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Yong C, Slaven JE, Wu Z, Margulis V, Djaladat H, Antonelli A, Simone G, Bhanvadia R, Ghoreifi A, Moghaddam FS, Ditonno F, Tuderti G, Bronimann S, Dhanji S, Eilender B, Franco A, Finati M, Tozzi M, Helstrom E, Mendiola DF, Amparore D, Porpiglia F, Moon SC, Rais-Bahrami S, Derweesh I, Mehrazin R, Autorino R, Abdollah F, Ferro M, Correa A, Singla N, Gonzalgo ML, Sundaram CP. The impact of bladder cuff excision on outcomes after nephroureterectomy for upper tract urothelial carcinoma: An analysis of the ROBUUST 2.0 registry. Urol Oncol 2024; 42:373.e1-373.e7. [PMID: 39112105 DOI: 10.1016/j.urolonc.2024.06.001] [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: 03/20/2024] [Revised: 04/29/2024] [Accepted: 06/02/2024] [Indexed: 09/07/2024]
Abstract
OBJECTIVES We sought to determine whether bladder cuff excision and its technique influence outcomes after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). METHODS AND MATERIALS A multicenter, international, retrospective analysis using the ROBotic surgery for Upper tract Urothelial cancer Study (ROBUUST) 2.0 registry identified 1,718 patients undergoing RNU for UTUC between 2015 and 2023 at 17 centers across the United States, Europe, and Asia. Data was gathered on (1) whether bladder cuff excision was performed and (2) what technique was used, including formal excision or other techniques (pluck technique, stripping/intussusception technique) and outcomes. Multivariate and survival analyses were performed to compare the groups. RESULTS Most patients (90%, 1,540/1,718) underwent formal bladder cuff excision in accordance with EAU and AUA guidelines. Only 4% (68/1,718) underwent resection using other techniques, and 6% (110/1,718) did not have a bladder cuff excised. Median follow up for the cohort was 24 months (IQR 9-44). When comparing formal bladder cuff excision to other excision techniques, there were no differences in oncologic or survival outcomes including bladder recurrence-free survival (BRFS), recurrence-free survival (RFS), metastasis-free survival (MFS), overall survival (OS), or cancer-specific survival (CSS). However, excision of any kind conferred a decreased risk of bladder-specific recurrence compared to no excision. There was no difference in RFS, MFS, OS, or CSS when comparing bladder cuff excision, other techniques, and no excision. CONCLUSIONS Bladder cuff excision improves recurrence-free survival, particularly when considering bladder recurrence. This benefit is conferred regardless of technique, as long as the intramural ureter and ureteral orifice are excised. However, the benefit of bladder cuff excision on metastasis-free, overall, and cancer-specific survival is unclear.
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Affiliation(s)
- Courtney Yong
- Indiana University Department of Urology, Indianapolis, IN
| | - James E Slaven
- Indiana University Department of Biostatistics and Health Data Science, Indianapolis, IN
| | - Zhenjie Wu
- Changhai Hospital Naval Medical University Department of Urology, Shanghai, China
| | - Vitaly Margulis
- University of Texas Southwestern Medical Center Department of Urology, Dallas, TX
| | - Hooman Djaladat
- University of Southern California Norris Comprehensive Cancer Center, Institute of Urology, Los Angeles, CA
| | | | - Giuseppe Simone
- IRCCS Regina Elena National Cancer Institute Department of Urology, Rome, Italy
| | - Raj Bhanvadia
- University of Texas Southwestern Medical Center Department of Urology, Dallas, TX
| | - Alireza Ghoreifi
- University of Southern California Norris Comprehensive Cancer Center, Institute of Urology, Los Angeles, CA
| | - Farshad Sheybaee Moghaddam
- University of Southern California Norris Comprehensive Cancer Center, Institute of Urology, Los Angeles, CA
| | | | - Gabriele Tuderti
- IRCCS Regina Elena National Cancer Institute Department of Urology, Rome, Italy
| | - Stephan Bronimann
- Department of Urology, The Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Sohail Dhanji
- University of California San Diego School of Medicine Department of Urology, La Jolla CA
| | - Benjamin Eilender
- Icahn School of Medicine at Mount Sinai Hospital Department of Urology, New York, NY
| | | | - Marco Finati
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Marco Tozzi
- European Institute of Oncology (IEO)-IRCCS Division of Urology, Milan, Italy
| | | | - Dinno F Mendiola
- Department of Urology, Desai Sethi Urology Institute University of Miami Miller School of Medicine, Miami, FL
| | - Daniele Amparore
- Division of Urology, University of Turin San Luigi Gonzaga Hospital, Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, University of Turin San Luigi Gonzaga Hospital, Turin, Italy
| | - Sol C Moon
- Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL; Department of Radiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
| | - Ithaar Derweesh
- University of California San Diego School of Medicine Department of Urology, La Jolla CA
| | - Reza Mehrazin
- Icahn School of Medicine at Mount Sinai Hospital Department of Urology, New York, NY
| | | | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Matteo Ferro
- European Institute of Oncology (IEO)-IRCCS Division of Urology, Milan, Italy
| | | | - Nirmish Singla
- Departments of Urology and Oncology, The Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark L Gonzalgo
- Department of Urology, Desai Sethi Urology Institute University of Miami Miller School of Medicine, Miami, FL
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Chan KH, Shu T, Al Shaarani M, Cen P. Complete Pathologic Response With Pembrolizumab and Enfortumab Vedotin in Urothelial Carcinoma of the Upper Urinary Tract. J Investig Med High Impact Case Rep 2024; 12:23247096241257333. [PMID: 38804541 PMCID: PMC11135087 DOI: 10.1177/23247096241257333] [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: 04/16/2024] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
Urothelial carcinoma of the upper urinary tract (UTUC) presents a significant clinical challenge, often requiring aggressive surgical intervention for optimal management. We present a case of an 84-year-old woman with recurrent high-grade papillary UTUC of the left renal pelvis, refractory to prior endourologic interventions, who underwent neoadjuvant treatment with pembrolizumab and enfortumab vedotin (Pembro/EV) due to contraindications to cisplatin therapy. Following a favorable response to neoadjuvant therapy, the patient underwent laparoscopic left radical nephroureterectomy, achieving a pathologic complete response. We discuss the utility of Pembro/EV in the perioperative management of patients with UTUC, particularly in those ineligible for cisplatin-based therapy. In addition, we highlight the potential role of somatic mutation testing and the integration of novel therapeutic agents such as olaparib in personalized treatment strategies for UTUC. This case underscores the importance of exploring innovative treatment approaches and optimizing patient selection for kidney preservation strategies in the management of UTUC. Further research and clinical trials are warranted to elucidate the full therapeutic potential of Pembro/EV and other emerging therapies in this setting.
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Affiliation(s)
- Kok Hoe Chan
- University of Texas Health Science Center at Houston, USA
| | - Tung Shu
- University of Texas Health Science Center at Houston, USA
| | | | - Putao Cen
- University of Texas Health Science Center at Houston, USA
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Jiang D, Liu G, Yang B, Niu H, Fan H, Ren Z, Mu L, Xu X, Qiao X, Wu K, He D. 450-nm blue diode laser: a novel medical apparatus for upper tract urothelial lesions. World J Urol 2023; 41:3773-3779. [PMID: 37833548 PMCID: PMC10693503 DOI: 10.1007/s00345-023-04647-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE To explore the feasibility, safety and effectiveness of the 450-nm blue diode laser (BL), novel blue laser in the treatment of upper tract urothelial carcinomas (UTUCs) and other lesions in a porcine model. MATERIAL AND METHODS For in vitro experiment, the ureter tissue was vaporised and coagulated with BL, green-light laser (GL) and Ho:YAG laser (Ho). The efficiency, width and depth of vaporisation, and depth of coagulation were recorded and compared. For in vivo experiments, four swines weighing 70 kg were used. In the acute group, different modes of operations were performed to evaluate the thermal damage, perforation and bleeding. In the chronic group, the overall appearance of the ureter and laser wound healing were observed by the naked eyes and H&E staining 3 weeks after surgery. RESULTS In in vitro study, the BL showed a higher efficiency of tissue vaporisation and less tissue coagulation for fresh ureter compared to GL and Ho. In the in vivo study, the power of BL set at 7 W was better, and the thickness of thermal damage varied with different surgery types in the range of 74-306 μm. After 3 weeks, the wound healed well static in vaporisation (SV), moving vaporisation (MV) and H&E staining indicated mucosal healing rather than scar healing. CONCLUSION 5-10W blue diode laser achieved a higher efficiency of tissue vaporisation and less tissue coagulation in a porcine model, indicating its potential application in the endoscopic surgery of UTUC as an optional device with high performance and safety.
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Affiliation(s)
- Dali Jiang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, People's Republic of China
| | - Guoxiong Liu
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, People's Republic of China
- Department of Urology, Xianyang Central Hospital, Xianyang, 712000, People's Republic of China
| | - Bing Yang
- Xi'an Blueray Technology Co., Ltd., Xi'an, 710061, People's Republic of China
| | - Haoming Niu
- Xi'an Blueray Technology Co., Ltd., Xi'an, 710061, People's Republic of China
| | - Hengtong Fan
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, People's Republic of China
| | - Zejun Ren
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, People's Republic of China
| | - Liyue Mu
- Xi'an Blueray Technology Co., Ltd., Xi'an, 710061, People's Republic of China
| | - Xiaofeng Xu
- Department of Urology, Xianyang Central Hospital, Xianyang, 712000, People's Republic of China
| | - Ximin Qiao
- Department of Urology, Xianyang Central Hospital, Xianyang, 712000, People's Republic of China
| | - Kaijie Wu
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, People's Republic of China.
| | - Dalin He
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, People's Republic of China.
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Franco A, Ditonno F, Feng C, Manfredi C, Sturgis MR, Farooqi M, Del Giudice F, Coogan C, Ferro M, Zhang C, Wu Z, Yang B, Wang L, Autorino R. Minimally Invasive Radical Nephroureterectomy: 5-Year Update of Techniques and Outcomes. Cancers (Basel) 2023; 15:4585. [PMID: 37760553 PMCID: PMC10527300 DOI: 10.3390/cancers15184585] [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: 08/15/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
The gold standard treatment for non-metastatic upper tract urothelial cancer (UTUC) is represented by radical nephroureterectomy (RNU). The choice of surgical technique in performing UTUC surgery continues to depend on several factors, including the location and extent of the tumor, the patient's overall health, and very importantly, the surgeon's skill, experience, and preference. Although open and laparoscopic approaches are well-established treatments, evidence regarding robot-assisted radical nephroureterectomy (RANU) is growing. Aim of our study was to perform a critical review on the evidence of the last 5 years regarding surgical techniques and outcomes of minimally invasive RNU, mostly focusing on RANU. Reported oncological and function outcomes suggest that minimally invasive RNU is safe and effective, showing similar survival rates compared to the open approach.
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Affiliation(s)
- Antonio Franco
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
- Department of Urology, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, 37126 Verona, Italy
| | - Carol Feng
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Morgan R. Sturgis
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
| | - Mustafa Farooqi
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, Policlinico Umberto I Hospital, “Sapienza” University of Rome, 00161 Rome, Italy;
| | - Christopher Coogan
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology (IEO), IRCCS, 20141 Milan, Italy;
| | - Chao Zhang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (C.Z.); (Z.W.); (B.Y.); (L.W.)
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (C.Z.); (Z.W.); (B.Y.); (L.W.)
| | - Bo Yang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (C.Z.); (Z.W.); (B.Y.); (L.W.)
| | - Linhui Wang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (C.Z.); (Z.W.); (B.Y.); (L.W.)
| | - Riccardo Autorino
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
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Shi Y, Wang S, Liu W, Sherryn S, Lei Z, Yang L, Gao Q, Liu Z, Xu Z, Wan H, Zhang B. Single-Position Complete Retroperitoneoscopic Radical Nephroureterectomy with Bladder Cuff Excision for Upper Urinary Tract Urothelial Carcinoma. J Endourol 2023; 37:768-774. [PMID: 36641634 PMCID: PMC10354305 DOI: 10.1089/end.2022.0491] [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: 01/16/2023] Open
Abstract
Purpose: We proposed a new technique, single-position complete retroperitoneoscopic radical nephroureterectomy (SCRNU), which proved to be efficient for the treatment of upper urinary tract urothelial carcinoma (UTUC). Materials and Methods: In this study, we retrospectively evaluated 86 patients diagnosed with UTUC at our hospital from June 2013 to June 2021. The patients who underwent traditional retroperitoneoscopic nephroureterectomy (TRNU) (n = 28) and SCRNU (n = 58) were consecutively enrolled. Demographic characteristics, perioperative parameters, and follow-up data were collected and compared between the two groups. Results: Both procedures were performed effectively in 86 patients without converting to open surgery. The mean follow-up time was 45.4 months for the SCRNU group and 39 months for the TRNU group. All follow-up patients survived without incidence of bladder incision tumor. Further, the follow-up results showed that there was no significant difference in the recurrence rate of bladder tumor between the two methods. SCRNU group was superior to TRNU group because of shorter operating time, fewer perioperative complications, less postoperative pain, lower recurrence rate, and cheaper medical expenditure. Conclusions: The SCRNU technique is less invasive, have fewer complications, and has a better cosmetic outcome.
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Affiliation(s)
- Yuqiang Shi
- Department of Urology, Aerospace Center Hospital, Beijing, China
- Peking University Aerospace Clinic School of Medicine, Beijing, China
| | - Shenghan Wang
- Department of Urology, Aerospace Center Hospital, Beijing, China
- Peking University Aerospace Clinic School of Medicine, Beijing, China
| | - Wei Liu
- Department of Urology, Aerospace Center Hospital, Beijing, China
- Peking University Aerospace Clinic School of Medicine, Beijing, China
| | | | - Zhentao Lei
- Department of Urology, Aerospace Center Hospital, Beijing, China
- Peking University Aerospace Clinic School of Medicine, Beijing, China
| | - Lin Yang
- Department of Urology, Aerospace Center Hospital, Beijing, China
- Peking University Aerospace Clinic School of Medicine, Beijing, China
| | - Qiang Gao
- Department of Urology, Aerospace Center Hospital, Beijing, China
- Peking University Aerospace Clinic School of Medicine, Beijing, China
| | - Zhongping Liu
- Department of Urology, Aerospace Center Hospital, Beijing, China
- Peking University Aerospace Clinic School of Medicine, Beijing, China
| | - Zhen Xu
- Department of Urology, Aerospace Center Hospital, Beijing, China
- Peking University Aerospace Clinic School of Medicine, Beijing, China
| | - Hua Wan
- Beijing USCI Medical Laboratory, Beijing, China
| | - Bao Zhang
- Department of Urology, Aerospace Center Hospital, Beijing, China
- Peking University Aerospace Clinic School of Medicine, Beijing, China
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Ni K, Yu C, Wang H, Zhu S, Yu S, Li G. Immunotherapy with or without targeted therapy for metastatic upper tract urothelial carcinoma: case report and literature review. Heliyon 2023; 9:e15813. [PMID: 37206016 PMCID: PMC10189380 DOI: 10.1016/j.heliyon.2023.e15813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 04/16/2023] [Accepted: 04/21/2023] [Indexed: 05/21/2023] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) have been proved having a better safety profile compared to platinum-based chemotherapy and have demonstrated encouraging anti-tumor therapeutic effects for patients with metastatic urothelial carcinoma (mUC). However, few studies have evaluated the efficacy of ICIs in patients with metastatic upper tract urothelial carcinoma (mUTUC). Case reports Case 1 was a 71-year-old male patient diagnosed with left renal pelvic carcinoma, accompanied by a metastasis to the second lumbar spine. As the patient became refractory to chemotherapy, four cycles of camrelizumab, one of the ICIs, were administered, which helped to control the metastases and extend the patient's progression-free survival to five months. Case 2 was an 88-year-old female with middle and lower right ureter carcinoma with right iliac arteriovenous invasion. The patient received five cycles of camrelizumab plus vascular endothelial growth factor receptor 2 (VEGFR2) inhibitors and achieved stable disease. Conclusion For patients who are ineligible for chemotherapy, immunotherapy might be a feasible treatment, regardless of whether or not they are given VEGFR2 inhibitors.
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Affiliation(s)
- Kangxin Ni
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, People's Republic of China
| | - Chenhao Yu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, People's Republic of China
| | - Huailan Wang
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, People's Republic of China
| | - Shibin Zhu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, People's Republic of China
| | - Shicheng Yu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, People's Republic of China
| | - Gonghui Li
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, People's Republic of China
- Corresponding author.)
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O'Sullivan NJ, Naughton A, Temperley HC, Casey RG. Robotic‐assisted versus laparoscopic nephroureterectomy; a systematic review and meta‐analysis. BJUI COMPASS 2023; 4:246-255. [PMID: 37025468 PMCID: PMC10071076 DOI: 10.1002/bco2.208] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/09/2022] [Accepted: 11/24/2022] [Indexed: 01/24/2023] Open
Abstract
Background Upper tract urothelial carcinoma (UTUC) is the malignant transformation of urothelial cells, from the renal calyces to the ureteral orifices. While the benefits of minimally invasive nephroureterectomy over their open counterpart have been established, the optimal technique remains a debate. We aimed to assess current evidence in the literature and compare outcomes between robotic-assisted (RANU) and laparoscopic nephroureterectomy (LNU). Methods A systematic review of the literature was performed for studies comparing RANU and LNU for bladder cancer. Outcome measurements were recurrence rates (local and distal), positive margins, positive lymph node yield and perioperative outcomes. Meta-analysis was performed using Review Manager 5. Results Our results demonstrate a significantly higher mortality rate in patients undergoing laparoscopic nephroureterectomy when compared with the robotic-assisted approach for the treatment of UTUC (1.8% vs. 1.1%, p = 0.008); however, these results were inconsistent on sensitivity analysis and should therefore be interpreted with caution. No significant difference was observed for other outcomes. Conclusion The ideal approach to minimally invasive radical nephroureterectomy remains undetermined. Future research, ideally prospective randomised studies, should focus on long-term outcomes, in particular recurrence, recurrence-free survival, overall survival and the correlation between surgical technique and survival.
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Affiliation(s)
- Niall J. O'Sullivan
- Department of Urology Tallaght University Hospital Dublin 24 Ireland
- School of Medicine Trinity College Dublin Dublin 2 Ireland
| | - Ailish Naughton
- Department of Urology St. Vincent's University Hospital Dublin 4 Ireland
| | | | - Rowan G. Casey
- Department of Urology Tallaght University Hospital Dublin 24 Ireland
- School of Medicine Trinity College Dublin Dublin 2 Ireland
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Wu F, Zhang P, Li L, Lin S, Liu J, Sun Y, Wang Y, Luo C, Huang Y, Yan X, Zhang M, Liu G, Li K. Inadvertent radical nephrectomy leads to worse prognosis in renal pelvic urothelial carcinoma patients: A propensity score-matched study. Front Oncol 2022; 12:948223. [PMID: 36249047 PMCID: PMC9561472 DOI: 10.3389/fonc.2022.948223] [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: 05/19/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo compare overall survival (OS) and cancer-specific survival (CSS) in renal pelvic urothelial carcinoma (RPUC) patients treated with radical nephroureterectomy (NU) and inadvertent radical nephrectomy (RN).Patients and methodsIn this retrospective study, patients with RPUC who underwent NU or RN diagnosed between 2004 and 2017 were identified from the Surveillance, Epidemiology, and End Results database. To adjust the confounders, the propensity score-matched analysis was conducted. The Kaplan–Meier method and log-rank test were performed to explore the effect of different surgical methods on OS and CSS.ResultsA total of 2197 cases were finally included in this analysis, among which, 187 (8.5%) patients were treated with RN and 2010 (91.5%) patients were treated with NU. Before matching, the survival analysis revealed that the OS (HR: 1.444, 95%CI: 1.197, 1.741) and CSS (HR: 1.522, 95%CI: 1.211, 1.914) of patients who received RN were worse than that of patients who received NU (p = 0.0001 and p = 0.0003, respectively). After matching, the RN group had a worse OS (HR: 1.298, 95%CI: 1.002, 1.682) than the NU group (p = 0.048). No significant difference was observed in CSS between the RN and NU groups (p = 0.282). The hierarchical analysis showed that there was no significant difference observed in OS and CSS in patients with tumor size ≤4.2 cm (p = 0.884 and p = 0.496, respectively). In tumor size >4.2 cm, both OS (HR: 1.545, 95%CI: 1.225, 1.948) and CSS (HR: 1.607, 95%CI: 1.233, 2.095) of patients who received RN were worse than those of patients who received NU (p = 0.0002 and p = 0.0005).ConclusionRN could lead to worse oncological outcomes than NU in patients with renal pelvis urothelial carcinoma. Accurate diagnosis of renal pelvis urothelial carcinoma is extremely important.
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Apolo AB, Msaouel P, Niglio S, Simon N, Chandran E, Maskens D, Perez G, Ballman KV, Weinstock C. Evolving Role of Adjuvant Systemic Therapy for Kidney and Urothelial Cancers. Am Soc Clin Oncol Educ Book 2022; 42:1-16. [PMID: 35609225 DOI: 10.1200/edbk_350829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The role of adjuvant therapy in renal cell carcinoma and urothelial carcinoma is rapidly evolving. To date, the U.S. Food and Drug Administration has approved sunitinib and pembrolizumab in the adjuvant setting for renal cell carcinoma and nivolumab for urothelial carcinoma based on disease-free survival benefit. The U.S. Food and Drug Administration held a joint workshop with the National Cancer Institute and the Society of Urologic Oncology in 2017 to harmonize design elements, including eligibility and radiologic assessments across adjuvant trials in renal cell carcinoma and urothelial carcinoma. Considerations from the discussion at these workshops led the U.S. Food and Drug Administration to draft guidances to help inform subsequent adjuvant trial design for renal cell carcinoma and urothelial carcinoma. Patient-centered decision-making is crucial when determining therapeutic choices in the adjuvant setting; utility functions can be used to help quantify each patient's goals, values, and risk/benefit trade-offs to ensure that the decision regarding adjuvant therapy is informed by their preferences and the evolving outcomes data.
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Affiliation(s)
- Andrea B Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Pavlos Msaouel
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX.,David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Scot Niglio
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Nicholas Simon
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Elias Chandran
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Deborah Maskens
- Patient Advocate, International Kidney Cancer Coalition Kidney Cancer Canada, Mississauga, ON, Canada
| | - Gabriela Perez
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Karla V Ballman
- Division of Biostatistics, Weill Cornell Medicine, New York, NY
| | - Chana Weinstock
- Division of Oncology 1, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD
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Low Hemoglobin-to-Red Cell Distribution Width Ratio Is Associated with Disease Progression and Poor Prognosis in Upper Tract Urothelial Carcinoma. Biomedicines 2021; 9:biomedicines9060672. [PMID: 34208273 PMCID: PMC8230812 DOI: 10.3390/biomedicines9060672] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/02/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022] Open
Abstract
The importance of blood cell markers in patients with malignant tumors has been studied, but there are few studies on the prognostic value of hemoglobin-to-red cell distribution width ratio (HRR) in cancer. This is the first study to investigate the effect of preoperative HRR on patients with upper tract urothelial carcinoma (UTUC). Our retrospective cohort study included 730 UTUC patients who underwent nephroureterectomy from 2000 to 2019. Clinicopathological parameters were compared according to HRR levels, and the relationship between blood cell markers (HRR, white blood cell [WBC] count, platelet count) and prognosis was evaluated using Kaplan-Meier method and Cox regression model. We found that patients with HRR ≤ 1.05 tended to have worse renal function, higher pathological stages, and more high-grade tumors. In univariate analysis, HRR ≤ 1.05, WBC > 8.65 × 103 cells/μL and platelets >309 × 103 cells/μL were associated with poor progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). Multivariate analysis demonstrated that HRR ≤ 1.05 and WBC > 8.65 × 103 cells/μL were independent prognostic factors for predicting deterioration of PFS, CSS, and OS. In conclusion, HRR and WBC are easy to obtain in clinical practice and are useful indicators to provide prognostic information before surgery for UTUC.
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11
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Abrate A, Vella M, Mogorovich A, Giaimo R, Serretta V, Pavone C, Bartoletti R, Simonato A. Time to safely omit bladder cuff removal for low-risk upper tract urothelial carcinoma. Minerva Urol Nephrol 2021; 73:417-420. [PMID: 33887892 DOI: 10.23736/s2724-6051.21.04299-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alberto Abrate
- Unit of Urology, Department of Surgery, ASST Valtellina e Alto Lario, Sondrio, Italy
| | - Marco Vella
- Section of Urology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Andrea Mogorovich
- Unit of Urology, Azienda Sanitaria Toscana Nord Ovest, Viareggio, Lucca, Italy
| | - Rosa Giaimo
- 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
| | - Carlo Pavone
- Section of Urology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Alchiede Simonato
- Section of Urology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy -
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12
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The Consequences of Inadvertent Radical Nephrectomy in the Treatment of Upper Tract Urothelial Carcinoma. Urology 2021; 154:127-135. [PMID: 33766715 DOI: 10.1016/j.urology.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 02/23/2021] [Accepted: 03/07/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To determine factors associated with performing inadvertent radical nephrectomy (RN) for upper tract urothelial carcinoma (UTUC), and to assess the impact of radical nephrectomy on overall survival (OS) compared to radical nephroureterectomy (NU). METHODS Using the National Cancer Database (NCDB), patients with UTUC of the renal pelvis who were diagnosed with renal cortical tumors and underwent RN (n = 820) with subsequent surgical pathology demonstrating urothelial carcinoma were identified. These patients were compared to those diagnosed with renal pelvis tumors who appropriately underwent NU (n = 16,464) between 2005 and 2015. Multivariable logistic regression was used to determine patient, facility and tumor-related factors associated with undergoing RN. The impact of surgery (RN vs NU) on OS was determined by Cox-regression after propensity score matching. RESULTS A total of 4.7% patients with UTUC underwent inadvertent RN. Black race (adjusted odds ratio [aOR] 1.62, 95%CI 1.23-2.13), larger tumors, advanced tumor stage, and high-grade tumors (P < 0.0001) were associated with RN. However, surgery at a facility performing a higher volume of NU/year was associated with lower odds of having RN performed (aOR 0.85, 95%CI 0.75-0.97). After propensity score matching, the 5-year OS was 39.9% for those undergoing RN vs 49.9% for those undergoing NU (hazard ratio 1.45, 95%CI 1.30-1.62). CONCLUSION Inadvertent RN is not uncommon, occurring in almost 5% of patients with UTUC in the NCDB. Patients who underwent RN had significantly worse OS as compared to those treated with NU. These data highlight that accurate diagnosis of UTUC is paramount and clinicians should not hesitate to perform further workup when imaging findings are equivocal.
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13
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Ryoo H, Kim J, Kim T, Kang M, Jeon HG, Jeong BC, Seo SI, Jeon SS, Lee HM, Sung HH. Effects of Complete Bladder Cuff Removal on Oncological Outcomes Following Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma. Cancer Res Treat 2020; 53:795-802. [PMID: 33421984 PMCID: PMC8291174 DOI: 10.4143/crt.2020.919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/25/2020] [Indexed: 01/19/2023] Open
Abstract
Purpose This study aimed to evaluate the effects of bladder cuff method on oncological outcomes in patients who underwent radical nephroureterectomy (RNU) for upper tract urothelial carcinoma. Materials and Methods The records of 1,095 patients treated with RNU performed at our hospital between 1994 and 2018 were retrospectively reviewed; 856 patients with no bladder tumor history were enrolled in the present study. The management of bladder cuff was divided into two categories: extravesical ligation (EL) or transvesical resection (TR). Survival was analyzed using the Kaplan-Meier method and Cox regression analyses were performed to determine which factors were associated with intravesical recurrence (IVR)–free survival (IVRFS), cancer-specific survival (CSS), and overall survival (OS). Results The mean patient age was 64.8 years and the median follow-up was 37.7 months. Among the 865 patients, 477 (55.7%) underwent the TR and 379 (44.3%) the EL. Significantly higher IVRFS (p=0.001) and OS (p=0.013) were observed in the TR group. In multivariable analysis, IVR, CSS, and OS were independently associated with the EL. Among 379 patients treated with the EL, eight underwent remnant ureterectomy. Based on radical cystectomy–free survival, significant difference was not observed between the two groups. However, significantly higher IVRFS was observed in the TR group when the tumor was located in the renal pelvis. Conclusion Intramural complete excision of the distal ureter during RNU should be the gold standard approach compared with EL for the management of distal ureter in terms of oncological outcomes.
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Affiliation(s)
- Hyunsoo Ryoo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jungyu Kim
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taejin Kim
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Minyong Kang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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14
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Barton GJ, Tan WP, Inman BA. The nephroureterectomy: a review of technique and current controversies. Transl Androl Urol 2020; 9:3168-3190. [PMID: 33457289 PMCID: PMC7807352 DOI: 10.21037/tau.2019.12.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The nephroureterectomy (NU) is the standard of care for invasive upper tract urothelial carcinoma (UTUC) and has been around for well over one hundred years. Since then new operative techniques have emerged, new technologies have developed, and the surgery continues to evolve and grow. In this article, we review the various surgical techniques, as well as present the literature surrounding current areas of debate surrounding the NU, including the lymphatic drainage of the upper urinary tract, management of UTUC involvement with the adrenals and caval thrombi, surgical management of the distal ureter, the use of intravesical chemotherapy as well as perioperative systemic chemotherapy, as well as various outcome measures. Although much has been studied about the NU, there still is a dearth of level 1 evidence and the field would benefit from further studies.
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Affiliation(s)
- Gregory J Barton
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Wei Phin Tan
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Brant A Inman
- Division of Urology, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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15
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Singla N, Christie A, Freifeld Y, Ghandour RA, Woldu SL, Clinton TN, Petros FG, Robyak H, Yeh HC, Fang D, Enikeev D, Bagrodia A, Sagalowsky AI, Lotan Y, Raman JD, Matin SF, Margulis V. Pathologic stage as a surrogate for oncologic outcomes after receipt of neoadjuvant chemotherapy for high-grade upper tract urothelial carcinoma. Urol Oncol 2020; 38:933.e7-933.e12. [PMID: 32430254 PMCID: PMC10676742 DOI: 10.1016/j.urolonc.2020.04.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/26/2020] [Accepted: 04/24/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Whether pathologic stage at radical nephroureterectomy (RNU) can serve as an appropriate surrogate for oncologic outcomes in patients with high-grade (HG) upper tract urothelial carcinoma (UTUC) treated with neoadjuvant chemotherapy (NAC) is not defined. We sought to determine whether patients who achieve pathologically non-muscle-invasive (ypT0, ypTa, ypT1, ypTis) HG UTUC after receipt of NAC exhibit oncologic outcomes comparable to those who are inherently low stage without chemotherapy. METHODS We identified 647 UTUC patients who underwent RNU among 3 institutions from 1993to2016. Patients with low or unknown grade, pathologic muscle invasion, or receipt of adjuvant chemotherapy were excluded. We compared clinicopathologic data and oncologic outcomes between pT0-1 and ypT0-1 patients. Kaplan-Meier analysis was used to assess overall (OS), cancer-specific (CSS), and systemic recurrence-free (RFS) survival. Predictors of these endpoints were identified using Cox regression. RESULTS 234 (43 ypT0-1, 191 pT0-1) patients with HG UTUC were included. Two patients exhibited pathologic complete response after NAC. OS (P = 0.055), CSS (P = 0.152), and RFS (P = 0.098) were similar between ypT0-1 and pT0-1 patients. Predictors of worse outcomes included African-American race (RFS, CSS, and OS), Charlson score (OS), and systemic recurrence (OS and CSS). CONCLUSIONS Patients with HG UTUC who achieve ypT0-1 stage after NAC exhibit favorable oncologic outcomes comparable to those inherently non-muscle-invasive who do not receive chemotherapy. Improvements in clinical staging will play an important role in better defining candidacy for NAC in treating HG UTUC while minimizing overtreatment. Furthermore, pathologic stage may serve as an appropriate early surrogate for oncologic endpoints in designing clinical trials.
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Affiliation(s)
- Nirmish Singla
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Alana Christie
- Division of Biostatistics, Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Yuval Freifeld
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Rashed A Ghandour
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Solomon L Woldu
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Timothy N Clinton
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Firas G Petros
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Haley Robyak
- Division of Urology, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Hsin-Chih Yeh
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Dong Fang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Aditya Bagrodia
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Arthur I Sagalowsky
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Yair Lotan
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Jay D Raman
- Division of Urology, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Surena F Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vitaly Margulis
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
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16
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Postoperative Chemotherapy Bladder Instillation After Radical Nephroureterectomy: Results of a European Survey from the Young Academic Urologist Urothelial Cancer Group. EUR UROL SUPPL 2020; 22:45-50. [PMID: 34337476 PMCID: PMC8317887 DOI: 10.1016/j.euros.2020.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2020] [Indexed: 11/22/2022] Open
Abstract
Background Level 1 evidence supports the administration of single postoperative intravesical chemotherapy (pIVC) following radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), in order to decrease intravesical recurrence risk. Objective The Young Academic Urologist Urothelial Cancer Group aimed to investigate the use of pIVC in daily practice among European colleagues. Design setting and participants An online survey was shared with European Association of Urology Section of Oncological Urology (ESOU) 2017 participants via e-mail. Submissions were accepted from April to June 2017. The topics for 15 questions of this survey included the habit of delivering pIVC, the choice of drug, its dosage, related doubts or concerns, reasons not to perform pIVC, knowledge of the evidence, and surgical preferences for RNU. Outcome measurements and statistical analysis Survey software was used for analyses. Logistic regression analyses were used to investigate the association between surgeons' experience and caseloads with pIVC utilization. Results and limitations Overall, 127 responses were collected (11.6%). About half of the participants (47%) regularly administered pIVC following RNU. The drug most commonly utilized was mitomycin (85%); 82% adhered to the standard dosage of 40 mg. Different administration protocols were adopted: ≤48 h (39%), 7-10 postoperative days (35%), >10 d (11%), and intraoperatively (10%). The evidence was supported by prospective randomized clinical trials for only 65% of responders. Among interviewees who did not deliver pIVC, the most commonly reported reasons were lack of supporting data (55%), fear of potential side effects (18%), and organizational hurdles (15%). Conclusions Our research highlights the limited use of pIVC following RNU for UTUC, raising the question of how the compliance with level 1 evidence in the urological community may be promoted. Patient summary Level 1 evidence supports the administration of single postoperative intravesical chemotherapy (pIVC) following radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), in order to decrease intravesical recurrence risk. The Young Academic Urologist Urothelial Cancer Group aimed to investigate the use of pIVC in daily practice among European colleagues. Our research highlights the limited use of pIVC (47%) following RNU for UTUC, raising the question of how the compliance with level 1 evidence in the urological community may be promoted.
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17
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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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18
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Kenigsberg AP, Meng X, Ghandour R, Margulis V. Oncologic outcomes of radical nephroureterectomy (RNU). Transl Androl Urol 2020; 9:1841-1852. [PMID: 32944548 PMCID: PMC7475687 DOI: 10.21037/tau.2019.12.29] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 12/20/2019] [Indexed: 12/31/2022] Open
Abstract
Radical nephroureterectomy is the mainstay of surgical treatment for upper tract urothelial carcinoma (UTUC), a disease which comprises approximately 5% of urothelial malignancies. Minimally-invasive and nephron-sparing interventions have been explored, although thus far have not shown comparable oncologic outcomes except in a relatively narrow set of patients. Due to the relative rarity of the disease, it has taken decades and multi-disciplinary efforts to sufficiently identify prognostic factors of oncologic outcomes. Despite these efforts, however, oncologic outcomes of nephroureterectomy have remained remarkably stable over the past 30 years. New techniques, such as laparoscopic and robotic surgery, have been applied to this procedure. High level evidence regarding equivalent oncologic outcomes is lacking and open surgery remains the standard of care for high-stage disease, although there is a role for laparoscopic and robotic nephroureterectomy. The importance of bladder cuff removal in improving oncologic outcomes has been broadly accepted, although there is no consensus as to the most oncologically appropriate technique. There does appear to be evidence that endoscopic techniques confer worse oncologic control. The role of lymphadenectomy remains controversial, although there is evidence that increased nodal yield could have oncologic benefit. Given disease heterogeneity and varied technical approaches to the procedure, no consensus standardized template has been identified. There is level 1 evidence for the use of intravesical chemotherapy peri-operatively and that this intervention can improve the risk of intravesical recurrence. Advances in systemic neoadjuvant and adjuvant chemotherapy have yielded promising results and are likely to become standard of care for patients without contraindications. Immunotherapy and targeted biologic agents are also likely to improve the surgical efficacy of radical nephroureterectomy as well. Ultimately, more high level evidence is needed to identify successful surgical and medical approaches to UTUC and multi-institutional collaboration is critical to this progress.
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Affiliation(s)
| | - Xiaosong Meng
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rashed Ghandour
- 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
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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19
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Braun AE, Srivastava A, Maffucci F, Kutikov A. Controversies in management of the bladder cuff at nephroureterectomy. Transl Androl Urol 2020; 9:1868-1880. [PMID: 32944551 PMCID: PMC7475677 DOI: 10.21037/tau.2020.01.17] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Upper tract urothelial carcinoma (UTUC) accounts for roughly 5% of urothelial carcinomas. Historically, the gold standard for high-risk or bulky low-risk UTUC was an open radical nephroureterectomy with formal bladder cuff excision (BCE). The development of novel endoscopic, laparoscopic, and robotic techniques has transformed this operation, yet no level I evidence exists at present that demonstrates the superiority of one strategy over another. While new approaches to nephroureterectomy in the last decade have shifted the management paradigm to decrease the morbidity of surgery, controversy continues to surround the approach to the distal ureter and bladder cuff. Debate continues within the urologic community over which surgical approach is best when managing UTUC and how various approaches impact clinical outcomes such as intravesical recurrence, recurrence-free survival (RFS) and disease-specific mortality (DSM). When focusing on the existing treatment algorithm, key metrics of quality include (I) removal of the entire specimen en bloc, (II) minimizing the risk of tumor and urine spillage, (III) R0 resection, and (IV) water-tight closure allowing for early use of prophylactic intravesical chemotherapy. In the absence of robust evidence demonstrating a single superior approach, the urologic surgeon should base decisions on technical comfort and each patient's particular clinical circumstance.
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Affiliation(s)
- Avery E Braun
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Abhishek Srivastava
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Fenizia Maffucci
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Alexander Kutikov
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
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20
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Pathak RA, Hemal AK. Fate of residual ureteral stump in patients undergoing robot-assisted radical nephroureterectomy for high-risk upper tract urothelial carcinoma. Transl Androl Urol 2020; 9:856-862. [PMID: 32420200 PMCID: PMC7214963 DOI: 10.21037/tau.2019.09.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Management of the distal ureter in radical nephroureterectomy and bladder cuff excision (RNUBCE) is paramount, directly influencing oncologic outcomes. Herein, we analyze the natural history of patients who have undergone robotic radical nephroureterectomy without formal bladder cuff excision and retained ureteral stump and compare this cohort with patients undergoing formal RNUBCE for high-risk upper tract urothelial carcinoma (UTUC). Methods From February 2008 to October 2018, all patients who underwent robotic RNUBCE by multiple surgeons in a single institution for high-risk UTUC were reviewed. Preoperative, perioperative, and postoperative variables were investigated. Overall survival, cancer specific survival, local recurrence-free survival, distant recurrence-free survival, and bladder recurrence-free survival were compared between the two cohorts. Further management treatments were explored for patients with retained ureteral stump. Follow-up consisted of abdominopelvic/chest imaging and cystoscopy at regular intervals. Results A total of 105 patients underwent robotic RNU during the above time period. Of patients with documented 6-month follow-up, approximately 6.6% of patients had retained ureteral stump. Median follow-up for the entire cohort was 31.5 months with a range of 6 to 114.2 months. Factors that precluded formal BCE were densely, fibrotic reaction near the ureterovesical junction due to prior vascular or pelvic surgery in 5 patients, severe pyonephrosis and continued anesthetic risk in one patient, and surgeon choice (patient co-morbidities) in another patient. Three patients died with metastatic disease and one patient succumbed to cardiovascular compromise. Two additional patients developed local recurrence only at the level of the ureteral stump, with one patient undergoing eventual distal excision, contralateral RNUBCE and radical cystectomy. Conclusions In these cases, responsibilities assumed by the surgeon demand the utmost in judgement and skill; however, at times, circumstances prevail such as patient factors and nature/biology of the disease. These factors may prevent adequate excision the complete ureter, ureterovesical junction, and bladder cuff at the time of RNU. In this robotic cohort of patients undergoing RNUBCE for UTUC, not excising the most distal part of the ureter directly translates to inferior oncologic outcomes. Complete ureteral excision with bladder cuff should be performed where possible as this is an integral part of the radical nephroureterectomy. Also, if feasible, adjunctive chemotherapy/immunotherapy treatments should be considered.
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Affiliation(s)
- Ram A Pathak
- Wake Forest University Baptist Medical Center, 1 Medical Center BLVD, Winston-Salem, NC 27157, USA
| | - Ashok K Hemal
- Wake Forest University Baptist Medical Center, 1 Medical Center BLVD, Winston-Salem, NC 27157, USA
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21
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Nephroureterectomy with or without Bladder Cuff Excision for Localized Urothelial Carcinoma of the Renal Pelvis. Eur Urol Focus 2020; 6:298-304. [DOI: 10.1016/j.euf.2018.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 09/05/2018] [Accepted: 09/12/2018] [Indexed: 11/19/2022]
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22
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Lemke E, Sahasrabudhe D, Guancial E, Bylow K, Johnson S, Messing E, Kilari D. The Role of Metastasectomy in Urothelial Carcinoma: Where Are We in 2020? Clin Genitourin Cancer 2020; 18:e478-e483. [PMID: 32085986 DOI: 10.1016/j.clgc.2020.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
Systemic therapy is the mainstay of treatment for metastatic urothelial carcinoma (UC). Responses to first-line platinum-based therapy tend to be short-lived with potential toxicity. Despite the approval of checkpoint inhibitors, the long-term prognosis for patients with metastatic UC remains dismal. Herein we report the case of a patient with a solitary pulmonary metastatic lesion of urothelial origin as the only site of metastatic disease who remained free of disease for more than 2 years without systemic therapy after metastasectomy. We review the literature discussing the role of combined surgical and medical management of oligometastatic UC. As our case illustrates, a growing body of evidence suggests a potential role for a multimodal approach in patients with oligometastatic UC.
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Affiliation(s)
- Emily Lemke
- Department of Medicine, Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI.
| | - Deepak Sahasrabudhe
- Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, Rochester, NY
| | | | - Kathryn Bylow
- Department of Medicine, Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Scott Johnson
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Edward Messing
- Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, Rochester, NY
| | - Deepak Kilari
- Department of Medicine, Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
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Assessing the impact of different distal ureter management techniques during radical nephroureterectomy for primary upper urinary tract urothelial carcinoma on oncological outcomes: A systematic review and meta-analysis. Int J Surg 2020; 75:165-173. [PMID: 31978650 DOI: 10.1016/j.ijsu.2020.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To assess the oncological outcomes of several distal ureter management techniques in patients administered with radical nephroureterectomy (RNU) for primary upper urinary tract urothelial carcinoma (UTUC). METHODS A systematic search of PubMed, EMBASE, and the Cochrane Library was conducted to identify studies comparing outcomes following RNU under various surgical methods for bladder cuff management. Standard cumulative analyses of hazard ratios (HRs) with 95% confidence intervals (CIs) were performed using Review Manager (5.3). RESULTS Nine studies involving 4683 patients were selected based upon eligibility criteria. Meta-analysis of cancer-specific survival (CSS) and overall survival (OS) revealed no significant differences among intravesical incision of the bladder cuff (IVBC), extravesical incision of the bladder cuff (EVBC) and transurethral incision of the bladder cuff (TUBC) techniques. However, the IVBC technique appeared to have better recurrence-free survival (RFS) (HR = 1.37, p < 0.01) and intravesical recurrence-free survival (IRFS) (HR = 1.45, p < 0.01) compared with non-IVBC methods, including both TUBC and EVBC. When studies involving patients with bladder tumour history were excluded, the pooled statistic appeared to confirm that IVBC was associated with improved IRFS (HR = 1.25, p = 0.03) compared with EVBC and TUBC. No significant difference was found between the EVBC and TUBC groups (HR = 1.81, p = 0.32). CONCLUSIONS The findings suggest that IVBC is associated with improved oncologic outcomes and that it may be recommended for distal ureter management. However, caution must be taken because this recommendation is based upon a very limited number of clinical studies. Further research with enhanced outcome data collection and improved reporting is required to confirm these findings.
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Carrion A, Ribal MJ, Morote J, Huguet J, Raventós C, Lozano F, Costa-Grau M, Alcaraz A. A comparative study of different surgical techniques for the management of distal ureter during laparoscopic radical nephroureterectomy. Actas Urol Esp 2019; 43:543-550. [PMID: 31447089 DOI: 10.1016/j.acuro.2019.07.001] [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: 05/28/2019] [Accepted: 07/14/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the oncological outcomes between two open surgical techniques and two endoscopic approaches for the management of the distal ureter during laparoscopic radical nephroureterectomy (LRNU). MATERIAL AND METHODS Retrospective review of 152 patients submitted to LRNU for the management of upper urinary tract tumors between 2007-2014. We analyzed the potential impact of two different open surgical (extravesical vs intravesical) and two endoscopic (resection of ureteral orifice and fragment removal vs endoscopic bladder cuff) techniques on the development of bladder recurrence, distant/local recurrence and cancer-specific survival (CSS). RESULTS A total of 152 patients with a mean age of 69.9 years (±10.1) underwent LRNU. We reported 62 pTa-T1 (41%), 35 pT2 (23%) and 55 pT3-4 (36%). Thirty-two were low grade (21.1%) and 120 high grade (78.9%). An endoscopic approach was performed in 89 cases (58.5%), 32 with resection (36%) and 57 with bladder cuff (64%), and open approach in 63 (41.5%), 42 intravesical (66.7%) and 21 extravesical (33.3%). Within a median follow-up of 32 months (3-120), 38 patients (25%) developed bladder recurrence, 42 distant/local recurrence (27.6%) and 34 died of tumor (22.4%). In the univariate analysis, the type of endoscopic technique was not related to bladder recurrence (P=.961), distant/local recurrence (P=.955) nor CSS (P=.802). The open extravesical approach was not related to bladder recurrence (P=.12) but increased distant/local recurrence (P=.045) and decreased CSS (P=.034) compared to intravesical approach. CONCLUSIONS LRNU outcomes are not dependant on the type of endoscopic approach performed. The open extravesical approach is a more difficult technique and could worsen the oncological outcomes when compared to the intravesical.
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Affiliation(s)
- A Carrion
- Departamento de Urología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
| | - M J Ribal
- Departamento de Urología, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - J Morote
- Departamento de Urología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - J Huguet
- Departamento de Urología, Fundación Puigvert, Universitat Autònoma de Barcelona, Barcelona, España
| | - C Raventós
- Departamento de Urología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - F Lozano
- Departamento de Urología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - M Costa-Grau
- Departamento de Urología, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - A Alcaraz
- Departamento de Urología, Hospital Clínic, Universidad de Barcelona, Barcelona, España
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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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26
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Lee SM, McKay A, Grimes N, Umez-Eronini N, Aboumarzouk OM. Distal Ureter Management During Nephroureterectomy: Evidence from a Systematic Review and Cumulative Analysis. J Endourol 2019; 33:263-273. [PMID: 30793934 DOI: 10.1089/end.2018.0819] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Standard of care in upper tract urothelial cancer is nephroureterectomy with bladder cuff excision (BCE). However, alternative techniques such as transurethral incision/resection have been used to simplify distal ureterectomy. The optimum strategy is unclear, and current guidelines do not specify a gold standard technique. The objective of this study was to perform a systematic review of the literature, to compare BCE and transurethral distal ureter methods. MATERIALS AND METHODS A Cochrane and PRISMA-guided systematic literature search was conducted on English language articles from January 2000 to present, reporting on centers' experience with either BCE or transurethral distal ureterectomy. A cumulative meta-analysis comparison between the two procedures was performed. Primary outcome was intravesical recurrence. Secondary outcomes were local/distant recurrence, surgical margins, and disease-specific mortality (DSM). Groups were compared using chi-square analysis. RESULTS In total, 66 studies were included after excluding 1795. BCE and transurethral groups contained 6130 and 1183 patients, respectively. Mean/median age ranged from 57.5 to 75.2 years, and follow-up from 6.1 to 78 months. Level of evidence was low, with high risk of bias and small sample size (<100 patients) in 41 (62%) and 52 (79%) studies, respectively. Baseline cancer demographic analysis identified significantly higher rates of high grade, advanced stage, node-positive and carcinoma in situ disease in the BCE group. However, intravesical recurrence (23.6% vs 28.7%, p = 0.0002) and local/distant recurrence (17.9% vs 21.6%, p = 0.02) were significantly lower than the transurethral group. No difference was seen regarding surgical margins (3.1% vs 2.4%, p = 0.27) or DSM (16.8% vs 14.3%, p = 0.06). CONCLUSIONS No prospective, randomized comparisons exist for distal ureterectomy at nephroureterectomy. In this analysis, patients undergoing BCE had more advanced disease burden compared with the transurethral group. Despite this, the BCE group had statistically lower intravesical and local/distant recurrence. Further prospective research should be encouraged to identify gold standard ureter management.
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Affiliation(s)
- Su-Min Lee
- 1 Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - Alistair McKay
- 2 Glasgow Urological Research Unit, Department of Urology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Nathan Grimes
- 2 Glasgow Urological Research Unit, Department of Urology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Nkem Umez-Eronini
- 2 Glasgow Urological Research Unit, Department of Urology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Omar M Aboumarzouk
- 2 Glasgow Urological Research Unit, Department of Urology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
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Survival Effect of Chemotherapy in Metastatic Upper Urinary Tract Urothelial Carcinoma. Clin Genitourin Cancer 2019; 17:e97-e103. [DOI: 10.1016/j.clgc.2018.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/08/2018] [Accepted: 09/21/2018] [Indexed: 11/22/2022]
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Edwards DC, Cahn DB, Smaldone MC, Kutikov A. Use of administrative data for comparative effectiveness research in the treatment of non-prostate genitourinary malignancies. Urol Oncol 2018; 36:193-212. [DOI: 10.1016/j.urolonc.2017.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 07/30/2017] [Accepted: 08/04/2017] [Indexed: 01/13/2023]
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Singla N, Fang D, Su X, Bao Z, Cao Z, Robyak H, Xiong G, Zhang L, Woldu S, Hutchinson R, Sagalowsky A, Lotan Y, Li X, Zhou L, Raman JD, Margulis V. Preoperative predictors of nonorgan-confined disease in upper-tract urothelial carcinoma differ between China and the United States. Urol Oncol 2017; 36:88.e11-88.e18. [PMID: 29174945 DOI: 10.1016/j.urolonc.2017.10.029] [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: 06/06/2017] [Revised: 10/15/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare preoperative predictors of nonorgan-confined (NOC) disease in patients with upper-tract urothelial carcinoma (UTUC) from the United States (US) and China. METHODS Clinicopathologic data of patients with UTUC treated surgically at tertiary care facilities in the US or China from 1998 to 2015 were, retrospectively, compiled. Patient characteristics, preoperative imaging, cytology, ureteroscopic findings, and serum markers (neutrophil-to-lymphocyte ratio, estimated glomerular filtration rate, hemoglobin, and albumin) were evaluated. After excluding patients who received neoadjuvant chemotherapy, rates of NOC disease at definitive surgery were tabulated. Logistic regression and receiver operating characteristic analyses were performed to determine predictors of NOC for each country using previously published nomograms, and the cohorts were compared. RESULTS Totally, 753 patients with UTUC were included for analysis (451 Chinese and 302 US). NOC rates were similar between the 2 countries (31% vs. 29%, P = 0.568). On multivariable analysis, cT3 stage (P = 0.001) and high-grade pathology on ureteroscopy (P = 0.011) were significant predictors for NOC in the US, while male gender (P = 0.034), tumor location on imaging (P = 0.009), tumor size on imaging (P = 0.044), neutrophil-to-lymphocyte (P = 0.043), and preoperative estimated glomerular filtration rate (P = 0.028) were significant in China. Areas under the curve differed by nomogram used (Western model: 0.750 in US, vs. 0.670 in China; Chinese model: 0.763 in US, vs. 0.828 in China). CONCLUSION Predictors for NOC in UTUC differ between the US and China. There may be unique population-based markers that more profoundly influence the accuracy of nomograms in certain populations. Our findings highlight the importance of considering population differences when clinically applying predictive tools in UTUC.
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Affiliation(s)
- Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dong Fang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xiaohong Su
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhengqing Bao
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhenpeng Cao
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Haley Robyak
- Division of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Gengyan Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Lei Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Solomon Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ryan Hutchinson
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Arthur Sagalowsky
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Jay D Raman
- Division of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
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Choi K, McCafferty R, Deem S. Contemporary management of upper tract urothelial cell carcinoma. World J Clin Urol 2017; 6:1-9. [DOI: 10.5410/wjcu.v6.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/17/2016] [Accepted: 12/28/2016] [Indexed: 02/06/2023] Open
Abstract
Upper tract urothelial cell carcinoma (UTUCC), formerly known as transitional cell carcinoma of the upper urinary tract, is a rare oncologic disease in Western countries. Thus its disease process and its management are not as well defined as other urologic cancers. We are reviewing the current evidence based literature available to develop a plan for the treatment of UTUCC. A PubMed search was completed using the key words “upper tract urothelial cell carcinoma”, “epidemiology”, “risk factor”, “treatment” and “prognosis”. Six hundred fifty two articles were found. We narrowed our search to articles published between January 2004 and June 2016 for a more contemporary review of the topic. Four hundred seventy articles were then available for review. Further detailed search was performed for relevance on the topic and hundred one articles were selected for the review. Many risk factors have been found to be associated with the development of UTUCC, including tobacco use. Patients are often asymptomatic and may only present with microscopic or gross hematuria. Tumor grade and stage are pivotal in determining the treatment options for UTUCC. Advancements in endoscopic techniques have aided in the diagnosis, grading and treatment of this disease. Treatment options include topical therapy, with combinations of methotrexate, vinblastine, doxorubicin and cisplatin or gemcitibine or cisplatin, endoscopic resection, segmental ureterectomy and ureteral implantation, and nephroureterectomy, including bladder cuff. Treatment recommendations depend on tumor grade and stage, renal function, tumor location and the patient’s prognosis. There are currently no tissue or blood-based biomarkers available to accurately monitor the disease. Further studies of gene expression and biomarkers may hopefully improve the management of this disease. Although rare in many countries, UTUCC is becoming more prevalent due to exposure to carcinogenic herbal remedies and other identifiable risk factors. Numerous treatment modalities, both surgical and chemotherapeutic, have been utilized to treat both low and high grade UTUCC tumors. Additional clinical trials are necessary to further develop methods for screening, treatment, and surveillance to improve management.
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Fragkoulis C, Pappas A, Papadopoulos GI, Stathouros G, Fragkoulis A, Ntoumas K. Transurethral resection versus open bladder cuff excision in patients undergoing nephroureterectomy for upper urinary tract carcinoma: Operative and oncological results. Arab J Urol 2017; 15:64-67. [PMID: 28275521 PMCID: PMC5329723 DOI: 10.1016/j.aju.2016.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/06/2016] [Accepted: 12/18/2016] [Indexed: 01/15/2023] Open
Abstract
Objectives To evaluate the impact of distal ureter management on oncological results after open nephroureterectomy (ONU) comparing transurethral resection of the intramural ureter to conventional open excision, as controversy still exists about the method of choice for managing the distal ureter and bladder cuff during ONU. Patients and methods We retrospectively collected data from 378 patients who underwent ONU for upper urinary tract transitional cell carcinoma (UUT-TCC) from 1988 to 2009. Patients were divided into two subgroups according to the type of operation performed. Group A comprised 192 patients who had ONU with open resection of the bladder cuff from 1988 to 1997. Group B comprised 186 patients in whom transurethral resection of the intramural ureter plus single incision ONU was performed between 1998 and 2009. The mean operative time, hospital stay, duration of catheterisation, bladder recurrence rates, and cancer-specific survival (CSS) were assessed. Results The total operative time was statistically significantly less in the endoscopic group (Group B). For catheterisation, patients treated with an open approach (Group A) had a statistically significantly shorter duration of postoperative catheterisation. There was no statistical difference between Groups A and B for the bladder recurrence rate (Group A 24% vs 27% in Group B, P = 0.51). There was no difference in CSS at the 5-year follow-up. Conclusions ONU with transurethral resection of the intramural ureter up to the extravesical fat followed by ureter extraction is an oncologically safe and technically feasible operation.
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Affiliation(s)
| | - Athanasios Pappas
- Department of Urology, Athens General Hospital 'G. Gennimatas', Athens, Greece
| | | | - Georgios Stathouros
- Department of Urology, Athens General Hospital 'G. Gennimatas', Athens, Greece
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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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Laparoscopic nephroureterectomy for upper tract urothelial carcinoma - Update. Asian J Urol 2016; 3:115-119. [PMID: 29264177 PMCID: PMC5730822 DOI: 10.1016/j.ajur.2016.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/08/2016] [Accepted: 05/12/2016] [Indexed: 12/13/2022] Open
Abstract
Upper urinary tract urothelial carcinomas (UTUCs) are uncommon and account for only 5%-10% of urothelial carcinomas. Pyelocaliceal tumors are about twice as common as ureteral tumors. Sixty percent of UTUCs are invasive at diagnosis. Radical nephroureterectomy, including the excision of the distal ureter and bladder cuff is standard of care for treatment of localized UTUCs, because of the high potential for recurrence, multifocality, and progression. Since first laparoscopic nephroureterectomy (LNU) was introduced by Clayman et al. in 1991 and improvement of laparoscopic technique and equipment, LNU has been reported to be equivalent to conventional open method. We reviewed the current literature of patients with UTUCs treated by LNU focusing on technical aspects, peri-operative and oncological outcomes. Laparoscopic radical nephroureterectomy offers the advantages of minimally invasive surgery without deteriorating the oncological outcome for treatment of UTUCs. Indications tend to increase as operator skills increase. Indications for laparoscopic or open nephroureterectomy are in principle the same. The basic requirement for laparoscopic surgery in UTUCs is to achieve benefits of minimal invasive surgery and maintain oncologic principles.
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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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36
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Prognostic factors and predictive tools for upper tract urothelial carcinoma: a systematic review. World J Urol 2016; 35:337-353. [DOI: 10.1007/s00345-016-1826-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 04/04/2016] [Indexed: 01/12/2023] Open
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37
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Gakis G, Schubert T, Alemozaffar M, Bellmunt J, Bochner BH, Boorjian SA, Daneshmand S, Huang WC, Kondo T, Konety BR, Laguna MP, Matin SF, Siefker-Radtke AO, Shariat SF, Stenzl A. Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of localized high-risk disease. World J Urol 2016; 35:327-335. [DOI: 10.1007/s00345-016-1819-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/23/2016] [Indexed: 12/11/2022] Open
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Bellmunt J, Mottet N, De Santis M. Urothelial carcinoma management in elderly or unfit patients. EJC Suppl 2016; 14:1-20. [PMID: 27358584 PMCID: PMC4917740 DOI: 10.1016/j.ejcsup.2016.01.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/18/2016] [Accepted: 01/21/2016] [Indexed: 12/15/2022] Open
Affiliation(s)
- Joaquim Bellmunt
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Nicolas Mottet
- Department of Urology, CHU de Saint-Etienne, University Jean Monnet, St Etienne, France
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Abstract
Nephrectomy is, perhaps, one of the techniques in which laparoscopic approach has been widely used. It has quickly evolved since Clayman introduced it in 1990 with a renal tumor. Since then, its goodness has been extrapolated to most entities that require surgical removal of the kidney. We review the current most discussed aspects referred to the main laparoscopic nephrectomy techniques (simple nephrectomy, nephroureterectomy, radical, and nephron-sparing nephrectomy) and particularities of this approach.
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40
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Mathieu R, Bensalah K, Lucca I, Mbeutcha A, Rouprêt M, Shariat SF. Upper urinary tract disease: what we know today and unmet needs. Transl Androl Urol 2016; 4:261-72. [PMID: 26816829 PMCID: PMC4708228 DOI: 10.3978/j.issn.2223-4683.2015.05.01] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose Upper tract urothelial carcinoma (UTUC) is a rare and poorly investigated disease. Intense collaborative efforts have increased our knowledge and improved the management of the disease. The objective of this review was to discuss recent advances and unmet needs in UTUC. Methods A non-systematic Medline/PubMed literature search was performed on UTUC using the terms “upper tract urothelial carcinoma” with different combinations of keywords. Original articles, reviews and editorials in English language were selected based on their clinical relevance. Results UTUC is a disease with specific epidemiologic and risk factors different to urothelial carcinoma of the bladder (UCB). Similarly to UCB, smoking increases the risk of UTUC and worsens its prognosis, whereas aristolochic acid (AA) exposure and mismatch repair genes abnormality are UTUC specific risk factors. A growing understanding of biological pathways involved in the tumorigenesis of UTUC has led to the identification of promising prognostic/predictive biomarkers. Risk stratification of UTUC is difficult due to limitations in staging and grading. Modern imaging and endoscopy have improved clinical decision-making, and allowed kidney-sparing management and surveillance in favorable-risk tumors. In high-risk tumors, radical nephroureterectomy (RNU) remains the standard. Complete removal of the intramural ureter is necessary with inferiority of endoscopic management. Post-RNU intravesical instillation has been shown to decrease bladder cancer recurrence rates. While the role of neoadjuvant cisplatin based combination chemotherapy and lymphadenectomy are not clearly established, the body of evidence suggests a survival benefit to these. There is currently no evidence for adjuvant chemotherapy (AC) in UTUC. Conclusions Despite growing interest and understanding of UTUC, its management remains challenging, requiring further high quality multicenter collaborations. Accurate risk estimation is necessary to avoid unnecessary RNUs while advances in technology are still required for optimal kidney-sparing approaches.
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Affiliation(s)
- Romain Mathieu
- 1 Department of Urology, Rennes University Hospital, Rennes, France ; 2 Department of Urology, General Hospital, Medical University Vienna, Vienna, Austria ; 3 Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland ; 4 Academic Department of Urology, La Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6, Paris, France ; 5 Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA ; 6 Department of Urology, Weill Cornell Medical College, New York, USA
| | - Karim Bensalah
- 1 Department of Urology, Rennes University Hospital, Rennes, France ; 2 Department of Urology, General Hospital, Medical University Vienna, Vienna, Austria ; 3 Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland ; 4 Academic Department of Urology, La Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6, Paris, France ; 5 Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA ; 6 Department of Urology, Weill Cornell Medical College, New York, USA
| | - Ilaria Lucca
- 1 Department of Urology, Rennes University Hospital, Rennes, France ; 2 Department of Urology, General Hospital, Medical University Vienna, Vienna, Austria ; 3 Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland ; 4 Academic Department of Urology, La Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6, Paris, France ; 5 Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA ; 6 Department of Urology, Weill Cornell Medical College, New York, USA
| | - Aurélie Mbeutcha
- 1 Department of Urology, Rennes University Hospital, Rennes, France ; 2 Department of Urology, General Hospital, Medical University Vienna, Vienna, Austria ; 3 Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland ; 4 Academic Department of Urology, La Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6, Paris, France ; 5 Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA ; 6 Department of Urology, Weill Cornell Medical College, New York, USA
| | - Morgan Rouprêt
- 1 Department of Urology, Rennes University Hospital, Rennes, France ; 2 Department of Urology, General Hospital, Medical University Vienna, Vienna, Austria ; 3 Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland ; 4 Academic Department of Urology, La Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6, Paris, France ; 5 Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA ; 6 Department of Urology, Weill Cornell Medical College, New York, USA
| | - Shahrokh F Shariat
- 1 Department of Urology, Rennes University Hospital, Rennes, France ; 2 Department of Urology, General Hospital, Medical University Vienna, Vienna, Austria ; 3 Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland ; 4 Academic Department of Urology, La Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6, Paris, France ; 5 Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA ; 6 Department of Urology, Weill Cornell Medical College, New York, USA
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41
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Bui D, Mach KE, Zlatev DV, Rouse RV, Leppert JT, Liao JC. A Pilot Study of In Vivo Confocal Laser Endomicroscopy of Upper Tract Urothelial Carcinoma. J Endourol 2015; 29:1418-23. [PMID: 26413927 DOI: 10.1089/end.2015.0523] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Tissue diagnosis of upper tract urothelial carcinoma (UTUC) is limited by variance in tumor sampling by standard ureteroscopic biopsy. Optical imaging technologies can potentially improve UTUC diagnosis, surveillance, and endoscopic treatment. We previously demonstrated in vivo optical biopsy of urothelial carcinoma of the bladder using confocal laser endomicroscopy (CLE). In this study, we evaluated a new 0.85-mm imaging probe in the upper urinary tract and demonstrated feasibility and compatibility with standard ureteroscopes to achieve in vivo optical biopsy of UTUC. MATERIALS AND METHODS Fourteen patients scheduled for ureteroscopy of suspected upper tract lesions or surveillance of UTUC were recruited. After intravenous (IV) administration of fluorescein, CLE was performed using a 0.85-mm-diameter imaging probe inserted through the working channel of standard ureteroscopes. Acquired confocal video sequences were reviewed and analyzed. A mosaicing algorithm was used to compile a series of images into a single larger composite image. Processed CLE images were compared with standard histopathologic analysis. RESULTS Optical biopsy of the UTUC using CLE was effectively achieved during standard ureteroscopy. There were no adverse events related to IV fluorescein administration or image acquisition. Confocal imaging of UTUC showed characteristic features similar to urothelial carcinoma of the bladder, including papillary structure, fibrovascular stalks, and pleomorphism. Lamina propria in normal areas of the renal pelvis and ureter was also identified. CONCLUSIONS We report an initial feasibility of CLE of UTUC. Pending further clinical investigation, CLE may become a useful adjunct to ureteroscopic biopsy, endoscopic ablation, and surveillance of UTUC.
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Affiliation(s)
- Daniel Bui
- 1 Department of Urology, Stanford University School of Medicine , Stanford, California.,2 Veterans Affairs Palo Alto Health Care System , Palo Alto, California
| | - Kathleen E Mach
- 1 Department of Urology, Stanford University School of Medicine , Stanford, California.,2 Veterans Affairs Palo Alto Health Care System , Palo Alto, California
| | - Dimitar V Zlatev
- 1 Department of Urology, Stanford University School of Medicine , Stanford, California.,2 Veterans Affairs Palo Alto Health Care System , Palo Alto, California
| | - Robert V Rouse
- 2 Veterans Affairs Palo Alto Health Care System , Palo Alto, California.,3 Department of Pathology, Stanford University School of Medicine , Stanford, California
| | - John T Leppert
- 1 Department of Urology, Stanford University School of Medicine , Stanford, California.,2 Veterans Affairs Palo Alto Health Care System , Palo Alto, California
| | - Joseph C Liao
- 1 Department of Urology, Stanford University School of Medicine , Stanford, California.,2 Veterans Affairs Palo Alto Health Care System , Palo Alto, California
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Rouprêt M, Babjuk M, Compérat E, Zigeuner R, Sylvester RJ, Burger M, Cowan NC, Böhle A, Van Rhijn BWG, Kaasinen E, Palou J, Shariat SF. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Cell Carcinoma: 2015 Update. Eur Urol 2015; 68:868-79. [PMID: 26188393 DOI: 10.1016/j.eururo.2015.06.044] [Citation(s) in RCA: 392] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 06/23/2015] [Indexed: 01/03/2023]
Abstract
CONTEXT The European Association of Urology (EAU) guidelines panel on upper urinary tract urothelial cell carcinoma (UTUC) has prepared updated guidelines to aid clinicians in the current evidence-based management of UTUC and to incorporate recommendations into clinical practice. OBJECTIVE To provide a brief overview of the EAU guidelines on UTUC as an aid to clinicians. EVIDENCE ACQUISITION The recommendations provided in the current guidelines are based on a thorough review of available UTUC guidelines and articles identified following a systematic search of Medline. Data on urothelial malignancies and UTUC were searched using these keywords: urinary tract cancer; urothelial carcinomas; upper urinary tract, carcinoma; renal pelvis; ureter; bladder cancer; chemotherapy; nephroureterectomy; adjuvant treatment; instillation; neoadjuvant treatment; recurrence; risk factors; and survival. References were weighted by a panel of experts. EVIDENCE SYNTHESIS Due to the rarity of UTUC, there are insufficient data to provide strong recommendations (ie, grade A). However, the results of recent multicentre studies are now available, and there is a growing interest in UTUC. The 2009 TNM classification is recommended. Recommendations are given for diagnosis and risk stratification as well as radical and conservative treatment, and prognostic factors are discussed. A single postoperative dose of intravesical mitomycin after nephroureterectomy reduces the risk of bladder tumour recurrence. Recommendations are also provided for patient follow-up after different therapeutic strategies. CONCLUSIONS These guidelines contain information on the management of individual patients according to a current standardised approach. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen, based on the proposed risk stratification of these tumours. PATIENT SUMMARY Urothelial carcinoma of the upper urinary tract is rare, but because 60% of these tumours are invasive at diagnosis, an appropriate diagnosis is most important. A number of known risk factors exist.
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Affiliation(s)
- Morgan Rouprêt
- Department of Urology, Hospital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie, Institut Universitaire de Cancérologie, Paris, France.
| | - Marko Babjuk
- Department of Urology, Hospital Motol and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Eva Compérat
- Department of Pathology, Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie, Institut Universitaire de Cancérologie, Paris, France
| | - Richard Zigeuner
- Department of Urology, Medizinische Universität Graz, Graz, Austria
| | - Richard J Sylvester
- EAU Guidelines Office Board, European Association of Urology, The Netherlands
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Nigel C Cowan
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK
| | | | - Bas W G Van Rhijn
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Eero Kaasinen
- Department of Surgery, Hyvinkää Hospital, Hyvinkää, Finland
| | - Joan Palou
- Department of Urology, Universitat Autònoma de Barcelona-Fundació Puigvert, Barcelona, Spain
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Weill Medical College of Cornell University, New York, NY, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Multi-institutional analysis of renal function outcomes following radical nephroureterectomy and partial ureterectomy for upper tract urothelial carcinoma. Urol Oncol 2015; 33:268.e1-7. [DOI: 10.1016/j.urolonc.2015.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 02/27/2015] [Accepted: 03/07/2015] [Indexed: 11/20/2022]
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44
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Lucca I, Leow JJ, Shariat SF, Chang SL. Diagnosis and Management of Upper Tract Urothelial Carcinoma. Hematol Oncol Clin North Am 2015; 29:271-88, ix. [DOI: 10.1016/j.hoc.2014.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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45
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Kang M, Jeong CW, Kwak C, Kim HH, Ku JH. The characteristics of recurrent upper tract urothelial carcinoma after radical nephroureterectomy without bladder cuff excision. Yonsei Med J 2015; 56:375-81. [PMID: 25683984 PMCID: PMC4329347 DOI: 10.3349/ymj.2015.56.2.375] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
PURPOSE To investigate oncological outcomes based on bladder cuff excision (BCE) during radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) and to provide clinical evidence of tumor recurrence in patients without BCE. MATERIALS AND METHODS We retrospectively collected data of 372 consecutive patients who underwent RNU at our institution from May 1989 through October 2010. After excluding some data, we reviewed 336 patients for the analysis. RESULTS Of the patients who underwent RNU with BCE (n=279, 83.0%) and without BCE (n=57, 17.0%), patients without BCE had poorer cancer-specific and overall survival rates. Among 57 patients without BCE, 35 (61.4%) experienced tumor recurrence. Recurrence at the remnant ureter resulted in poor oncological outcomes compared to those in patients with bladder recurrence, but better outcomes were observed compared to recurrence at other sites. No significant predictors for tumor recurrence at the remnant ureter were identified. In patients without BCE, pathological T stage [hazard ratio (HR), 5.73] and lymphovascular invasion (HR, 3.65) were independent predictors of cancer-specific survival, whereas age (HR, 1.04), pathological T stage (HR, 5.11), and positive tumor margin (HR, 6.50) were independent predictors of overall survival. CONCLUSION Patients without BCE had poorer overall and cancer-specific survival after RNU than those with BCE. Most of these patients experienced tumor recurrence at the remnant ureter and other sites. Patients with non-organ confined UTUC after RNU without BCE may be considered for adjuvant chemotherapy with careful follow-up.
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Affiliation(s)
- Minyong Kang
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea.
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46
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Colin P, Irani J, Drouin S, Shariat S, Rouprêt M. Facteurs pronostiques des tumeurs de la voie excrétrice supérieure et impact sur la survie : une revue systématique pour le rapport annuel de l’Association française d’urologie. Prog Urol 2014; 24:1000-10. [DOI: 10.1016/j.purol.2014.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 07/16/2014] [Accepted: 07/22/2014] [Indexed: 02/02/2023]
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47
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Neuzillet Y, Colin P, Phé V, Shariat S, Rouprêt M. Traitement chirurgical des tumeurs de la voie excrétrice supérieure par néphro-urétérectomie totale : état-de-l’art pour le rapport annuel de l’Association française d’urologie. Prog Urol 2014; 24:1021-9. [DOI: 10.1016/j.purol.2014.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 06/27/2014] [Accepted: 07/16/2014] [Indexed: 01/18/2023]
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48
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Borghesi M, Brunocilla E, Schiavina R, Martorana G. Robot-Assisted Radical Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma: A Promising Alternative to Open Surgery or a Future “Gold Standard”? Clin Genitourin Cancer 2014; 12:e65-6. [DOI: 10.1016/j.clgc.2013.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 05/03/2013] [Indexed: 11/27/2022]
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49
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Sun M, Abdo A, Abdollah F, Schmitges J, Thuret R, Jeldres C, Shariat SF, Perrotte P, Karakiewicz PI. Management of upper urinary tract urothelial carcinoma. Expert Rev Anticancer Ther 2014; 10:1955-65. [DOI: 10.1586/era.10.194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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50
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Surgical management of the distal ureter during radical nephroureterectomy is an independent predictor of oncological outcomes: Results of a current series and a review of the literature. Urol Oncol 2014; 32:54.e19-26. [DOI: 10.1016/j.urolonc.2013.08.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 08/25/2013] [Accepted: 08/30/2013] [Indexed: 01/02/2023]
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