacquet SF, Seisen T, Roupret M, Shariat SF, Peyronnet B, Bensalah K. Risk stratification for kidney sparing procedure in upper tract urothelial carcinoma. Transl Androl Urol 2016; 5:711-719. [PMID: 27785428 PMCID: PMC5071190 DOI: 10.21037/tau.2016.09.05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Risk stratification for kidney sparing procedures (KSP) to treat upper tract urothelial carcinoma (UTUC) is a major issue. A non-systematic Medline/PubMed literature search was performed using the terms “upper tract urothelial carcinoma” with different combinations of keywords to review the current knowledge on this topic. Original articles, reviews and editorials in English language were selected based on their clinical relevance. Available techniques for KSP include segmental ureterectomy and endoscopic resection through a percutaneous or flexible ureteroscopic access. These approaches were traditionally restricted to patients with imperative indications. Current recommendations suggest that selected patients with normal contralateral kidney should also be candidates for such treatments. Modern imaging and endoscopy have improved to accurately stage and grade the tumor while various prognostic clinical factors and biomarkers have been proposed to identify tumor with aggressive features and worse outcomes. Several predictive models using different combinations of such baseline characteristics may help clinicians in clinical decision making. However, risk-adapted based approach that has been proposed in recent guidelines to identify patients who are more likely to benefit from KSP only relies on few clinical and pathological factors. Despite growing understanding of the disease, treatment of UTUC remains challenging. Further efforts and collaborative multicenter studies are mandatory to improve risk stratification to decide and promote optimal KSP in UTUC. These efforts should focus on the integration of promising biomarkers and predictive tools in clinical decision making.
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Affiliation(s)
| | - Romain Mathieu
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Solène-Florence Kammerer-Jacquet
- Department of Urology, Rennes University Hospital, Rennes, France;; Department of Pathology, Rennes University Hospital, Rennes, France
| | - Thomas Seisen
- Academic Department of Urology, Pitié-Salpêtrière University Hospital, Paris, France; ; GRC 5, ONCOTYPE-Uro, University Institute of Oncology, UMPC University Paris 6, Paris, France
| | - Morgan Roupret
- Academic Department of Urology, Pitié-Salpêtrière University Hospital, Paris, France; ; GRC 5, ONCOTYPE-Uro, University Institute of Oncology, UMPC University Paris 6, Paris, France
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; ; Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA; ; Department of Urology, Weill Cornell Medical College, New York, NY, USA; ; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Benoit Peyronnet
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Karim Bensalah
- Department of Urology, Rennes University Hospital, Rennes, France
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Yao L, Yang K, Li X, Zhang Z, Zhang C, Gong K, Xi Z, He Z, Zhou L. Comparison between completely and traditionally retroperitoneoscopic nephroureterectomy for upper tract urothelial cancer. World J Surg Oncol 2016; 14:171. [PMID: 27349891 PMCID: PMC4924241 DOI: 10.1186/s12957-016-0924-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/15/2016] [Indexed: 11/15/2022] Open
Abstract
Background To evaluate the safety and efficacy of the completely retroperitoneoscopic nephroureterectomy (CRNU), a retrospectively comparative study between completely and traditionally retroperitoneoscopic nephroureterectomy (TRNU) was done in a single center. Methods From January 2014 to December 2014, 107 patients with upper tract urothelial cancer (UTUC) underwent CRNU. The kidney was retroperitoneoscopically dissected and the bladder cuff was cut by endoscopic gastrointestinal automatic stapler, and the specimen was removed from a 6-cm incision by posterior axillary line. Demographic, perioperative, and follow-up data were collected and compared retrospectively with 110 patients undergoing TRNU. Results The patients’ characteristics between the two groups were not statistically different (p > 0.05), and all patients successfully received the procedure. The mean operative time (106 ± 37.9 versus 199 ± 69.1 min, p < 0.0001), the mean estimated blood loss (47.2 ± 82.4 versus 166.9 ± 250.9 ml, p = 0.002), and the mean hospital stay (6.1 ± 3.5 versus 8.1 ± 3.3 days, p = 0.03) of the CRNU group decreased significantly compared to the traditional group. The operative time was not affected by gender. No open conversion and major complications occurred. The surgical margin of the ureter was all negative. The mean follow-up time was 13.4 months for the CRNU group and 37.5 months for the TRNU group. All follow-up patients in the CRNU group were alive without local recurrence. No cases of port site metastasis and local recurrence were observed in both groups. Bladder tumor recurrence occurred in 4 patients of the CRNU group and 21 patients of the TRNU group. Conclusions The CRNU using an endoscopic gastrointestinal automatic stapler to manage the bladder cuff is feasible and advantageous in decreasing the operative time, the blood loss, and the hospital stay. However, a larger sample and longer follow-up time will be still required.
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Affiliation(s)
- Lin Yao
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Zheng Zhang
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. .,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. .,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
| | - Cuijian Zhang
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Kan Gong
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Zhijun Xi
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Zhisong He
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. .,Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China. .,National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing, 100034, China.
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