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Ditonno F, Franco A, Veccia A, Bertolo R, Wu Z, Wang L, Abdollah F, Finati M, Simone G, Tuderti G, Helstrom E, Correa A, De Cobelli O, Ferro M, Porpiglia F, Amparore D, Tufano A, Perdonà S, Bhanvadia R, Margulis V, Brönimann S, Singla N, Puri D, Derweesh IH, Mendiola DF, Gonzalgo ML, Ben-David R, Mehrazin R, Moon SC, Rais-Bahrami S, Yong C, Sundaram CP, Moghaddam FS, Ghoreifi A, Djaladat H, Autorino R, Antonelli A. Decisional and prognostic impact of diagnostic ureteroscopy in high-risk upper tract urothelial carcinoma: A multi-institutional collaborative analysis (ROBUUST collaborative group). Urol Oncol 2024; 42:290.e1-290.e9. [PMID: 38760274 DOI: 10.1016/j.urolonc.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/11/2024] [Accepted: 04/20/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Diagnostic ureteroscopy (URS) with or without biopsy remains a subject of contention in the management of upper tract urothelial carcinoma (UTUC), with varying recommendations across different guidelines. The study aims to analyse the decision-making and prognostic role of diagnostic ureteroscopy (URS) in high-risk UTUC patients undergoing curative surgery. MATERIALS AND METHODS In this retrospective multi-institutional analysis of high-risk UTUC patients from the ROBUUST dataset, a comparison between patients who received or not preoperative URS and biopsy before curative surgery was carried out. Logistic regression analysis evaluated differences between patients receiving URS and its impact on treatment strategy. Survival analysis included 5-year recurrence-free survival (RFS), metastasis-free survival (MFS), cancer-specific survival (CSS) and overall survival (OS). After adjusting for high-risk prognostic group features, Cox proportional hazard model estimated significant predictors of time-to-event outcomes. RESULTS Overall, 1,912 patients were included, 1,035 with preoperative URS and biopsy and 877 without. Median follow-up: 24 months. Robot-assisted radical nephroureterectomy was the most common procedure (55.1%), in both subgroups. The 5-year OS (P = 0.04) and CSS (P < 0.001) were significantly higher for patients undergoing URS. The 5-year RFS (P = 0.6), and MFS (P = 0.3) were comparable between the 2 groups. Preoperative URS and biopsy were neither a significant predictor of worse oncological outcomes nor of a specific treatment modality. CONCLUSIONS The advantage in terms of OS and CSS in patients undergoing preoperative URS could derive from a better selection of candidates for curative treatment. The treatment strategy is likely more influenced by tumor features than by URS findings.
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Affiliation(s)
- Francesco Ditonno
- University of Verona, Department of Urology, Verona, Italy; Rush University, Department of Urology, Chicago, IL
| | - Antonio Franco
- Rush University, Department of Urology, Chicago, IL; Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
| | | | | | - Zhenjie Wu
- Changhai Hospital Naval Medical University, Department of Urology, Shanghai, China
| | - Linhui Wang
- Changhai Hospital Naval Medical University, Department of Urology, Shanghai, China
| | - Firas Abdollah
- Henry Ford Hospital, Vattikuti Urology Institute, Detroit, MI
| | - Marco Finati
- Henry Ford Hospital, Vattikuti Urology Institute, Detroit, MI
| | - Giuseppe Simone
- IRCCS Regina Elena National Cancer Institute, Department of Urology, Rome, Italy
| | - Gabriele Tuderti
- IRCCS Regina Elena National Cancer Institute, Department of Urology, Rome, Italy
| | - Emma Helstrom
- Fox Chase Cancer Center, Department of Urology, Philadelphia, PA
| | - Andres Correa
- Fox Chase Cancer Center, Department of Urology, Philadelphia, PA
| | | | - Matteo Ferro
- European Institute of Oncology IRCCS, Division of Urology, Milan, Italy
| | - Francesco Porpiglia
- University of Turin San Luigi Gonzaga Hospital, Division of Urology, Turin, Italy
| | - Daniele Amparore
- University of Turin San Luigi Gonzaga Hospital, Division of Urology, Turin, Italy
| | - Antonio Tufano
- Istituto Nazionale Tumori Fondazione Pascale, Department of Urology, Naples, Italy
| | - Sisto Perdonà
- Istituto Nazionale Tumori Fondazione Pascale, Department of Urology, Naples, Italy
| | - Raj Bhanvadia
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX
| | - Vitaly Margulis
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX
| | - Stephan Brönimann
- John Hopkins University, The James Buchanan Brady Urological Institute, Baltimore, MD
| | - Nirmish Singla
- John Hopkins University, The James Buchanan Brady Urological Institute, Baltimore, MD
| | - Dhruv Puri
- UC San Diego School of Medicine, Department of Urology, La Jolla, CA
| | - Ithaar H Derweesh
- UC San Diego School of Medicine, Department of Urology, La Jolla, CA
| | - Dinno F Mendiola
- University of Miami Miller School of Medicine, Desai Sethi Urology Institute, Miami, FL
| | - Mark L Gonzalgo
- University of Miami Miller School of Medicine, Desai Sethi Urology Institute, Miami, FL
| | - Reuben Ben-David
- Icahn School of Medicine at Mount Sinai Hospital, Department of Urology, New York, NY
| | - Reza Mehrazin
- Icahn School of Medicine at Mount Sinai Hospital, Department of Urology, New York, NY
| | - Sol C Moon
- Department of Urology, University of Alabama, Heersink School of Medicine, Birmingham, AL
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama, Heersink School of Medicine, Birmingham, AL
| | - Courtney Yong
- Indiana University, Department of Urology, Indianapolis, IN
| | | | - Farshad Sheybaee Moghaddam
- Norris Comprehensive Cancer Center University of Southern California, Institute of Urology, Los Angeles, CA
| | - Alireza Ghoreifi
- Norris Comprehensive Cancer Center University of Southern California, Institute of Urology, Los Angeles, CA
| | - Hooman Djaladat
- Norris Comprehensive Cancer Center University of Southern California, Institute of Urology, Los Angeles, CA
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Ditonno F, Franco A, Veccia A, Bologna E, Wang L, Abdollah F, Finati M, Simone G, Tuderti G, Helstrom E, Correa A, DE Cobelli O, Ferro M, Porpiglia F, Amparore D, Tufano A, Perdonà S, Bhanvadia R, Margulis V, Brönimann A, Singla N, Puri D, Derweesh IH, Mendiola DF, Gonzalgo ML, Ben-David R, Mehrazin R, Moon SC, Rais-Bahrami S, Yong C, Moghaddam FS, Ghoreifi A, Sundaram CP, Wu Z, Djaladat H, Antonelli A, Autorino R. Robotic distal ureterectomy for high-risk distal ureteral urothelial carcinoma: a retrospective multicenter comparative analysis (ROBUUST 2.0 collaborative group). Minerva Urol Nephrol 2024; 76:331-339. [PMID: 38920013 DOI: 10.23736/s2724-6051.24.05737-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
BACKGROUND The role of kidney-sparing surgery in patients with high-risk upper urinary tract urothelial carcinoma is controversial. The present study aimed to assess oncological and functional outcomes of robot-assisted distal ureterectomy in patients with high-risk distal ureteral tumors. METHODS The ROBUUST 2.0 multicenter international (2015-2022) dataset was used for this retrospective cohort analysis. High-risk patients with distal ureteral tumors were divided based on type of surgery: robot-assisted distal ureterectomy or robot-assisted nephroureterectomy. A survival analysis was performed for local recurrence-free survival, distant metastasis-free survival, and overall survival. After adjusting for clinical features of the high-risk prognostic group, Cox proportional hazard model was plotted to evaluate significant predictors of time-to-event outcomes. RESULTS Overall, 477 patients were retrieved, of which 58 received robot-assisted distal ureterectomy and 419 robot-assisted nephroureterectomy, respectively, with a mean (±SD) follow-up of 29.6 months (±2.6). The two groups were comparable in terms of baseline features. At survival analysis, no significant difference was observed in terms of recurrence-free survival (P=0.6), metastasis-free survival (P=0.5) and overall survival (P=0.7) between robot-assisted distal ureterectomy and robot-assisted nephroureterectomy. At Cox regression analysis, type of surgery was never a significant predictor of worse oncological outcomes. At last follow-up patients undergoing robot-assisted distal ureterectomy had significantly better postoperative renal function. CONCLUSIONS Comparable outcomes in terms of recurrence-free survival, metastasis-free survival, and overall survival between robot-assisted distal ureterectomy and robot-assisted nephroureterectomy patients, and better postoperative renal function preservation in the former group were observed. Kidney-sparing surgery should be considered as a potential option for selected patients with high-risk distal ureteral UTUC.
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Affiliation(s)
- Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, University of Verona, Verona, Italy
| | - Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | | | - Eugenio Bologna
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
| | - Linhui Wang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Marco Finati
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - Ottavio DE Cobelli
- Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy
| | - Francesco Porpiglia
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Daniele Amparore
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Antonio Tufano
- Istituto Nazionale Tumori (INT), IRCCS G. Pascale Foundation, Naples, Italy
| | - Sisto Perdonà
- Istituto Nazionale Tumori (INT), IRCCS G. Pascale Foundation, Naples, Italy
| | - Raj Bhanvadia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Andres Brönimann
- School of Medicine, Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Nirmish Singla
- School of Medicine, Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Dhruv Puri
- UC San Diego School of Medicine, Department of Urology, La Jolla, CA, USA
| | - Ithaar H Derweesh
- UC San Diego School of Medicine, Department of Urology, La Jolla, CA, USA
| | - Dinno F Mendiola
- Miller School of Medicine, Desai Sethi Urology Institute, University of Miami, Miami, FL, USA
| | - Mark L Gonzalgo
- Miller School of Medicine, Desai Sethi Urology Institute, University of Miami, Miami, FL, USA
| | - Reuben Ben-David
- Icahn School of Medicine, Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | - Reza Mehrazin
- Icahn School of Medicine, Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | - Sol C Moon
- Heersink School of Medicine, Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soroush Rais-Bahrami
- Heersink School of Medicine, Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Courtney Yong
- Department of Urology, Indiana University, Indianapolis, IN, USA
| | - Farshad Sheybaee Moghaddam
- Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Alireza Ghoreifi
- Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | | | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Hooman Djaladat
- Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USA
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Nakamoto T, Yoshida T, Katayama S, Ohe C, Kawaura T, Horii S, Ikeda J, Kono Y, Murota T, Kitawaki T, Araki M, Kinoshita H. Development and Validation of a Preoperative Nomogram for Endoscopic Management Decision Making in Upper Urinary Tract Urothelial Carcinoma. Ann Surg Oncol 2024; 31:1393-1401. [PMID: 37925655 DOI: 10.1245/s10434-023-14514-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE We aimed to develop and validate a preoperative nomogram that predicts low-grade, non-muscle invasive upper urinary tract urothelial carcinoma (LG-NMI UTUC), thereby aiding in the accurate selection of endoscopic management (EM) candidates. METHODS This was a retrospective study that included 454 patients who underwent radical surgery (Cohort 1 and Cohort 2), and 26 patients who received EM (Cohort 3). Utilizing a multivariate logistic regression model, a nomogram predicting LG-NMI UTUC was developed based on data from Cohort 1. The nomogram's accuracy was compared with conventional European Association of Urology (EAU) and National Comprehensive Cancer Network (NCCN) models. External validation was performed using Cohort 2 data, and the nomogram's prognostic value was evaluated via disease progression metrics in Cohort 3. RESULTS In Cohort 1, multivariate analyses highlighted the absence of invasive disease on imaging (odds ratio [OR] 7.04; p = 0.011), absence of hydronephrosis (OR 2.06; p = 0.027), papillary architecture (OR 24.9; p < 0.001), and lack of high-grade urine cytology (OR 0.22; p < 0.001) as independent predictive factors for LG-NMI disease. The nomogram outperformed the two conventional models in predictive accuracy (0.869 vs. 0.759-0.821) and exhibited a higher net benefit in decision curve analysis. The model's clinical efficacy was corroborated in Cohort 2. Moreover, the nomogram stratified disease progression-free survival rates in Cohort 3. CONCLUSION Our nomogram ( https://kmur.shinyapps.io/UTUC_URS/ ) accurately predicts LG-NMI UTUC, thereby identifying suitable candidates for EM. Additionally, the model serves as a useful tool for prognostic stratification in patients undergoing EM.
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Affiliation(s)
- Takahiro Nakamoto
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
- Department of Pathology, Kansai Medical University Hospital, Osaka, Japan
| | - Takashi Yoshida
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
- Corporate Sponsored Research Programs for Multicellular Interactions in Cancer, Kansai Medical University, Osaka, Japan.
- Faculty of Engineering, Tottori University Graduate School of Engineering, Tottori, Japan.
| | - Satoshi Katayama
- Department of Urology, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Chisato Ohe
- Department of Pathology, Kansai Medical University Hospital, Osaka, Japan
- Corporate Sponsored Research Programs for Multicellular Interactions in Cancer, Kansai Medical University, Osaka, Japan
| | - Takayuki Kawaura
- Department of Mathematics, Kansai Medical University, Osaka, Japan
| | - Satoshi Horii
- Department of Urology, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Junichi Ikeda
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Yumiko Kono
- Department of Radiology, Kansai Medical University, Osaka, Japan
| | - Takashi Murota
- Department of Urology and Andrology, General Medical Center, Kansai Medical University, Osaka, Japan
| | - Tomoki Kitawaki
- Department of Mathematics, Kansai Medical University, Osaka, Japan
| | - Motoo Araki
- Department of Urology, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
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Bitaraf M, Ghafoori Yazdi M, Amini E. Upper Tract Urothelial Carcinoma (UTUC) Diagnosis and Risk Stratification: A Comprehensive Review. Cancers (Basel) 2023; 15:4987. [PMID: 37894354 PMCID: PMC10605461 DOI: 10.3390/cancers15204987] [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: 08/18/2023] [Revised: 09/22/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Diagnosis and risk stratification are cornerstones of therapeutic decisions in the management of patients with upper tract urothelial carcinoma (UTUC). Diagnostic modalities provide data that can be integrated, to provide nomograms and stratification tools to predict survival and adverse outcomes. This study reviews cytology, ureterorenoscopy and the novel tools and techniques used with it (including photodynamic diagnosis, narrow-band imaging, optical coherence tomography, and confocal laser endomicroscopy), and biopsy. Imaging modalities and novel biomarkers are discussed in another article. Patient- and tumor-related prognostic factors, their association with survival indices, and their roles in different scores and predictive tools are discussed. Patient-related factors include age, sex, ethnicity, tobacco consumption, surgical delay, sarcopenia, nutritional status, and several blood-based markers. Tumor-related prognosticators comprise stage, grade, presentation, location, multifocality, size, lymphovascular invasion, surgical margins, lymph node status, mutational landscape, architecture, histologic variants, and tumor-stroma ratio. The accuracy and validation of pre-operative predictive tools, which incorporate various prognosticators to predict the risk of muscle-invasive or non-organ confined disease, and help to decide on the surgery type (radical nephroureterectomy, or kidney-sparing procedures) are also investigated. Post-operative nomograms, which help decide on adjuvant chemotherapy and plan follow-up are explored. Finally, a revision of the current stratification of UTUC patients is endorsed.
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Affiliation(s)
| | | | - Erfan Amini
- Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran 1419733141, Iran; (M.B.); (M.G.Y.)
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Ghoreifi A, Sari Motlagh R, Fuchs G. Modern Kidney-Sparing Management of Upper Tract Urothelial Carcinoma. Cancers (Basel) 2023; 15:4495. [PMID: 37760465 PMCID: PMC10526335 DOI: 10.3390/cancers15184495] [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: 08/18/2023] [Revised: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE To review the latest evidence on the modern techniques and outcomes of kidney-sparing surgeries (KSS) in patients with upper tract urothelial carcinoma (UTUC). METHODS A comprehensive literature search on the study topic was conducted before 30 April 2023 using electronic databases including PubMed, MEDLINE, and EMBASE. A narrative overview of the literature was then provided based on the extracted data and a qualitative synthesis of the findings. RESULTS KSS is recommended for low- as well as select high-risk UTUCs who are not eligible for radical treatments. Endoscopic ablation is a KSS option that is associated with similar oncological outcomes compared with radical treatments while preserving renal function in well-selected patients. The other option in this setting is distal ureterectomy, which has the advantage of providing a definitive pathological stage and grade. Data from retrospective studies support the superiority of this approach over radical treatment with similar oncological outcomes, albeit in select cases. Novel chemoablation agents have also been studied in the past few years, of which mitomycin gel has received FDA approval for use in low-risk UTUCs. CONCLUSION KSSs are acceptable approaches for patients with low- and select high-risk UTUCs, which preserve renal function without compromising the oncological outcomes.
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Affiliation(s)
- Alireza Ghoreifi
- Institute of Urology, University of Southern California, Los Angeles, CA 90089, USA;
| | | | - Gerhard Fuchs
- Institute of Urology, University of Southern California, Los Angeles, CA 90089, USA;
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Baboudjian M, Territo A, Gallioli A, Verri P, Aumatell J, Izquierdo P, Uleri A, Tedde A, Basile G, Gaya JM, Huguet J, Rodriguez-Faba O, Sanguedolce F, Algaba F, Palou J, Breda A. Long-Term Oncologic Outcomes of Endoscopic Management of High-Risk Upper Tract Urothelial Carcinoma: The Fundació Puigvert's Experience. J Endourol 2023; 37:973-977. [PMID: 37310884 DOI: 10.1089/end.2023.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Objectives: Many patients with upper tract urothelial carcinoma (UTUC) outside of the low-risk criteria may possess low absolute risks of distant progression. Herein, we hypothesized that careful selection of high-risk patients undergoing an endoscopic approach could result in acceptable oncologic outcomes. Materials and Methods: Patients with high-risk UTUC managed endoscopically between 2015 and 2021 were retrospectively identified from a prospectively maintained single academic institution database. Elective and imperative indications for endoscopic treatment were considered. Regarding elective indications, the decision to perform endoscopic treatment was systematically proposed to high-risk patients in whom macroscopically complete ablation was deemed feasible, excluding invasive appearance on CT scan, and without histologic variant. Results: A total of 60 patients with high-risk UTUC met our inclusion criteria (29 imperative and 31 elective indications). The median follow-up in patients without any event was 36 months. At 5 years, the estimated overall survival, cancer-specific survival, metastasis-free survival, UTUC recurrence-free survival, radical nephroureterectomy-free survival, and bladder recurrence-free survival were 57% (41-79), 75% (57-99), 86% (71-100), 56% (40-76), 81% (70-93), and 69% (54-88), respectively. All oncologic outcomes were similar between patients with elective and imperative indications (all log-rank p > 0.05). Conclusions: In conclusion, we report the first large series of endoscopic treatment in patients with high-risk UTUC, arguing that promising oncologic outcomes can be achieved in properly selected candidates. We encourage multi-institutional collaborative work as a large cohort of high-risk patients treated endoscopically may allow subgroup analyses to define the best candidates.
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Affiliation(s)
- Michael Baboudjian
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
- Department of Urology, APHM, North Academic Hospital, Marseille, France
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Paolo Verri
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Julia Aumatell
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Paula Izquierdo
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Alessandro Uleri
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Alessandro Tedde
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Giuseppe Basile
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
- Department of Urology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Josep Maria Gaya
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Jorge Huguet
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Oscar Rodriguez-Faba
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Francesco Sanguedolce
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Ferran Algaba
- Department of Pathology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
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Yoshida T, Ohe C, Nakamoto T, Kinoshita H. Learning from the past and present to change the future: Endoscopic management of upper urinary tract urothelial carcinoma. Int J Urol 2023; 30:634-647. [PMID: 37294007 DOI: 10.1111/iju.15208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023]
Abstract
Current guidelines recommend endoscopic management (EM) for patients with low-risk upper urinary tract urothelial carcinoma, as well as those with an imperative indication. However, regardless of the tumor risk, radical nephroureterectomy is still mainly performed worldwide despite the benefits of EM, such as renal function maintenance, no hemodialysis requirement, and treatment cost reduction. This might be explained by the association of EM with a high risk of local recurrence and progression. Furthermore, the need for rigorous patient selection and close surveillance following EM may be relevant. Nevertheless, recent developments in diagnostic modalities, pathological evaluation, surgical devices and techniques, and intracavitary regimens have been reported, which may contribute to improved risk stratification and treatments with superior oncological outcomes. In this review, considering recent advances in endourology and oncology, we propose novel treatment strategies for optimal EM.
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Affiliation(s)
- Takashi Yoshida
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
- Corporate Sponsored Research Programs for Multicellular Interactions in Cancer, Kansai Medical University, Osaka, Japan
| | - Chisato Ohe
- Corporate Sponsored Research Programs for Multicellular Interactions in Cancer, Kansai Medical University, Osaka, Japan
- Department of Pathology, Kansai Medical University, Osaka, Japan
| | - Takahiro Nakamoto
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
- Department of Pathology, Kansai Medical University, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
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Jiang Y, Peng Y, Ding S, Zheng Y, He Y, Liu J. Kidney‐sparing surgery for distal high‐risk ureteral carcinoma: Clinical efficacy and preliminary experiences in 22 patients. Cancer Med 2022; 12:7835-7843. [PMID: 36533431 PMCID: PMC10134309 DOI: 10.1002/cam4.5544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Several groups proved kidney-sparing surgery (KSS) had equivalent oncological outcomes compared with radical nephroureterectomy (RNU) for the low-risk upper urinary tract urothelial carcinoma (UTUC) patients. Whereas, the clinical efficacy of KSS for high-risk UTUC, especially for distal high-risk ureteral carcinoma, remains unclear. OBJECTIVE To evaluate the feasibility of KSS for patients with distal high-risk ureter cancer. MATERIALS AND METHODS Our study included 22 patients who diagnose the distal high-risk ureter cancer and underwent KSS between May 2012 and July 2021 in the First Affiliated Hospital of Chongqing Medical University. Overall survival (OS), confirmed as the primary endpoint of present study, was assessed by a blinded independent review committee (BIRC). The secondary endpoints included the postoperative SF-36 (the short form 36 health survey questionnaire) score, progression-free survival (PFS), postoperative complications, and so on. RESULTS Overall, 17 (77.3%) and 5 (22.7%) patients underwent segmental ureterectomy (SU) and endoscopic ablation (EA), respectively. By the cut-off date, the mean OS was 76.3 months (95% Cl: 51.3-101.1 months) and the mean PFS was 47.0 months (95% Cl: 31.1-62.8 months), respectively. And the SF-36 score in a majority of patients was >300 (90.9%). CONCLUSION This is a daring endeavor to explore the clinical efficacy of KSS in distal high-risk ureter cancer based on the high-risk UTUC criteria, which shows satisfactory results in the long-term prognosis and operation-associated outcomes. However, future randomized or prospective multicenter studies are necessary to validate our conclusions.
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Affiliation(s)
- Yu Jiang
- Department of Urology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Yueqiang Peng
- Department of Urology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Siwei Ding
- Department of Urology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Yongbo Zheng
- Department of Urology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Yunfeng He
- Department of Urology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Jiayu Liu
- Department of Urology The First Affiliated Hospital of Chongqing Medical University Chongqing China
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Masson-Lecomte A, Vaillant V, Roumiguié M, Lévy S, Pradère B, Peyromaure M, Duquesne I, De La Taille A, Lebâcle C, Panis A, Traxer O, Leon P, Hulin M, Xylinas E, Audenet F, Seisen T, Loriot Y, Allory Y, Rouprêt M, Neuzillet Y. Oncological Outcomes of Distal Ureterectomy for High-Risk Urothelial Carcinoma: A Multicenter Study by The French Bladder Cancer Committee. Cancers (Basel) 2022; 14:cancers14215452. [PMID: 36358870 PMCID: PMC9656759 DOI: 10.3390/cancers14215452] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/19/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022] Open
Abstract
Simple Summary Radical nephroureterectomy (RNU) is the standard treatment for high-risk upper tract urothelial carcinoma (UTUC). It implies significant reduction in the renal function, compromising adjuvant chemotherapy administration and leading to risk of end stage renal disease in frail patients. Distal ureterectomy (DU) might be an alternative for tumors of the distal ureter but its indications remain unclear mainly due to concern about potential upper tract recurrences. The objective of our retrospective study was to determine the oncologic outcomes of DU for high-risk UTUC of the pelvic ureter, and to assess factors associated with recurrence in the particular population. We showed that oncological outcomes after DU were similar to those after RNU. Some of the classical prognostic factors after RNU were not identified in this cohort, pinpointing the necessity to consider tumors of the distal ureter as a specific entity. Abstract Upper urinary tract urothelial carcinoma (UTUC) is an uncommon disease and its gold-standard treatment is radical nephroureterectomy (RNU). Distal ureterectomy (DU) might be an alternative for tumors of the distal ureter but its indications remain unclear. Here, we aimed to evaluate the oncological outcomes of DU for UTUC of the pelvic ureter. We performed a multicenter retrospective analysis of patients with UTUC who underwent DU. The primary endpoint was 5-year cancer-specific survival (CSS), followed by overall survival (OS), intravesical recurrence-free (IVR) and homolateral urinary tract recurrence-free (HUR) survivals as secondary endpoints. Univariate and multivariate Cox regressions were performed to assess factors associated with outcomes. 155 patients were included, 91% of which were high-risk. 5-year CSS was 84.4%, OS was 71.9%, IVR-free survival was 43.6% and HUR-free survival was 74.4%. Multifocality, high grade and tumor size were the most significant predictors of survival endpoints. Of note, neither hydronephrosis nor pre-operative diagnostic ureteroscopy/JJ stent were associated with any of the endpoints. Perioperative morbidity was minimal. In conclusion, DU stands as a possible alternative to RNU for UTUC of the pelvic ureter. Close monitoring is mandatory due to the high risk of recurrence in the remaining urinary tract.
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Affiliation(s)
- Alexandra Masson-Lecomte
- Department of Urology, APHP, Hôpital Saint Louis, 75010 Paris, France
- Inserm, CEA, HIPI, Université Paris Cité, 75475 Paris, France
- Correspondence:
| | - Victoire Vaillant
- Department of Urology, APHP, Hôpital Henri Mondor, Université Paris-Est Créteil, 94000 Créteil, France
| | - Mathieu Roumiguié
- Department of Urology, CHU de Toulouse, UPS, Université de Toulouse, 31000 Toulouse, France
| | - Stéphan Lévy
- Department of Urology, CHU de Toulouse, UPS, Université de Toulouse, 31000 Toulouse, France
| | - Benjamin Pradère
- Department of Urology-UROSUD, La Croix du Sud Hospital, 31130 Quint-Fonsegrives, France
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Michaël Peyromaure
- Department of Urology, APHP, Hôpital Cochin, Université Paris Cité, 75014 Paris, France
| | - Igor Duquesne
- Department of Urology, APHP, Hôpital Cochin, Université Paris Cité, 75014 Paris, France
| | - Alexandre De La Taille
- Department of Urology, APHP, Hôpital Henri Mondor, Université Paris-Est Créteil, 94000 Créteil, France
| | - Cédric Lebâcle
- Department of Urology, APHP, Hôpital Bicêtre, Université Paris Sud-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - Adrien Panis
- Department of Urology, APHP, Hôpital Bicêtre, Université Paris Sud-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - Olivier Traxer
- GRC 10 Lithiase Urinaire, Department of Urology, APHP, Tenon Hospital, Sorbonne University, 75020 Paris, France
| | - Priscilla Leon
- Department of Urology, clinique Pasteur, 17200 Royan, France
| | - Maud Hulin
- Department of Urology, clinique Pasteur, 17200 Royan, France
| | - Evanguelos Xylinas
- Department of Urology, APHP, Hôpital Bichat Claude-Bernard, Université Paris Cité, 75014 Paris, France
| | - François Audenet
- Department of Urology, APHP, Hôpital Européen Georges Pompidou, Université Paris Cité, 75014 Paris, France
| | - Thomas Seisen
- GRC 5 Predictive Onco-Urology, Department of Urology, APHP, Pitié Salpêtrière Hospital, Sorbonne University, 75013 Paris, France
| | - Yohann Loriot
- Department of Cancer Medicine, INSERM U981, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Yves Allory
- Department of Pathology, Curie Institute, University of Paris-Saclay–UVSQ, 92210 Saint-Cloud, France
| | - Morgan Rouprêt
- GRC 5 Predictive Onco-Urology, Department of Urology, APHP, Pitié Salpêtrière Hospital, Sorbonne University, 75013 Paris, France
| | - Yann Neuzillet
- Department of Urology, Hôpital Foch, University of Paris-Saclay–UVSQ, 92150 Suresnes, France
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10
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Lonati C, Suardi N. Re: Novel Classification for Upper Tract Urothelial Carcinoma to Better Risk-stratify Patients Eligible for Kidney-sparing Strategies: An International Collaborative Study. Eur Urol 2022; 82:574. [PMID: 35965207 DOI: 10.1016/j.eururo.2022.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Chiara Lonati
- Urology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy.
| | - Nazareno Suardi
- Urology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
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Hendriks N, Baard J, Beerlage HP, Schout BM, Doherty KS, Pelger RC, Kamphuis GM. Survival and Long-term Effects of Kidney-sparing Surgery Versus Radical Nephroureterectomy on Kidney Function in Patients with Upper Urinary Tract Urothelial Carcinoma. EUR UROL SUPPL 2022; 40:104-111. [PMID: 35638087 PMCID: PMC9142752 DOI: 10.1016/j.euros.2022.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 12/04/2022] Open
Abstract
Background Current European Association of Urology (EAU) guidelines discriminate between high- and low-risk upper urinary tract urothelial carcinoma (UTUC) to determine treatment by means of radical nephroureterectomy (RNU) or kidney-sparing surgery (KSS). Objective To compare long-term oncological outcomes and renal function for patients with UTUC treated by RNU versus KSS. Design, setting, and participants A retrospective cohort study, including 186 renal units with nonmetastatic UTUC treated in a tertiary referral centre between 2010 and 2021, was conducted. Intervention RNU, ureterorenoscopy, percutaneous tumour resection, and segmental ureteral resection. Outcome measurements and statistical analysis Recurrence-free survival, metastasis-free survival (MFS), overall survival (OS), cancer-specific survival (CSS), and renal function were analysed by means of the log-rank test and the independent-sample t test. Results and limitations OS was 71.1% for the RNU group and 81.9% for the KSS group. In a cohort matched for propensity weight based on EAU risk stratification progression-free survival (PFS; RNU 96.0%; KSS 86.0%), MFS (RNU 72.0%; KSS 84.0%), CSS (RNU 84.0%; KSS 86.0%), and OS (RNU 76.0%; KSS 76.0%) were all similar between both groups. No significant differences in renal function were seen at 2 and 5 yr after the intervention. Although this series represents the largest cohort of (high-risk) UTUC patients treated by means of KSS to date, it is not suitable for performing a multivariate analysis. Conclusions PFS, MFS, CSS, and OS were all comparable when analysing the RNU and KSS groups. Similar results for groups with evenly distributed risk factors and a large percentage of high-risk disease suggest that current risk stratification might not be accurate in discriminating low-risk from high-risk disease. Patient summary In this report, we looked at outcomes for upper urinary tract urothelial carcinoma in a specialised hospital. We conclude that kidney-sparing surgery and radical nephroureterectomy have comparable outcomes and that risk factors for worse outcome might not be identified correctly.
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Gao X, Zhou L, Ai J, Wang W, Di X, Peng L, Liao B, Jin X, Li H, Wang K. The Impact of Diabetes on the Prognosis of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:741145. [PMID: 34733784 PMCID: PMC8558518 DOI: 10.3389/fonc.2021.741145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/04/2021] [Indexed: 02/05/2023] Open
Abstract
Background Studies have reported that diabetes is related to the prognosis of upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU), but this conclusion is still controversial. Here, we performed a meta-analysis to comprehensively explore the association between diabetes and UTUC prognosis. Methods In November 2020, we searched PubMed, Web of science and the Cochrane Library to find relevant studies that evaluated the effect of diabetes on the prognosis of UTUC. The Newcastle Ottawa Scale was used to assess the quality of the literature. Review Manager 5.3 was used to pool cancer-specific survival (CSS), overall survival (OS), recurrence-free survival (RFS) and intravesical recurrence (IVR). Results A total of 10 studies with 11,303 patients were included in this meta-analysis. Our pooled results showed that diabetes did not affect the survival outcome of UTUC, including CSS (HR: 1.33, 95% CI: 0.89-1.98; P = 0.16), OS (HR: 1.18, 95% CI: 0.77-1.80; P = 0.45) and RFS (HR: 1.37, 95% CI: 0.91-2.05; P = 0.13). However, diabetes increased the risk of IVR of UTUC patients (HR: 1.26, 95% CI: 1.11-1.43; P = 0.0004). Conclusion Although diabetes has no significant impact on the survival outcomes of UTUC after RNU, it increases the risk of IVR. Therefore, special attention should be paid to monitoring the IVR for UTUC patients with diabetes and the necessity of appropriate intravesical adjuvant treatment when needed.
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Affiliation(s)
- Xiaoshuai Gao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Liang Zhou
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Jianzhong Ai
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Wei Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Xingpeng Di
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Liao Peng
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Banghua Liao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Xi Jin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Kunjie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
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Cheng PY, Chung SD, Tsai CY. Concomitant carcinoma in situ is an independent prognostic predictor for patients with localized lymph node–negative upper-tract urothelial carcinoma undergoing nephroureterectomy. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211040711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: This study aimed to determine the predictive value of concomitant carcinoma in situ (CIS) for cancer-specific survival (CSS) in patients with upper-tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy. Methods: This was a retrospective analysis of the clinicopathological features in a cohort of 126 patients with localized lymph node–negative UTUC who underwent radical nephroureterectomy with bladder-cuff excision in a tertiary medical center between January 1, 2007, and June 30, 2018. Cox proportional hazards models were used to identify risk factors for CSS in UTUC. Additionally, Kaplan–Meier analyses were performed in subgroups according to pathological tumor stage. Results: The median age and follow-up duration were 70 years and 3.5 years, respectively. Concomitant CIS, which was present in 21% of the patient specimens, was not associated with most clinical or pathological features, except for lymphovascular invasion and multifocality. Concomitant CIS (adjusted hazard ratio (HR)=4.64, 95% confidence interval (CI) 1.78–12.06, p=0.002) and pathological tumor stage (adjusted HR=4.07, 95% CI 1.99–8.31, p<0.001) were significantly associated with CSS in the multivariate Cox regression model. In the subgroup analysis, concomitant CIS in patients with locally advanced (pT3/pT4) UTUC was associated with significantly worse CSS compared to those without CIS (HR=3.83, 95% CI 1.20–12.21). Conclusion: The pathological presence of concomitant CIS was independently associated with poor CSS in patients with localized lymph node–negative UTUC undergoing radical nephroureterectomy. These findings provide crucial information relevant for postoperative patient counseling, use of adjuvant therapy, follow-up intensity, and clinical trial enrollment. Level of evidence Level II.
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Affiliation(s)
- Pai-Yu Cheng
- Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, Taiwan
| | - Shiu-Dong Chung
- Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, Taiwan
- Graduate Program in Biomedical Informatics, College of Informatics, Yuan Ze University, Taiwan
| | - Chung-You Tsai
- Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, Taiwan
- Department of Healthcare Information and Management, Ming Chuan University, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taiwan
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