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Margulis V, Ghandour RA, Singla N. Nephroureterectomy for Upper Tract Urothelial Carcinoma: Indications and Technique. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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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Kenigsberg AP, Smith W, Meng X, Ghandour R, Rapoport L, Bagrodia A, Lotan Y, Woldu SL, Margulis V. Robotic Nephroureterectomy vs Laparoscopic Nephroureterectomy: Increased Utilization, Rates of Lymphadenectomy, Decreased Morbidity Robotically. J Endourol 2020; 35:312-318. [PMID: 33081512 DOI: 10.1089/end.2020.0496] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction and Objective: Robotic radical nephroureterectomy (RRNU) may offer advantages over laparoscopic radical nephroureterectomy (LRNU). The purpose of this study is to evaluate the overall survival (OS) of patients with upper tract urothelial carcinoma (UTUC) who underwent RRNU vs LRNU and identify factors that account for differences. Methods: The National Cancer Database was queried from 2010 to 2016 for patients with American Joint Committee on Cancer 6th/7th edition Stage I/II/III UTUC. Kaplan-Meier analysis compared LRNU and RRNU OS. Univariate analysis detected differences between the groups. Cox regression determined factors associated with mortality rate. Logistic regression identified predictors of a lymph node dissection (LND) and 90-day mortality rate. Results: A total of 2631 patients met the criteria, 1129 of whom underwent RRNU and 1502 LRNU, with a follow-up of 33 and 35 months, respectively (p = 0.063). RRNU had a median OS of 71.1 vs 62.6 months (p = 0.033). LRNU patients were older (72.7 vs 71.4, p < 0.001) and had no differences in comorbidities, pathologic T stage, or grade. The LRNU cohort was less likely to undergo LND (19% vs 35%, p < 0.001) and had a lower median lymph node yield (3 vs 4, p < 0.001). LRNU patients more likely underwent conversion to an open procedure, had longer hospital stays, and higher 30- and 90-day mortality rates. LRNU was independently associated with mortality rate (p = 0.030). Age, grade, positive margins, pT/pN stage were associated with mortality rate. Younger age, RRNU, surgery at an academic center, and neoadjuvant chemotherapy predicted an LND. Conclusions: RRNU demonstrated increased rates of LND and may offer a short-term morbidity benefit to LRNU. Survival differences may be due to improved characterization of disease through LND.
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Affiliation(s)
- Alexander P Kenigsberg
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Wesley Smith
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Xiaosong Meng
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rashed Ghandour
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Leonid Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Solomon L Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Site of metastatic recurrence impacts prognosis in patients with high-grade upper tract urothelial carcinoma. Urol Oncol 2020; 39:74.e9-74.e16. [PMID: 33071108 DOI: 10.1016/j.urolonc.2020.09.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/10/2020] [Accepted: 09/29/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Metastatic recurrence occurs in over 25% of upper tract urothelial carcinoma patients treated with radical nephroureterectomy. While metastatic recurrence suggests poor prognosis, the impact of the specific site of recurrence on prognosis is not well documented. MATERIALS AND METHODS We retrospectively analyzed 188 patients who underwent radical nephroureterectomy for high-grade, node-negative upper tract urothelial carcinoma at our institution from 2003 to 2018 without receiving neoadjuvant or adjuvant chemotherapy. Competing-risks survival analysis was performed to evaluate the cumulative incidence and predictors of metastatic recurrence. The Kaplan-Meier method and log-rank test were used to estimate and compare recurrence site-specific survival probabilities following metastatic recurrence. Cox regression analyses were performed to assess site-specific prognoses. RESULTS Of the 188 patients, 47 (25%) developed metastatic recurrence over a median follow-up of 30 months (interquartile range: 10.5-58.5 months). The 1- and 2-year cumulative incidences of metastatic recurrence were 13.6% and 23.6%, respectively. On multivariable analysis, lymphovascular invasion was significantly predictive of metastatic recurrence (subhazard ratio: 2.6, P = 0.01). Of the 47 patients who developed recurrence, 38 (80.9%) died over a median follow-up of 10 months (interquartile range: 5-20 months). Metastatic recurrence was most common in the lungs (n= 13, 28%) and at multiple sites (n= 14, 30%). Median time to recurrence was shorter for recurrences at multiple sites (6.5 months) and those in the liver (13 months) and bone (18 months) compared to other sites. Patients who recurred in the liver (hazard ratio: 6.3, P = 0.007), bone (hazard ratio: 4.9, P = 0.02), and multiple sites (hazard ratio: 4.6, P = 0.01) had significantly worse prognosis compared to those who recurred in lymph nodes. Statistical significance persisted after adjusting for treatment with salvage therapy. CONCLUSIONS A significant proportion of high-grade upper tract urothelial carcinoma patients recur systemically after radical nephroureterectomy. Lymphovascular invasion is a predictor of metastatic recurrence and may inform decisions regarding perioperative chemotherapy. Hepatic and osseous recurrences have relatively quicker onset and less favorable prognosis compared to other sites. These findings may benefit future efforts to develop recurrence site-specific treatment plans and highlight the necessity of subsequent endeavors to explore the genetic associations of recurrence in upper tract urothelial carcinoma.
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Drakaki A, Pantuck A, Mhatre SK, Dhillon PK, Davarpanah N, Degaonkar V, Surinach A, Chamie K, Grivas P. "Real-world" outcomes and prognostic indicators among patients with high-risk muscle-invasive urothelial carcinoma. Urol Oncol 2020; 39:76.e15-76.e22. [PMID: 32778476 DOI: 10.1016/j.urolonc.2020.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/25/2020] [Accepted: 07/08/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is no current standard of care for patients with high-risk muscle-invasive urothelial carcinoma (MIUC) after neoadjuvant chemotherapy and surgical resection or for those who cannot receive or decline cisplatin-based perioperative chemotherapy. Understanding current, real-world treatment patterns may help inform decisions from clinical, research, and population health management perspectives. We examined real-world treatment patterns, survival outcomes, and prognostic factors among Medicare beneficiaries with high-risk MIUC who did not receive adjuvant treatment after surgical resection. METHODS We identified patients with high-risk MIUC in the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database who underwent surgical resection (radical cystectomy and/or radical nephroureterectomy). Eligible patients had indicators of high-risk MIUC and surgical resection between 2001 and 2013. Demographic and clinical characteristics, including comorbidities, American Joint Commission on Cancer (AJCC) stage, tumor stage/grade and nodal status, and distribution of neoadjuvant treatment by the year of surgical resection were evaluated. Overall survival (OS) and disease-free survival (DFS) were assessed for the full cohort and by subgroups using Kaplan-Meier survival analysis. Adjusted Cox proportional hazards models were used to evaluate patient demographics and clinical characteristics associated with OS and DFS. RESULTS A total of 665 patients were included in the analysis, with a mean age of 75.5 years; most were men (61%) and had AJCC stage IIIA disease (69%). Neoadjuvant treatment increased over the entire study period, both overall (from 12% to 46%) and cisplatin based (from 5% to 38%). Median OS for the entire cohort was 23.1 months (95% confidence interval: 18, 27); median DFS was 13.5 months (95% confidence interval: 11.3, 16.8). AJCC stage IIIB/IVA was the most significant predictor of poor prognosis for both OS and DFS, followed by non-white race and comorbidity burden. CONCLUSION The prognosis for high-risk patients with MIUC remains poor, with significant risk of mortality within 2 years of radical cystectomy despite increasing use of neoadjuvant treatment. Unmet treatment needs persist for this difficult-to-treat patient population despite the increasing use of cisplatin-based neoadjuvant chemotherapy.
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Affiliation(s)
| | - Allan Pantuck
- University of California Los Angeles, Los Angeles, CA
| | | | | | | | | | | | - Karim Chamie
- University of California Los Angeles, Los Angeles, CA
| | - Petros Grivas
- University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, WA
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D’Andrea D, Foerster B, Matin SF, Ku JH, Muilwijk T, Monteiro LL, Liao R, Petros FG, Spiess PE, Bivalacqua TJ, Hendricksen K, van Rhijn BW, Shabsigh A, Briganti A, Joniau S, Kassouf W, Pierorazio PM, Margulis V, Necchi A, Shariat SF. Impact of Sex on Response to Neoadjuvant Chemotherapy in Patients with Upper-tract Urothelial Cancer. EUR UROL SUPPL 2020; 19:16-19. [PMID: 34337449 PMCID: PMC8317786 DOI: 10.1016/j.euros.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- David D’Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Beat Foerster
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Surena F. Matin
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Ja H. Ku
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
| | - Tim Muilwijk
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Leonardo L. Monteiro
- Department of Surgery (Division of Urology), McGill University Health Center, Montreal, Canada
| | - Ross Liao
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Firas G. Petros
- Department of Urology and Kidney Transplant, The University of Toledo Medical Center and Eleanor N. Dana Cancer Center, Toledo, OH, USA
| | - Philippe E. Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Trinity J. Bivalacqua
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kees Hendricksen
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Bas W.G. van Rhijn
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Ahmad Shabsigh
- Department of Urology, Ohio State University, Columbus, OH, USA
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Wassim Kassouf
- Department of Surgery (Division of Urology), McGill University Health Center, Montreal, Canada
| | - Phillip M. Pierorazio
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Shahrokh F. Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Urology, University of Jordan, Amman, Jordan
- Corresponding author. Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. Tel.: +43 1 404002615; Fax: +43 1 404002332.
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Taylor J, Meng X, Ghandour R, Margulis V. Advancements in the clinical management of upper tract urothelial carcinoma. Expert Rev Anticancer Ther 2019; 19:1051-1060. [PMID: 31770492 DOI: 10.1080/14737140.2019.1698295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction: Upper tract urothelial carcinoma (UTUC) remains a complex disease to manage given challenges in staging, surgical resection, use of perioperative therapy, and prevention of bladder recurrences. High-level evidence is limited to guide management; however, recent data have shifted treatment paradigms. We intend to review recent evidence on advancements in the clinical management for UTUC.Areas covered: This review summarizes advancements in pre-operative work-up, surgical technique, and the use of intravesical and systemic therapy in both the neoadjuvant and adjuvant settings. Special comment is made on progress in the genomics of UTUC and how that can inform clinical practice.Expert opinion: Advancements in the clinical management of UTUC are most prominently being made in the neoadjuvant chemotherapy setting. Although level I evidence is sparse, data from both single and multi-institutional retrospective studies strongly encourage the use of neoadjuvant chemotherapy especially in high-risk or advanced-stage patients.
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Affiliation(s)
- Jacob Taylor
- Department of Urology, NYU Langone Health, New York, NY, USA
| | - Xiaosong Meng
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rashed Ghandour
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Meng X, Chao B, Vijay V, Silver H, Margolin EJ, Balar A, Taneja SS, Shah O, Bjurlin MA, Anderson CB, Huang WC. High Response Rates to Neoadjuvant Chemotherapy in High-Grade Upper Tract Urothelial Carcinoma. Urology 2019; 129:146-152. [DOI: 10.1016/j.urology.2019.01.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/11/2019] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
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Nazzani S, Preisser F, Mazzone E, Tian Z, Mistretta FA, Shariat SF, Soulières D, Saad F, Montanari E, Luzzago S, Briganti A, Carmignani L, Karakiewicz PI. Survival effect of perioperative systemic chemotherapy on overall mortality in locally advanced and/or positive regional lymph node non-metastatic urothelial carcinoma of the upper urinary tract. World J Urol 2018; 37:1329-1337. [PMID: 30298285 DOI: 10.1007/s00345-018-2516-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/01/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To analyze the potential survival benefit of perioperative chemotherapy (CHT) in patients treated with nephroureterectomy (NU) for non-metastatic locally advanced upper tract urothelial carcinoma. METHODS Within the Surveillance, Epidemiology, and End Results database (2004-2014), we identified 1286 patients with T3 or T4, N 0-3 M0 UTUC. Kaplan-Meier plots, as well as multivariable Cox regression models (MCRMs) relying on inverse probability after treatment weighting (IPTW) and landmark analyses, were used to test the effect of CHT vs no CHT on overall mortality (OM) in the overall population (n =1286), as well as after stratification according to lymph node invasion (LNI). RESULTS Overall, 37.4% patients received CHT. The CHT rate was higher with LNI (62.2% vs 35.2%, p < 0.001). In MCRMs, testing for OM in the overall population, CHT was associated with lower rates of OM (HR 0.71, CI 0.58-0.87; p = 0.001). Similarly, in MCRMs testing for OM in patients with LNI, CHT achieved independent predictor status for lower OM (HR 0.61, CI 0.48-0.78; p < 0.001). Conversely, in MCRMs testing for OM in patients without LNI, no CHT effect was recorded (HR 0.72, CI 0.52-1.01; p = 0.05). All results were confirmed after IPTW adjustment and in landmark analyses. CONCLUSIONS Our results represent a contemporary North American report indicating lower OM after CHT for patients with locally advanced non-metastatic upper tract urothelial carcinoma, specifically in patients with T3-T4, N1-N3, M0 disease. Validation of the current and of the previous study is required within a randomized prospective design.
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Affiliation(s)
- Sebastiano Nazzani
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada. .,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, QC, Canada. .,Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Corso San Gottardo 12, Milano MI, Italy.
| | - Felix Preisser
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, QC, Canada.,Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Elio Mazzone
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, QC, Canada.,Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Zhe Tian
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, QC, Canada
| | | | | | - Denis Soulières
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, QC, Canada
| | - Fred Saad
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, QC, Canada
| | - Emanuele Montanari
- Department of Urology, IRCCS Fondazione Ca' Granda-Ospedale Maggiore Policlinico University of Milan, Milan, Italy
| | - Stefano Luzzago
- Department of Urology, IRCCS Fondazione Ca' Granda-Ospedale Maggiore Policlinico University of Milan, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Luca Carmignani
- Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Corso San Gottardo 12, Milano MI, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal, Montréal, QC, Canada
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Farnum JA, Vikram R, Rao A, Bedi D, Dinney CP, Matin SF. Accuracy of High-Frequency Endoluminal Ultrasonography for Clinical Staging of Upper Tract Urothelial Carcinoma. J Endourol 2018; 32:806-811. [PMID: 30014707 DOI: 10.1089/end.2018.0442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Staging of upper tract urothelial carcinoma (UTUC) remains a dilemma due to imaging and biopsy limitations leading to understaging. We seek to determine the accuracy of endoluminal ultrasound (ELUS) for clinical staging of UTUC. MATERIALS AND METHODS Patients evaluated for UTUC underwent retrograde pyelography, ureteroscopy, and ELUS. ELUS was performed using mechanical radial scanning at 20 MHz in B-mode with a 5F probe. Cine clips were evaluated by 2 radiologists blinded to ureteroscopic and pathology findings. Results were compared to pathology from nephroureterectomy. Inclusion criteria were patients who underwent nephroureterectomy without pretreatment or managed endoscopically for cTa-1 disease and were without recurrence for >1 year. RESULTS From 2008 to 2013, 53 patients underwent ELUS without complication. Twenty-seven patients met inclusion criteria with conclusive ELUS imaging. ELUS accurately identified 16 of 21 patients with non-muscle invasive (MI) disease (18 pTa, 2 pT1, 1 CIS) and 1 of 6 patients with at least MI disease (2 pT2, 4 pT3). For MI disease, the positive predictive value (PPV), negative predictive value, and accuracy was 76.2%, 16.7%, and 63%, respectively, while for non-organ confined (OC) disease results were 0%, 81.8%, and 66.7%, respectively. CONCLUSIONS With current technique and instrumentation, ELUS may prove useful in select cases to confirm findings of non-MI and OC disease. However, it has insufficient PPV for stage pT2-3 disease. Further studies and better instrumentation are needed before incorporation into clinical practice.
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Affiliation(s)
- Jeffrey A Farnum
- 1 Department of Urology, University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Raghunandan Vikram
- 2 Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Arvind Rao
- 3 Department of Biostatistics, University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Deepak Bedi
- 2 Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Colin P Dinney
- 1 Department of Urology, University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Surena F Matin
- 1 Department of Urology, University of Texas MD Anderson Cancer Center , Houston, Texas
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