1
|
Abstract
Upper urinary tract urothelial carcinoma (UTUC) is an uncommon malignancy involving the renal pelvis and ureter. Careful pathologic analysis plays a critical role in the diagnosis and clinical management of UTUC. In combination with clinical and radiologic evaluation, pathologic features can be used to stratify patients into low-risk and high-risk groups. This risk stratification can help clinicians select the optimal treatment for patients with UTUC, such as kidney-sparing (conservative) treatment, radical nephroureterectomy or ureterectomy, and perioperative systemic therapy. However, due to the technical difficulty of obtaining sufficient tissue from the upper urinary tract, it is often challenging for pathologists to accurately grade the tumor and assess tumor invasion in small biopsy specimens. Although the majority of UTUCs are pure urothelial carcinoma, a considerable subset of UTUCs show histologic subtypes or divergent differentiation. Recent studies have identified genetically distinct molecular subtypes of UTUC by examining DNA, RNA, and protein expression profiles. The prognosis of pT3 UTUC, particularly renal pelvic UC, remains controversial, and several studies have proposed subclassification of pT3 UTUC. Lynch syndrome is a significant risk factor for UTUC, and screening tests may be considered in young patients and those with familial histories of the disease. Despite significant progress in recent years, several issues remain to be addressed in the pathologic diagnosis, molecular classification, and treatment of UTUC.
Collapse
Affiliation(s)
- Jianping Zhao
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles C. Guo
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priya Rao
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
2
|
Ma R, Liu Z, Cheng Y, Zhou P, Pan Y, Bi H, Tao L, Yang B, Xia H, Zhu X, He J, He W, Wang G, Huang Y, Ma L, Lu J. Prognostic Value of Tumor Size in Patients with Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-analysis. EUR UROL SUPPL 2022; 42:19-29. [PMID: 35783990 PMCID: PMC9244730 DOI: 10.1016/j.euros.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 10/25/2022] Open
|
3
|
Chen TS, Chen YT, Wang HJ, Chiang PH, Yang WC, Lee WC, Chuang YC, Cheng YT, Kang CH, Lee WC, Chen CH, Shen YC, Liu YY, Liu HY, Chang YL, Su YL, Huang CC, Luo HL. The Prognostic Impact of Tumor Location in pT3N0M0 Upper Urinary Tract Urothelial Carcinoma: A Retrospective Cohort Study. Front Oncol 2022; 12:850874. [PMID: 35372015 PMCID: PMC8964942 DOI: 10.3389/fonc.2022.850874] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background We aimed to evaluate the impact of tumor location on cancer outcomes in patients with pT3N0M0 upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU) with bladder cuff excision. Materials and Methods We retrospectively reviewed 302 patients with pT3N0M0 UTUC who underwent RNU with bladder cuff excision at our institution between 2005 and 2019, including 191 renal pelvis tumors and 111 ureteral tumors. Clinicopathologic characteristics were compared between renal pelvis and ureter urothelial carcinomas. Multivariate Cox proportional hazard regression was used to assess the association between outcomes and clinical factors. Outcomes of interest included intravesical recurrence-free survival (IVRFS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and cancer-specific survival (CSS), which were measured using the Kaplan-Meier curve with a log-rank test. Results A total of 302 patients underwent RNU with bladder cuff excision. During the median follow-up of 42.7 months, 70 (23.2%), 95 (31.5%), and 99 (32.8%) patients experienced intravesical recurrence, local recurrence, and distant metastasis, respectively. Seventy (23.2%) patients died from UTUC. Multivariate Cox regression analysis showed that tumor location was an independent predictor of local recurrence (HR = 2.05, p = 0.001), with borderline independent significance in intravesical recurrence (HR = 1.54, p = 0.074) and distant metastasis (HR = 1.45, p = 0.08). Kaplan-Meier analysis showed that ureter tumors had a worse 5-year local recurrence (log-rank p < 0.001) and borderline worse 5-year intravesical recurrence (log-rank p = 0.055) and 5-year distant metastasis (log-rank p = 0.073). Conclusion Ureter tumors seem to be associated with worse oncological outcomes, especially with local recurrence in UTUC. Further large and long-term studies are warranted for investigating biological differences based on tumor location.
Collapse
Affiliation(s)
- Tzu Shuang Chen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen Ta Chen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hung Jen Wang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | | | - Wen Chou Yang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei Ching Lee
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yao Chi Chuang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yuan Tso Cheng
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih Hsiung Kang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei Chia Lee
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien Hsu Chen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yuan Chi Shen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi Yang Liu
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hui Ying Liu
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yin Lun Chang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu Li Su
- Department of Hematology and Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun Chieh Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hao Lun Luo
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| |
Collapse
|
4
|
Wu D, Lee CT, Zynger DL. Reclassifying pT3 renal pelvic urothelial carcinoma with renal parenchyma invasion to pT2 improves correlation with overall survival. Hum Pathol 2022; 125:79-86. [DOI: 10.1016/j.humpath.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022]
|
5
|
Treatment Strategy for Dialysis Patient with Urothelial Carcinoma. Diagnostics (Basel) 2021; 11:diagnostics11111966. [PMID: 34829313 PMCID: PMC8624138 DOI: 10.3390/diagnostics11111966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
To investigate postoperative complications and oncologic outcomes of prophylactic nephroureterectomy and/or cystectomy in dialysis patients with urothelial carcinoma (UC), we retrospectively reviewed the records of dialysis patients with UC and a final status of complete urinary tract extirpation (CUTE, i.e., the removal of both kidneys, ureters, and bladder) between January 2004 and December 2015. Patients undergoing dialysis after initial radical nephroureterectomy and/or cystectomy were excluded. Eighty-four and 27 dialysis patients, undergoing one-stage and multi-stage CUTE, were enrolled in this study, respectively. Demographic, medical, perioperative, and pathologic features were collected to determine variables associated with oncologic outcomes. Although there was no significant difference in mortality between the 2 groups (p = 0.333), all 5 (4.5%) patients with Clavien-Dindo grade 5 complications were from the one-stage CUTE group. On multivariate logistic regression analysis, advanced age (p = 0.042) and high Charlson comorbidity index (CCI) (p = 0.000) were related to postoperative major complications. Compared with multi-stage CUTE, one-stage CUTE had no overall, cancer-specific, and recurrence-free survival benefits (all p > 0.05). According to multivariate analysis with Cox regression, age > 70 years (HR 2.70, 95% CI 1.2-6.12; p = 0.017), CCI ≥ 5 (HR 2.16, 95% CI 1.01-4.63; p = 0.048), and bladder cancer stage ≥ 3 (HR 12.4, 95% CI 1.82-84.7; p = 0.010) were independent, unfavorable prognostic factors for the overall survival. One-stage CUTE is not associated with superior oncologic outcomes, and all perioperative mortalities in our series occurred in the one-stage CUTE group. Our data do not support prophylactic nephroureterectomy and/or cystectomy for uremic patients with UC.
Collapse
|
6
|
Liu MZ, Gao XS, Qin SB, Li XY, Ma MW, Xie M, Lyu F, Wang D. Radiation therapy for nonmetastatic medically inoperable upper-tract urothelial carcinoma. Transl Androl Urol 2021; 10:2929-2937. [PMID: 34430395 PMCID: PMC8350229 DOI: 10.21037/tau-21-291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/01/2021] [Indexed: 11/14/2022] Open
Abstract
Background The standard management for upper urinary tract urothelial carcinoma (UTUC) is radical nephroureterectomy (RNU). However, some patients cannot undergo this procedure for several reasons, such as unresectable disease, old age, and multiple comorbidities. Our study explored the potential safety and effectiveness of radiotherapy as a curative treatment for UTUC patients unfit for surgery. Methods The data of patients treated with radiotherapy between December 2017 and November 2019 were retrospectively reviewed. For the literature review, computerized PubMed Medline, Index Medicus, and Web of Science databases and reference lists from the identified publications of interest were used. And “upper-tract urothelial carcinoma” and “radiotherapy” were used as key words in the search. Results We describe 8 patients with UTUC who were treated with radiotherapy. The median follow-up time was 13.5 months (range, 8.6–30.9 months). Local tumor control was achieved in all patients. However, distant metastases were observed in 2 patients with T3-4/N+ status. One patient had T4 status and the other had N2+ status. The patients died of tumor progression at 15.0 and 17.7 months. In addition, the other 6 patients who were still alive had relatively early-stage tumors without nodal involvement. Regarding acute toxicity, according to the CTCAE v5.0, mild side effects were noted, including grade 1 nausea and diarrhea. Four patients developed mild anemia, generally of grade 1–2. One patient experienced grade 3 anemia, but it was manageable and improved with symptomatic support. In addition, no grade 4 acute or late toxicities were observed. No significant long-term impairment of renal function occurred. Conclusions For patients with nonmetastatic UTUC who are not suitable for surgery, radiotherapy is a safe treatment and can achieve good local tumor control.
Collapse
Affiliation(s)
- Ming-Zhu Liu
- Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, China
| | - Xian-Shu Gao
- Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, China
| | - Shang-Bin Qin
- Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, China
| | - Xiao-Ying Li
- Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, China
| | - Ming-Wei Ma
- Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, China
| | - Mu Xie
- Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, China
| | - Feng Lyu
- Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, China
| | - Dian Wang
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
7
|
Sano T, Kato M, Sassa N, Sadachi R, Hirakawa A, Kamihira O, Hirabayashi T, Nishikimi T, Katsuno S, Kimura T, Hattori R, Gotoh M, Tsuzuki T. pT3 subclassification of renal pelvic cancer considering the tumor location improves the patients' prognostic accuracy. Virchows Arch 2021; 478:1089-1097. [PMID: 33420835 DOI: 10.1007/s00428-020-02973-8] [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: 10/17/2020] [Revised: 11/09/2020] [Accepted: 11/15/2020] [Indexed: 12/30/2022]
Abstract
Whether pT3 urothelial carcinoma of the renal pelvis (UCRP) and urothelial carcinoma of the ureter (UCU) have the same prognosis is controversial, this study compared the prognosis of pT3 UCRP with that of pT3 UCU. We retrospectively evaluated 954 patients who underwent nephroureterectomy at our institutions between January 1983 and December 2017. All surgical specimens were reviewed by a single genitourinary pathologist. Cases of pT3 UCRP were subclassified as pT3a (urothelial carcinomas extending only to the renal medulla) and pT3b (urothelial carcinomas extending into the renal cortex and/or peripelvic adipose tissue). Fine and Gray's model was used to predict recurrence-free survival (RFS) and cancer-specific survival (CSS). A total of 493 (51.7%) had UCRP and 461 (48.3%) had UCU. Within this group, 202 patients had pT3 UCRP and 146 had pT3 UCU. The pT3 subclassification of UCRP resulted in 79 cases of pT3a and 120 of pT3b. The difference in 5-year CSS among the pT3a UCRP, pT2 UCRP, and pT2 UCU subgroups was not statistically significant (pT3a UCRP vs pT2 UCRP, HR = 0.69, p = 0.56; pT3a UCRP vs pT2 UCU, HR = 0.66, p = 0.31) However, RFS and CSS were significantly higher in the pT3a UCRP group than in the pT3b group (pT3a vs pT3b, HR = 2.59, p = 0.0038 and pT3a vs pT3b, HR = 3.10, p = 0.001). The results suggest that our proposed pT3 subclassification better predicts the prognosis of UCRP patients than does the pT3 of the current AJCC/UICC classification.
Collapse
Affiliation(s)
- Tomoyasu Sano
- Department of Urology, Nagoya University Graduate School of Medicine, Tsuruma-Cho, Showa-Ku, Nagoya, 466-0065, Japan
| | - Masashi Kato
- Department of Urology, Nagoya University Graduate School of Medicine, Tsuruma-Cho, Showa-Ku, Nagoya, 466-0065, Japan
| | - Naoto Sassa
- Department of Urology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, 480-1195, Japan
| | - Ryo Sadachi
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, 113-8654, Tokyo, Japan
| | - Akihiro Hirakawa
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, 113-8654, Tokyo, Japan
| | - Osamu Kamihira
- Department of Urology, Komaki City Hospital, 1-20 Jobushi, Komaki, 485-8520, Japan
| | - Tsuyoki Hirabayashi
- Department of Urology, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Toshinori Nishikimi
- Department of Urology, Japanese Red Cross Nagoya Daini Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Satoshi Katsuno
- Department of Urology, Okazaki City Hospital, 3-1, Goshoai-aza, Koryuji-cho, Showa-ku, Okazaki, 444-8553, Japan
| | - Toru Kimura
- Department of Urology, Japan Community Healthcare Organization Chukyo Hospital, 1-1-10, Sanjo, Minami-ku, Nagoya, 457-8510, Japan
| | - Ryohei Hattori
- Department of Urology, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Douge-Cho, Nakamura-Ku, Nagoya, 453-8511, Japan
| | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Tsuruma-Cho, Showa-Ku, Nagoya, 466-0065, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, 480-1195, Japan.
| |
Collapse
|
8
|
Liu Z, Huang J, Li X, Huang C, Ye Y, Zhang J, Liu Z. The effectiveness of chemotherapy for patients with pT3N0M0 renal pelvic urothelial carcinomas: An inverse probability of treatment weighting comparison using Surveillance, Epidemiology, and End Results data. Cancer Med 2020; 9:5756-5766. [PMID: 32585775 PMCID: PMC7433845 DOI: 10.1002/cam4.3238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/26/2020] [Accepted: 05/30/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Unlike the established evidence to use chemotherapy for urothelial carcinoma of the bladder, presently there are insufficient data to inform a recommendation on upper urinary tract urothelial carcinoma treatment. The prognosis for patients with stage T4 and positive lymph nodes is poor; however, primary tumors in the renal pelvis are associated with favorable prognoses compared to those located in the ureter. Our study aimed at investigating the effectiveness of chemotherapy in patients with pT3N0M0 renal pelvic urothelial carcinomas (RPUC) who have relative favorable prognosis. Methods Patients with pT3N0M0 tumors who underwent radical nephroureterectomy combined with bladder cuff excision between 2005 and 2014 and registered in the Surveillance, Epidemiology, and End Results database were eligible for inclusion (n = 939). Baseline characteristics between the chemotherapy and observation groups were controlled for with inverse probability of treatment weighting (IPTW)‐adjusted analysis. Results After the IPTW‐adjusted analysis, the 5‐year IPTW‐adjusted rates of overall survival (OS) for the chemotherapy and observation groups were 53.1% and 44.9%, respectively. The IPTW‐adjusted Kaplan‐Meier curves suggested that chemotherapy was associated with increased OS compared with observation (P = .028). In the IPTW‐adjusted Cox proportional hazards regression model, chemotherapy was associated with favorable survival benefits compared with observation (hazard ratio [HR] 0.71, 95% CI 0.52‐0.92, P = .031), and this was maintained after bootstrapping (HR 0.72, 95% CI 0.49‐0.93). Chemotherapy had a protective effect on OS benefits, which were found in a majority of the results of the subgroup analysis and were consistent with the main results (all P‐interactions > 0.05). Conclusion Chemotherapy may provide significant OS benefits for patients with pT3N0M0 RPUC. The results of our study could strengthen the evidence for using adjuvant chemotherapy in this rare group of patients.
Collapse
Affiliation(s)
- Zefu Liu
- Department of Urology, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Jialing Huang
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Xiangdong Li
- Department of Urology, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Chaowen Huang
- Department of Urology, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Yunlin Ye
- Department of Urology, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Jinxin Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Zhouwei Liu
- Department of Urology, Cancer Center, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
9
|
Li X, Cui M, Gu X, Fang D, Li H, Qin S, Yang K, Zhu T, Li X, Zhou L, Gao XS, Wang D. Pattern and risk factors of local recurrence after nephroureterectomy for upper tract urothelial carcinoma. World J Surg Oncol 2020; 18:114. [PMID: 32473636 PMCID: PMC7261378 DOI: 10.1186/s12957-020-01877-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 05/11/2020] [Indexed: 01/20/2023] Open
Abstract
Purpose This study aims to identify predictive local recurrence risk factors and site-specific local recurrence pattern of upper tract urothelial carcinoma (UTUC) with different primary tumor locations. Methods Three hundred and eighty-nine UTUC patients with radical nephroureterectomy were included in this study. Univariate and multivariate Cox proportional hazards regressions were performed to measure the risk of local recurrence. We also mapped the position of local recurrence sites stratified by primary tumor locations. Results A total of 73 patients (18.7%) developed local recurrence within a median follow-up of 41 months (range, 3-80 months). For patients with local recurrence, the median interval of local recurrence was 9 months. Ureter tumor, multifocality, T stage, G grade, lymph node metastasis (LNM), lymph node dissection (LND), and lymph vascular invasion (LVI) were all significantly associated with increased local recurrence by univariable analyses (P < 0.05). Only multifocality, T3–4, G3, and LNM remained independent predictors of increased local recurrence by multivariable analyses. Adjuvant radiotherapy could reduce the local recurrence (HR = 0.177; 95% CI 0.064-0.493, P = 0.001). Patients with local recurrence had poorer cancer-specific survival (4-year cancer-specific survival rate 36 ± 7.5% vs 88.4 ± 2.2%, P = 0.000). We evaluated local recurrence pattern stratified by tumor locations. Para-aortic lymph node region was the most common recurrence area for all the patients. Left-sided UTUC had more than 70% recurrent lymph nodes in the left para-aortic region (LPA). For right-sided UTUC patients, recurrent para-aortic lymph nodes distributed in the LPA (33.3%), aortocaval (AC) (41.5%), and right paracaval (RPC) (25.2%) regions. Recurrence in the internal and external iliac regions was only found in the distal ureter group (P < 0.05). Renal pelvic fossa recurrence was only found in renal pelvic tumor (22.2%, P = 0.007). The ureter tumor bed recurrence rate was higher for ureter patients (P = 0.001). Conclusions Multifocality, T3–4, G3, and LNM are predictors of higher local recurrence rate of UTUC. Adjuvant radiotherapy can reduce local recurrence rate. Local recurrence patterns are different according to primary tumor locations.
Collapse
Affiliation(s)
- Xiaoying Li
- Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, China
| | - Ming Cui
- Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, China
| | - Xiaobin Gu
- Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, China
| | - Dong Fang
- Department of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Hongzhen Li
- Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, China
| | - Shangbin Qin
- Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Tianzhao Zhu
- Department of Medical Imaging, Peking University First Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Peking University, Beijing, China.
| | - Xian-Shu Gao
- Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, China.
| | - Dian Wang
- Department of Radiation Oncology, Rush University Medical Center , Chicago, USA
| |
Collapse
|
10
|
Yoshida R, Yoshizako T, Maruyama M, Mori H, Ishikawa N, Tamaki Y, Kitagaki H. The value of adding diffusion-weighted images for tumor detection and preoperative staging in renal pelvic carcinoma for the reader's experience. Abdom Radiol (NY) 2017; 42:2297-2304. [PMID: 28352951 DOI: 10.1007/s00261-017-1116-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE This retrospective study aimed to assess the value of adding diffusion-weighted magnetic resonance imaging (DWI) or gadolinium-enhanced fat-suppressed T1WI (CEI) to T2-weighted imaging (T2WI) for preoperative T categorization in renal pelvic carcinoma by the reader's experience using surgical specimens as the reference standard. METHODS Two radiologists (Reader 1; 3 years, 2; 13 years) reviewed 49 cases with urothelial carcinoma who underwent magnetic resonance imaging examination before surgery, independently, using three image sets: T2WI alone, T2WI plus DWI, and T2WI plus CEI for tumor detection and T categorization. The differences in the apparent diffusion coefficient values between tumors and renal parenchyma, histopathologic grade were analyzed. RESULTS T2WI plus CEI or DWI had high detection rates (93.4%) compared to T2WI alone. When discriminating T3a/T3b, for Reader 1, the use of T2WI plus DWI (88.0%) and T2WI plus CEI (92.0%) was significantly more accurate than T2WI alone (73%), with AUCs of 0.86, 0.86 and 0.77, respectively. For Reader 2, the accuracies were high on all image sets, with AUCs of 0.87-0.95, and the mean ADC of the tumors was significantly lower than that of the normal renal parenchyma. In addition, the mean ADC values of high-grade tumors were significantly lower than that of low-grade tumors. CONCLUSIONS DWI and CEI could be more helpful than T2WI alone for preoperative T categorization by less-experienced reader and DWI could be used for preoperative T categorization and for predicting the histopathologic grade of renal pelvic carcinoma.
Collapse
Affiliation(s)
- Rika Yoshida
- Department of Radiology, Faculty of Medicine, Shimane University, 89-1, Enya-cho, Izumo, Shimane, 693-8501, Japan.
| | - Takeshi Yoshizako
- Department of Radiology, Faculty of Medicine, Shimane University, 89-1, Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Minako Maruyama
- Department of Radiology, Faculty of Medicine, Shimane University, 89-1, Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Hiroshi Mori
- Department of Radiology, Faculty of Medicine, Shimane University, 89-1, Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Noriyoshi Ishikawa
- Department of Organ Pathology, Faculty of Medicine, Shimane University, 89-1, Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Yukihisa Tamaki
- Department of Radiation Oncology, Faculty of Medicine, Shimane University, 89-1, Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Hajime Kitagaki
- Department of Radiology, Faculty of Medicine, Shimane University, 89-1, Enya-cho, Izumo, Shimane, 693-8501, Japan
| |
Collapse
|
11
|
Ganguly S, Chandra A, Chattopadhyay DJ, Chatterjee IB. p-Benzoquinone initiates non-invasive urothelial cancer through aberrant tyrosine phosphorylation of EGFR, MAP kinase activation and cell cycle deregulation: Prevention by vitamin C. Toxicol Rep 2017; 4:296-305. [PMID: 28959653 PMCID: PMC5615141 DOI: 10.1016/j.toxrep.2017.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/23/2017] [Accepted: 06/13/2017] [Indexed: 12/26/2022] Open
Abstract
p-Benzoquinone induces non-invasive urothelial carcinoma in a guinea pig model. The mechanisms involved are persistent growth signaling and cell cycle deregulation. Vitamin C prevents p-benzoquinone-induced non-invasive urothelial carcinoma.
According to WHO classification system, non-invasive urothelial carcinoma represents urothelial carcinoma in situ (CIS) and dysplasia. Dysplastic urothelium often progresses to CIS that further advances to urothelial carcinoma (UC). The strongest risk factor for UC is cigarette smoking. However, the pathogenesis of cigarette smoke (CS)-induced UC is poorly understood. Earlier we had shown that p-benzoquinone (p-BQ), a major toxic quinone derived from p-benzosemiquinone of CS in vivo, is a causative factor for various CS-induced diseases. Here, using a guinea pig model we showed that prolonged treatment with p-BQ led to non-invasive UC, specifically carcinoma in situ (CIS) of the renal pelvis and dysplasia in the ureter and bladder. The mechanisms of carcinogenesis were p-BQ-induced oxidative damage and apoptosis that were later suppressed and followed by activation of epidermal growth factor receptor, aberrant phosphorylation of intracellular tyrosine residues, activation of MAP kinase pathway and persistent growth signaling. This was accompanied by deregulation of cell cycle as shown by marked decrease in the expression of p21waf1/cip1 and cyclin D1 proteins as well as hyperphosphorylation of pRb. UC has been characterised by histopathology and immunohistochemistry showing aberrant CK20, increased Ki-67, and marked p53 nuclear immunopositivity with uniformly negative labelling of CD44. Oral supplementation of vitamin C (30 mg/kg body weight/day) prevented CIS of the renal pelvis and dysplasia in the ureter and bladder. Since majority of non-invasive UC progresses to invasive cancer with increased risk of mortality, our preclinical study might help to devise effective strategies for early intervention of the disease.
Collapse
Key Words
- Aberrant EGFR activation
- Bax, BCL2-associated X protein
- Bcl-2, B-cell lymphoma 2
- CIS, carcinoma in situ
- CS, cigarette smoke
- Carcinoma in situ
- Cell cycle deregulation
- DNPH, 2 4-dinitrophenylhydrazine
- Dysplasia
- EGFR, epidermal growth factor receptor
- GAPDH, glyceraldehyde 3-phosphate dehydrogenase
- IARC, International Agency for Research on Cancer
- MAPK, mitogen activated protein kinase
- PAHs, polycyclic aromatic hydrocarbons
- PBS, phosphate buffered saline
- ROS, reactive oxygen species
- SDS PAGE, sodium dodecyl sulfate polyacrylamide gel electrophoresis
- TUNEL, terminal deoxynucleotidyl transferase dUTP nick end labelling
- UC, urothelial carcinoma
- Vitamin C
- WHO, World Health Organization
- p-BQ, p-benzoquinone
- p-BSQ, p-benzosemiquinone
- p-Benzoquinone
Collapse
Affiliation(s)
- Shinjini Ganguly
- Department of Biotechnology and Dr. B. C. Guha Centre for Genetic Engineering & Biotechnology, Calcutta University College of Science, Kolkata 700019, India
| | - Ayan Chandra
- Department of Statistics, St. Xavier's College (Autonomous), Kolkata 700016, India
| | - Dhruba J Chattopadhyay
- Department of Biotechnology and Dr. B. C. Guha Centre for Genetic Engineering & Biotechnology, Calcutta University College of Science, Kolkata 700019, India
| | - Indu B Chatterjee
- Department of Biotechnology and Dr. B. C. Guha Centre for Genetic Engineering & Biotechnology, Calcutta University College of Science, Kolkata 700019, India
| |
Collapse
|
12
|
Adjuvant radiotherapy for locally advanced upper tract urothelial carcinoma. Sci Rep 2016; 6:38175. [PMID: 27910890 PMCID: PMC5133570 DOI: 10.1038/srep38175] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/04/2016] [Indexed: 12/29/2022] Open
Abstract
There is relatively little literature on adjuvant radiotherapy after radical nephroureterectomy with bladder cuff excision (RNU) for patients with upper tract urothelial carcinoma (UTUC). This study was designed to determine the efficacy of adjuvant radiotherapy for patients with pT3N0M0 UTUC. We retrospectively reviewed 198 patients treated with RNU between December 2001 and January 2015. Postoperative radiotherapy was administered in 40 (20.2%) of patients. Patients who received radiotherapy were younger than those that did not (65.2 vs. 70.5 years, p = 0.023). With median follow up of 29.1 months, Kaplan-Meier analysis with the log-rank test demonstrated no significant differences between those omitting vs receiving adjuvant radiotherapy in regards to 2-year rates of overall survival (72.0% vs. 73.4%, p = 0.979), cancer-specific survival (73.2% vs. 75.3%, p = 0.844), and recurrence-free survival (61.2% vs. 66.3%, p = 0.742). However, in multivariable analysis with Cox regression, young age, absence of chronic kidney disease, negative lymphovascular invasion, negative surgical margin, and adjuvant chemotherapy were also associated with better cancer-specific survival. In conclusion, adjuvant radiotherapy did not offer any significant benefit in terms of overall, cancer-specific, and recurrence-free survivals in patients with pT3N0M0 UTUC after RNU. More effective systemic adjuvant chemotherapy is necessary to improve the outcome of these patients.
Collapse
|
13
|
Szarvas T, Módos O, Horváth A, Nyirády P. Why are upper tract urothelial carcinoma two different diseases? Transl Androl Urol 2016; 5:636-647. [PMID: 27785420 PMCID: PMC5071198 DOI: 10.21037/tau.2016.03.23] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
In the last few years growing evidence highlighted the differences between upper tract urothelial carcinoma (UTUC) and urothelial bladder carcinoma (UBC) which cannot be explained solely by their different anatomical location. The aim of this review was to summarize current progress in UTUC research and to underline the differences and similarities between UTUC and UBC by focusing on epidemiology, etiology, staging and risk factors as well as on surgical and medical management. UBC and UTUC sharing common risk factors such as smoking and aromatic amines, while aristolochic acid exposure or familiar Lynch syndrome are rather specific for UTUC. The grading of UBC and UTUC are identical, but inherent from their different anatomical locations, there are some differences between their stage classifications. As an example, in contrast to UBC where a clear recommendation for pT3 subclassification exists, in UTUC current research aims to define an adequate subclassification for pelvic pT3 cases aiming to provide a better risk stratification. The primary treatment for both UBC and UTUC is surgery. Similarly to UBC, UTUC patients at high risk of disease progression are treated by radical surgery. However, because of the inaccurate preoperative or transurethral staging of UTUC, many radical nephroureterectomies are performed unnecessarily. Preoperative prediction of pathological stage or patients' prognosis may reduce this overtreatment by selecting patients for nephron-sparing surgery. To this end, predictive models combining histological and molecular features together with imaging data may be used. The antegrade or retrograde instillation of BCG or mitomycin C, as topical agents is feasible after conservative treatment of UTUC or for the treatment of CIS. However, the prognostic significance of lymph node positivity in UTUC seems to be similar to that of UBC, the therapeutic benefit of lymph node dissection (LND) in UTUC has not been firmly established yet. In addition, the number of lymph nodes to be removed and the sequence of lymphadenectomy also remain to be defined. Systemic neoadjuvant and adjuvant chemotherapies appear to have beneficial effect on UTUC survival, however, this has to be confirmed by large prospective studies. Due to the intensive research of the last few years, our knowledge on UTUC has been largely improved, but many questions remained to be answered. Further research on the molecular background of UTUC holds the potential to identify prognostic or predictive markers which, together with imaging and histologic data, may help to overcome the inaccuracy of ureteroscopic endoscopy and may therefore help to improve therapeutic decision-making. Further, prospective studies should confirm the benefit of LND and adjuvant chemotherapy. Considering the low incidence of UTUC, conduction of such studies is difficult and may only be performed in a multicenter setting.
Collapse
Affiliation(s)
- Tibor Szarvas
- Department of Urology, Semmelweis University, Budapest, Hungary; ; Department of Urology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Orsolya Módos
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - András Horváth
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Péter Nyirády
- Department of Urology, Semmelweis University, Budapest, Hungary
| |
Collapse
|
14
|
Huang YC, Chen MF, Shi CS, Shindel AW, Huang CE, Pang ST, Chuang CK, Chen CS, Chang YH, Lin WY, Ho DR, Chin CC, Kuo YH, Wu CF. The Efficacy of Postoperative Adjuvant Chemotherapy for Patients with pT3N0M0 Upper Tract Urothelial Carcinoma. J Urol 2015; 194:323-9. [DOI: 10.1016/j.juro.2015.03.077] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Yun-Ching Huang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Miao-Fen Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chung-Sheng Shi
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Alan W. Shindel
- Department of Urology, University of California, Davis, California
| | - Cih-En Huang
- Department of Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - See-Tong Pang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Cheng-Keng Chuang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Shou Chen
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ying-Hsu Chang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wei-Yu Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Dong-Ru Ho
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chih-Chien Chin
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yi-Hung Kuo
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ching-Fang Wu
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| |
Collapse
|
15
|
Transurethral electric coagulation combined with retroperitoneal laparoscopic nephroureterectomy for upper urinary urothelial carcinoma. Int Surg 2015; 100:547-51. [PMID: 25785342 DOI: 10.9738/intsurg-d-13-00282.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Retroperitoneal laparoscopic nephroureterectomy (LNU) combined with transurethral electric resection of ipsilateral bladder cuff is widely accepted to treat the upper urinary tract urothelial carcinoma (UUT-UC). To reduce the local recurrence rate, we improved the procedure from electric resection to electric coagulation. From May 2008 to July 2012, of all the 156 retroperitoneal LNU patients, 76 cases (test group) were performed with LNU combined with electric coagulation, and 80 cases (control group) were with electric resection. For the clinical outcomes, the hospital stay in the test group was shorter (5.2 ± 2.6 days versus 8.2 ± 3.4 days; P < 0.05), and the 1-year tumor recurrence rate was much lower (1.6% versus 13.3%, P < 0.05). There was no difference in operation time and blood loss between groups. Retroperitoneal LNU combined with electric coagulation is technically feasible and safe with lower tumor recurrence rate and shorter hospital stay.
Collapse
|
16
|
Park J, Habuchi T, Arai Y, Ohyama C, Inoue T, Hatakeyama S, Jeon SS, Kwon GY, Kwak C, Moon KC, Kim CS, Ahn H. Reassessment of Prognostic Heterogeneity of pT3 Renal Pelvic Urothelial Carcinoma: Analysis in Terms of Proposed pT3 Subclassification Systems. J Urol 2014; 192:1064-71. [DOI: 10.1016/j.juro.2014.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Jinsung Park
- Department of Urology, Eulji University Hospital, Daejeon, Republic of Korea
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Youichi Arai
- Department of Urology, Tohoku University School of Medicine, Sendai, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takamitsu Inoue
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ghee Young Kwon
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
17
|
Bruzzi M, Le Goux C, Pignot G, Amsellem-Ouazana D, Vieillefond A, Patard JJ, Zerbib M. [Pronostic value of parenchyma renal invasion of pT3 upper tract urinary carcinoma]. Prog Urol 2014; 24:556-62. [PMID: 24975790 DOI: 10.1016/j.purol.2013.12.005] [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: 08/11/2013] [Revised: 12/01/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Upper tract urinary carcinoma (UTUC) pT3 tumors are a heterogeneous entity including tumors invading the renal parenchyma, tumors with peripelvic fat invasion or peri-ureteral fat invasion. The aim of this study was to evaluate the prognostic significance of these three different groups of pT3 tumors. PATIENTS AND METHODS Between 1998 and 2012, 205 patients with UTUC were operated in two centers, including 52 patients with pT3 tumor stage. pT3 tumors were divided into three groups: peri-ureteral fat invasion (pT3U, n = 16), peripelvic fat invasion (pT3G, n = 21), and renal parenchyma invasion (pT3P, n = 15). The prognostic significance of the type of tumor infiltration was evaluated on specific and disease-free survival. RESULTS Median follow-up was 18.9 months [6-133.4]. In univariate analysis, renal parenchyma invasion was associated with a better prognostic in both specific (P = 0.026) and disease-free survival (P = 0.031) compared with peripelvic or peri-ureteral fat invasion. Mutivariate analysis retained the pT3 subgroup as an independant prognostic factor in both specific and disease-free survival (P = 0.02). CONCLUSION pT3 tumors with renal parenchyma invasion had a better prognosis than those with peripelvic or peri-ureteral fat invasion. The heterogeneity of the pT3 group should be taken into account to improve the care of patients.
Collapse
Affiliation(s)
- M Bruzzi
- Service d'urologie, hôpital Bicêtre, université Paris-Sud Paris XI, 94270 Le Kremlin-Bicêtre, France
| | - C Le Goux
- Service d'urologie, hôpital Bicêtre, université Paris-Sud Paris XI, 94270 Le Kremlin-Bicêtre, France.
| | - G Pignot
- Service d'urologie, hôpital Bicêtre, université Paris-Sud Paris XI, 94270 Le Kremlin-Bicêtre, France
| | - D Amsellem-Ouazana
- Service d'urologie, hôpital Cochin, université Paris Descartes Paris V, 75014 Paris, France
| | - A Vieillefond
- Service d'anatomopathologie, hôpital Cochin, 75014 Paris, France
| | - J-J Patard
- Service d'urologie, hôpital Bicêtre, université Paris-Sud Paris XI, 94270 Le Kremlin-Bicêtre, France
| | - M Zerbib
- Service d'urologie, hôpital Cochin, université Paris Descartes Paris V, 75014 Paris, France
| |
Collapse
|
18
|
Kapoor A, Allard CB, Black P, Kassouf W, Morash C, Rendon R. Canadian guidelines for postoperative surveillance of upper urinary tract urothelial carcinoma. Can Urol Assoc J 2013; 7:306-11. [PMID: 24319507 DOI: 10.5489/cuaj.1578] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON
| | | | | | | | | | | |
Collapse
|
19
|
Williams PA, Mai KT. Primary carcinoma of renal calyx. Pathol Res Pract 2013; 209:654-61. [PMID: 23999038 DOI: 10.1016/j.prp.2013.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 06/12/2013] [Accepted: 07/15/2013] [Indexed: 10/26/2022]
Abstract
Renal calyx carcinoma (RCXC) may mimic collecting duct carcinoma (CDC) or urothelial carcinoma (UC) of the renal pelvis. RCXC is distinguished from CDC and UC of the renal pelvis as having the tumor epicenter in the renal calyx, with limited involvement of the surrounding renal pelvis surface urothelium. In this study, we summarize our experience with this entity. Ten cases of RCXC, including 9 cases with urothelial differentiation (RCXC-UC) and 1 case with salivary gland-type differentiation (RCXC-SC), were identified. Ten consecutive cases of UC were selected for comparison, with extensive renal pelvis involvement and with secondary renal parenchymal invasion. Two cases of collecting duct carcinoma (CDC) were also examined. Immunohistochemistry (IHC) was performed on representative tissue blocks for PAX8, PAX2, CK5, CK7, CK20, p63, GATA3, AMACR, RCC, CD10, vimentin, S100, and MSA. The 10 cases of RCXC (M:F=4:6, ages: 62-91 years, mean: 76) presented with renal masses of 3-6cm. Ureteroscopic studies and renal pelvic washings showed atypical/malignant cells in three cases. Seven patients were treated with nephrectomy followed by radiation±chemotherapy, and all cases developed metastases to lymph nodes or liver/lung/bone. In all 7 cases with nephrectomy, there was extensive renal parenchymal involvement with infiltrating borders and diffuse spread along collecting ducts. Six RCXC-UC contained focal squamous differentiation. The RCXC-SC displayed features of adenoid cystic and basaloid features. In situ UC, with or without papillary components, was identified in the calyces in all 7 nephrectomy cases with remaining renal pelvis harboring small tumor burden in 5 cases, and no tumor in another 2 cases. Of the three cases without nephrectomy, no tumor in the renal pelvis could be visualized with endoscopy, however one case was associated with UC of the urinary bladder. Of 10 control UC cases, tumor was limited to the tip of renal papilla in 7 cases, extensive in 3 cases, and with no extension into the collecting ducts. RCXC-UC were all positive for p63, CK5, CK7, and PAX2, with all negative for RCC. PAX8 (70% positive) and GATA3 (50% positive) reactivity was variable. The 10 UC cases shared IHC properties with RCXC-UC but frequent negativity for PAX8 and positivity for GATA3. RCXC is an aggressive neoplasm with high risk of metastases. Similar to CDC, it is located in the renal papilla and rarely with clinically visible renal pelvis tumor or ureteral urine positive for tumor cells. Unlike CDC and non-calyceal UC, RCXC shows predominantly urothelial and squamous differentiation and is associated with an in situ component of adjacent renal calyces. By IHC, RCXC exhibited features intermediate between UC and CDC with decreased or negative immunoreactivity for PAX8 and GATA.
Collapse
Affiliation(s)
- Phillip A Williams
- Department of Anatomical Pathology, The Ottawa Hospital and Ottawa University, Ottawa, Ontario, Canada
| | | |
Collapse
|
20
|
Park J, Park S, Song C, Hong JH, Kim CS, Ahn H. Peripelvic/periureteral fat invasion is independently associated with worse prognosis in pT3 upper tract urothelial carcinoma. World J Urol 2013; 32:157-63. [PMID: 23568447 DOI: 10.1007/s00345-013-1073-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 03/30/2013] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To elucidate the reasons for conflicting results regarding the prognostic significance of tumor location in upper tract urothelial carcinoma (UTUC), we analyzed the stage-specific impact of tumor location on oncological outcomes following radical nephroureterectomy (RNU). METHODS Data from 392 patients who underwent RNU with curative intent between 1991 and 2010 were reviewed. Prognostic impact of tumor location and various clinicopathological factors for recurrence-free survival (RFS) and cancer-specific survival (CSS) was evaluated using Kaplan-Meier and Cox regression analyses at each pathological stage. Tumor location was classified as renal pelvis or ureter, and pT3 tumors were further stratified as invading the renal parenchyma or peripelvic or periureteral fat. RESULTS In stage-specific analysis, tumor location did not have prognostic significance in patients with ≤pT2 tumors, whereas RFS and CSS rates were significantly lower in patients with pT3 ureteral tumors than renal pelvic tumors. Subgroup analysis showed that RFS and CSS rates were significantly higher for pT3 tumors invading the renal parenchyma than the peripelvic or periureteral fat. On multivariate analysis in pT3 tumors adjusting other clinicopathological parameters, tumor location remained significant predictors for both RFS and CSS. Compared with tumors invading renal parenchyma, tumors invading peripelvic fat or periureteral fat were associated with about 3.5 times higher risk for cancer-specific mortality (p < 0.05). CONCLUSIONS Location-dependent survival difference exists only in patients with pT3 UTUC. Conflicting institutional results regarding tumor location in UTUC may be due to difference in the proportions of parenchymal versus peripelvic fat invasion in pT3 pelvic tumors.
Collapse
Affiliation(s)
- Jinsung Park
- Department of Urology, Eulji University Hospital, Daejeon, Korea
| | | | | | | | | | | |
Collapse
|
21
|
Radhakrishnan S, Aga P, Jain M, Srivastava A, Kapoor R, Mandhani A. Clinicopathological spectrum and the outcome of treatment of upper tract transitional cell carcinoma. Indian J Urol 2012; 28:174-8. [PMID: 22919133 PMCID: PMC3424894 DOI: 10.4103/0970-1591.98460] [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] [Indexed: 11/22/2022] Open
Abstract
Introduction: Disease spectrum of upper tract transitional cell carcinoma (TCC) in Indian patients is not known. Herein, we present data on clinical presentation, pathological characteristics, and the outcome of treatment of upper tract TCC. Materials and Methods: Clinicopathological data of patients who were diagnosed for upper tract TCC between January 2000 and January 2010 were collected from the hospital information system and case records. Preoperative diagnosis was based on contrast-enhanced computerized tomography of the whole abdomen and urine cytology. Cross tab and logistic regression analysis was done on the effect of various clinicopathological characteristics on the outcome and cancer-specific and recurrence survival were derived. Results: There were total 40 patients, 35 (87.5%) of them were male. The mean age was 62.7 ± 7.9 years. The most common symptom was gross hematuria present in 30 (75%). Mean tumor size was 2.8 ± 1.2 cm. Median duration of follow up was 36 (12 to 100) months. Laparoscopic nephroureterectomy was done in 27 patients along with bladder cuff excision and seven patients underwent open surgery. Thirty two (88.8%) patients had invasive T stage and high-grade lesions were seen in 24 (66.6%). Lymphovascular invasion was found only in one case and necrosis in 30 (83.3%). Necrosis was found to be the poor prognostic factor. Five-year recurrence-free and cancer-specific survivals were 36.33% and 26%, respectively. Conclusion: Patients with upper tract TCC present very late with a high-stage disease and a very low 5-year cancer-specific and recurrence-free survivals.
Collapse
Affiliation(s)
- Surdas Radhakrishnan
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | | | | | | | | | | |
Collapse
|
22
|
Subclassification of pT3 Urothelial Carcinoma of the Renal Pelvicalyceal System is Associated With Recurrence-Free and Cancer-Specific Survival: Proposal for a Revision of the Current TNM Classification. Eur Urol 2012; 62:224-31. [DOI: 10.1016/j.eururo.2012.01.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 01/12/2012] [Indexed: 11/23/2022]
|
23
|
Sassa N, Tsuzuki T, Fukatsu A, Majima T, Kimura T, Nishikimi T, Yoshino Y, Hattori R, Gotoh M. Is pT3 urothelial carcinoma of the renal pelvis a homogeneous disease entity? Proposal for a new subcategory of the pT3 classification. Histopathology 2012; 61:620-8. [DOI: 10.1111/j.1365-2559.2012.04183.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
24
|
Roscigno M, Cha EK, Rink M, Seitz C, Novara G, Chromecki TF, Fritsche HM, Matsumoto K, Walton TJ, Carballido J, Filippo Da Pozzo L, Bertini R, Ficarra V, Otto W, Karakiewicz PI, Pycha A, Fajkovic H, Naspro R, Scherr DS, Montorsi F, Shariat SF. International validation of the prognostic value of subclassification for AJCC stage pT3 upper tract urothelial carcinoma of the renal pelvis. BJU Int 2012; 110:674-81. [DOI: 10.1111/j.1464-410x.2012.10930.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
25
|
Preoperative T Categorization and Prediction of Histopathologic Grading of Urothelial Carcinoma in Renal Pelvis Using Diffusion-Weighted MRI. AJR Am J Roentgenol 2011; 197:1130-6. [DOI: 10.2214/ajr.10.6299] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
26
|
Yap SA, Schupp CW, Chamie K, Evans CP, Koppie TM. Effect of age on transitional cell carcinoma of the upper urinary tract: presentation, treatment, and outcomes. Urology 2011; 78:87-92. [PMID: 21601253 DOI: 10.1016/j.urology.2011.03.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 03/16/2011] [Accepted: 03/16/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the effect of age on the disease characteristics, treatment administered, and disease-specific survival (DSS) for patients with upper tract urothelial carcinoma. The effect of advancing age on the disease extent and survival has not been well delineated in patients with upper tract urothelial carcinoma. METHODS Using the Surveillance, Epidemiology, and End Results database from the National Cancer Institute, we identified patients diagnosed with UTUC from 1984 to 2004. The data were analyzed for age (40-49, 50-59, 60-69, 70-79, and ≥80 years), sex, race, disease extent, treatment type, and cause of death. Relationships among age, clinicopathologic features, and treatment were tabulated. The effect of age on overall and DSS were calculated using Cox proportional hazards ratio analyses. RESULTS The final cohort consisted of 12 639 patients. Advancing age was associated with greater T stage and grade at presentation. Of those 40-49 years old, 41% presented with invasive tumors (T2-T4) compared with 50% of octogenarians. Poor or undifferentiated tumors increased in frequency from 42% among those 40-49 years old to 59% among those≥80 years old. Extirpative surgery was less likely among those with Stage T1 or less disease (88.3% vs 92.8%). Octogenarians were less likely to have undergone extirpative surgery than those 40-49 years old (86% vs 95%). Despite adjustments for T stage, grade, and treatment, DSS (hazard ratio 2.64) worsened with increasing age. CONCLUSIONS With advancing age, we found a corresponding increase in stage and grade at presentation. After adjustment for stage, grade, and treatment type, older patients still had worse DSS.
Collapse
Affiliation(s)
- Stanley A Yap
- Department of Urology, University of California, Davis, School of Medicine, Sacramento, California 95817, USA.
| | | | | | | | | |
Collapse
|
27
|
Qian CN, Furge KA, Knol J, Huang D, Chen J, Dykema KJ, Kort EJ, Massie A, Khoo SK, Vanden Beldt K, Resau JH, Anema J, Kahnoski RJ, Morreau H, Camparo P, Comperat E, Sibony M, Denoux Y, Molinie V, Vieillefond A, Eng C, Williams BO, Teh BT. Activation of the PI3K/AKT pathway induces urothelial carcinoma of the renal pelvis: identification in human tumors and confirmation in animal models. Cancer Res 2009; 69:8256-64. [PMID: 19843858 DOI: 10.1158/0008-5472.can-09-1689] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Urothelial carcinoma of the renal pelvis is a deadly disease with an unclear tumorigenic mechanism. We conducted gene expression profiling on a set of human tumors of this type and identified a phosphatidylinositol 3-kinase (PI3K)/AKT activation expression signature in 76.9% (n = 13) of our samples. Sequence analysis found both activating mutations of PIK3CA (13.6%, n = 22) and loss of heterozygosity at the PTEN locus (25%, n = 8). In contrast, none of the other subtypes of kidney neoplasms (e.g., clear-cell renal cell carcinoma) harbored PIK3CA mutations (n = 87; P < 0.001). Immunohistochemical analysis of urothelial carcinoma samples found loss of PTEN protein expression (36.4%, n = 11) and elevation of phosphorylated mammalian target of rapamycin (mTOR; 63.6%, n = 11). To confirm the role of the PI3K/AKT pathway in urothelial carcinoma, we generated mice containing biallelic inactivation of Pten in the urogenital epithelia. These mice developed typical renal pelvic urothelial carcinomas, with an incidence of 57.1% in mice older than 1 year. Laser capture microdissection followed by PCR confirmed the deletion of Pten exons 4 and 5 in the animal tumor cells. Immunohistochemical analyses showed increased phospho-mTOR and phospho-S6K levels in the animal tumors. Renal lymph node metastases were found in 15.8% of the animals with urothelial carcinoma. In conclusion, we identified and confirmed an important role for the PI3K/AKT pathway in the development of urothelial carcinoma and suggested that inhibitors of this pathway (e.g., mTOR inhibitor) may serve as effective therapeutic agents.
Collapse
Affiliation(s)
- Chao-Nan Qian
- Laboratories of Cancer Genetics, Van Andel Research Institute, Grand Rapids, Michigan 49503, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Huang WW, Huang HY, Liao AC, Shiue YL, Tai HL, Lin CM, Wang YH, Lin CN, Shen KH, Li CF. Primary urothelial carcinoma of the upper tract: Important clinicopathological factors predicting bladder recurrence after surgical resection. Pathol Int 2009; 59:642-9. [DOI: 10.1111/j.1440-1827.2009.02420.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
29
|
Park J, Ha SH, Min GE, Song C, Hong B, Hong JH, Kim CS, Ahn H. The protective role of renal parenchyma as a barrier to local tumor spread of upper tract transitional cell carcinoma and its impact on patient survival. J Urol 2009; 182:894-9. [PMID: 19616243 DOI: 10.1016/j.juro.2009.05.040] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Indexed: 11/17/2022]
Abstract
PURPOSE We investigated whether tumor location has independent prognostic significance in upper tract transitional cell carcinoma cases and which factor determines it. MATERIALS AND METHODS We reviewed data on 122 renal pelvis and 102 ureteral tumor cases, including the recurrence pattern. Tumor location and other clinicopathological variables were evaluated regarding cancer specific and recurrence-free survival. Stage pT3 tumors were stratified into those invading renal parenchyma or peripelvic/periureteral fat. RESULTS Overall 5-year cancer specific survival and recurrence-free survival rates were 77.0% and 71.6%, respectively, at a mean followup of 60.7 months. Of the clinicopathological parameters T stage was the most significant prognosticator of the survival rate, while nodal involvement, high grade and ureteral tumor location were also significant for lower survival rates. Stratification analysis for matching pathological stage revealed that, while survival rates were similar in the renal pelvis and ureteral tumor groups at stage pT2 or less, renal pelvic tumors were associated with significantly higher survival rates than ureteral tumors for stage pT3. Specifically renal pelvic tumors invading the renal parenchyma were associated with a lower local failure rate, and higher cancer specific and recurrence-free survival rates than tumors invading peripelvic or periureteral fat, ie 77.5% vs 49.7% 5-year cancer specific survival and 75.6% vs 32.0% 5-year recurrence-free survival (p = 0.014 and 0.003, respectively). CONCLUSIONS Tumor location is an independent prognostic factor for pT3 upper tract transitional cell carcinoma. The overall better prognosis of renal pelvic tumors was mainly attributable to pT3 tumor outcomes, specifically lesions invading the renal parenchyma. These findings may be due to the protective role of thick renal parenchyma against local tumor spread.
Collapse
Affiliation(s)
- Jinsung Park
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Margulis V, Shariat SF, Matin SF, Kamat AM, Zigeuner R, Kikuchi E, Lotan Y, Weizer A, Raman JD, Wood CG. Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer 2009; 115:1224-33. [PMID: 19156917 DOI: 10.1002/cncr.24135] [Citation(s) in RCA: 795] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The literature on upper tract urothelial carcinoma (UTUC) has been limited to small, single center studies. A large series of patients treated with radical nephroureterectomy for UTUC were studied, and variables associated with poor prognosis were identified. METHODS Data on 1363 patients treated with radical nephroureterectomy at 12 academic centers were collected. All pathologic slides were re-reviewed by genitourinary pathologists according to strict criteria. RESULTS Pathologic review revealed renal pelvis location (64%), necrosis (21.6%), lymphovascular invasion (LVI) (24.8%), concomitant carcinoma in situ (28.7%), and high-grade disease (63.7%). A total of 590 patients (43.3%) underwent concurrent, lymphadenectomy and 135 (9.9%) were lymph node (LN) -positive. Over a mean follow-up of 51 months, 379 (28%) patients experienced disease recurrence outside of the bladder and 313 (23%) died of UTUC. The 5-year recurrence-free and cancer-specific survival probabilities (+/-SD) were 69%+/-1% and 73%+/-1%, respectively. On multivariate analysis, high tumor grade (hazards ratio [HR]: 2.0, P<.001), advancing pathologic T stage (P-for-trend<.001), LN metastases (HR: 1.8, P<.001), infiltrative growth pattern (HR: 1.5, P<.001), and LVI (HR: 1.2, P=.041) were associated with disease recurrence. Similarly, patient age (HR: 1.1, P=.001), high tumor grade (HR: 1.7, P=.001), increasing pathologic T stage (P-for-trend<.001), LN metastases (HR: 1.7, P<.001), sessile architecture (HR: 1.5, P=.002), and LVI (HR: 1.4, P=.02) were independently associated with cancer-specific survival. CONCLUSIONS Radical nephroureterectomy provided durable local control and cancer-specific survival in patients with localized UTUC. Pathologic tumor grade, T stage, LN status, tumor architecture, and LVI were important prognostic variables associated with oncologic outcomes, which could potentially be used to select patients for adjuvant systemic therapy.
Collapse
Affiliation(s)
- Vitaly Margulis
- Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Chung SD, Wang SM, Lai MK, Huang CY, Liao CH, Huang KH, Pu YS, Chueh SC, Yu HJ. Lymphovascular invasion predicts poor outcome of urothelial carcinoma of renal pelvis after nephroureterectomy. BJU Int 2008; 103:1047-51. [PMID: 19076143 DOI: 10.1111/j.1464-410x.2008.08253.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the significance of lymphovascular invasion (LVI) to predict cancer-specific survival (CSS) in patients with renal pelvic urothelial carcinoma (UC). PATIENTS AND METHODS In all, 76 patients with primary renal pelvic UC were treated by nephroureterectomy (NU). Inclusion criteria included nonmetastatic renal pelvic UC with no previous history of bladder cancer, concomitant ureteric lesion, or neoadjuvant chemotherapy. Age, gender, adrenalectomized or not, pathological T stage, grade, and LVI were examined by univariate and multivariate analyses to determine which were independent risk factors. RESULTS In all, 38 men and 38 women were included with a mean (range) age of 66 (41-93) years. The median (range) follow-up was 48 (15-88) months. At follow-up, eight cancer-related deaths (10.5%) were censored, and 66 patients (85.9%) were alive and disease-free. LVI was the only significant predictor of CSS in the univariate and multivariate analyses. CONCLUSIONS Adrenal metastases from primary renal pelvic UCs were rare. The present results suggest that ipsilateral adrenalectomy is not necessary during radical NU for treating patients with renal pelvic UCs. LVI appears to be a better prognostic factor for predicting poor outcome of renal pelvic UC than pT stage or tumour grade when using the current tumour-nodes-metastases staging system.
Collapse
Affiliation(s)
- Shiu-Dong Chung
- Division of Urology, Department of Surgery, Far-Eastern Memorial Hospital, Ban Ciao, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Chung SD, Liao CH, Yu HJ, Chueh SC. Re: Clinical significance of lymphovascular invasion in upper urinary tract urothelial cancer. BJU Int 2008; 102:1749-50. [PMID: 19035861 DOI: 10.1111/j.1464-410x.2008.08215_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
33
|
Kidney and Ureter Cancers. Radiat Oncol 2008. [DOI: 10.1007/978-3-540-77385-6_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
34
|
Simone G, Papalia R, Loreto A, Leonardo C, Sentinelli S, Gallucci M. Independent prognostic value of tumour diameter and tumour necrosis in upper urinary tract urothelial carcinoma. BJU Int 2008; 103:1052-7. [PMID: 18990140 DOI: 10.1111/j.1464-410x.2008.08134.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To identify significant prognostic indicators of upper urinary tract (UUT) urothelial carcinoma (UC) and to assess a risk stratification of patients. PATIENTS AND METHODS We retrospectively analysed data from 162 patients with non-metastatic UC primarily occurring in UUT treated with open nephroureterectomy. Variables assessed included age, gender, pT, tumour grade, tumour necrosis extension, pN, tumour location, multifocal location, tumour diameter, and subsequent development of a bladder tumour. Tumour necrosis was measured using commercial software (Eureka interface system, version 4.0.22, HESP technology, Menarini Diagnostics, Italy) and was classified as none, focal (<10% of tumour area) or extensive, >or=10% of tumour area). The prognostic significance of each variable on metastasis-free survival (MFS) and disease-free survival (DFS) was tested in univariable analysis with the log-rank test. Variables with significance levels of P < 0.05 according to the univariable analyses were entered into a multivariable forward-stepwise Cox regression model. RESULTS At a mean follow-up of 66 months, 20 cancer-related deaths (12.3%) were censored. In multivariable analysis, tumour diameter, pT stage and tumour necrosis were independent predictors of MFS and DFS. All events occurred in patients with extensive tumour necrosis and a tumour diameter of >or=3 cm. The median survival of patients with advanced-stage tumours, extensive necrosis and a tumour diameter of >or=3 cm were significantly impaired by increasing pT stage(P < 0.001). CONCLUSION Tumour necrosis and tumour diameter are compelling prognostic factors that deserve further study in a prospective setting to determine if their use in combination with more traditional variables, such as pT stage, might better determine prognosis and guide the follow-up and treatment of patients.
Collapse
Affiliation(s)
- Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy.
| | | | | | | | | | | |
Collapse
|
35
|
Brausi MA. Reply to Giuseppe Simone, Rocco Papalia and Michele Gallucci's Letter to the Editor re: Maurizio A. Brausi, Mirko Gavioli, Giuseppe De Luca et al. Retroperitoneal Lymph Node Dissection (RPLD) in Conjunction with Nephroureterectomy in the Treatment of Infiltrative Transitional Cell Carcinoma (TCC) of the Upper Urinary Tract: Impact on Survival. Eur Urol 2007;52:1414–20. Eur Urol 2008. [DOI: 10.1016/j.eururo.2008.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
36
|
Urothelial carcinoma of the upper urinary tract: surgical approach and prognostic factors. Eur Urol 2008; 53:720-31. [PMID: 18207315 DOI: 10.1016/j.eururo.2008.01.006] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2007] [Accepted: 01/04/2008] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Open radical nephroureterectomy (O-RNU) has been the gold standard for the treatment of upper urinary tract urothelial carcinoma (UUT-UC) for decades. With the advances in laparoscopic techniques and endourologic procedures, this concept has been increasingly challenged. Oncologic outcome prediction is mainly based on stage and grade. With progress in medical treatment, adjuvant therapies may gain importance in the future. This review assesses the values of the variety of available treatments as well as prognostic factors that may become relevant regarding patient selection for future adjuvant treatment trials. METHODS We performed a systematic literature research using MEDLINE with emphasis on open surgical, laparoscopic, and endourologic (ureteroscopic or percutaneous) techniques and prognostic contents. RESULTS Overall, no evidence level 1 information from prospective randomised trials is available for treatment of UUT-UC. Laparoscopic radical nephroureterectomy (L-RNU) is increasingly challenging open surgery. Currently, L-RNU should be reserved for low-stage, low-grade tumours. Ureteroscopy and percutaneous nephron-sparing techniques show favourable survival data but high local recurrence rates. Regarding prognosis, estimation of outcome still relies mainly on stage and grade because no additional parameters have been introduced in a routine clinical setting. CONCLUSIONS O-RNU still represents the gold standard for the treatment of UUT-UC. The laparoscopic approach is not yet standard of care and should be reserved for low-stage, low-grade tumours. Endourologic nephron-sparing treatments are still experimental in elective indications due to high local recurrence rates. For prognosis, no parameters in addition to stage and grade have been standardised.
Collapse
|