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Ditonno F, Franco A, Wu Z, Wang L, Abdollah F, Simone G, Correa AF, Ferro M, Perdonà S, Amparore D, Bhanvadia R, Brönimann S, Puri D, Mendiola DF, Ben-David R, Moon SC, Yong C, Moghaddam FS, Ghoreifi A, Bologna E, Licari LC, Finati M, Tuderti G, Helstrom E, Tozzi M, Tufano A, Rais-Bahrami S, Sundaram CP, Mehrazin R, Gonzalgo ML, Derweesh IH, Porpiglia F, Singla N, Margulis V, Antonelli A, Djaladat H, Autorino R. Robot-assisted nephroureterectomy: surgical and mid-term oncological outcomes in over 1100 patients (ROBUUST 2.0 collaborative group). BJU Int 2024. [PMID: 39263834 DOI: 10.1111/bju.16526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
OBJECTIVE To analyse surgical, functional, and mid-term oncological outcomes of robot-assisted nephroureterectomy (RANU) in a contemporary large multi-institutional setting. PATIENTS AND METHODS Data were retrieved from the ROBotic surgery for Upper tract Urothelial cancer STtudy (ROBUUST) 2.0 database, an international, multicentre registry encompassing data of patients with upper urinary tract urothelial carcinoma undergoing curative surgery between 2015 and 2022. The analysis included all consecutive patients undergoing RANU except those with missing data in predictors. Detailed surgical, pathological, and postoperative functional data were recorded and analysed. Oncological time-to-event outcomes were: recurrence-free survival (RFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). Survival analysis was performed using the Kaplan-Meier method, with a 3-year cut-off. A multivariable Cox proportional hazard model was built to evaluate predictors of each oncological outcome. RESULTS A total of 1118 patients underwent RANU during the study period. The postoperative complications rate was 14.1%; the positive surgical margin rate was 4.7%. A postoperative median (interquartile range) estimated glomerular filtration rate decrease of -13.1 (-27.5 to 0) mL/min/1.73 m2 from baseline was observed. The 3-year RFS was 59% and the 3-year MFS was 76%, with a 3-year OS and CSS of 76% and 88%, respectively. Significant predictors of worse oncological outcomes were bladder-cuff excision, high-grade tumour, pathological T stage ≥3, and nodal involvement. CONCLUSIONS The present study contributes to the growing body of evidence supporting the increasing adoption of RANU. The procedure consistently offers low surgical morbidity and can provide favourable mid-term oncological outcomes, mirroring those of open NU, even in non-organ-confined disease.
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Affiliation(s)
- Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, University of Verona, Verona, Italy
| | - Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Linhui Wang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Andres F Correa
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy
| | - Sisto Perdonà
- Istituto Nazionale Tumori di Napoli, IRCCS 'Fondazione G. Pascale', Naples, Italy
| | - Daniele Amparore
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Raj Bhanvadia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Stephan Brönimann
- Brady Urological Institute, School of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Dhruv Puri
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Dinno F Mendiola
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Reuben Ben-David
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Sol C Moon
- Department of Urology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Courtney Yong
- Department of Urology, Indiana University, Indianapolis, IN, USA
| | - Farshad S Moghaddam
- Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Alireza Ghoreifi
- Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | | | | | - Marco Finati
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Gabriele Tuderti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Emma Helstrom
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Marco Tozzi
- Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy
| | - Antonio Tufano
- Istituto Nazionale Tumori di Napoli, IRCCS 'Fondazione G. Pascale', Naples, Italy
| | - Soroush Rais-Bahrami
- Department of Urology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Mark L Gonzalgo
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ithaar H Derweesh
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Francesco Porpiglia
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Nirmish Singla
- Brady Urological Institute, School of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Hooman Djaladat
- Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USA
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Ma Z, Yi Y, Qiu Z. Recent trends in incidence, mortality, survival, and treatment of upper tract urothelial carcinoma. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102573. [PMID: 38330829 DOI: 10.1016/j.fjurol.2024.102573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/18/2023] [Accepted: 12/10/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND To examine the recent trends in incidence, incidence-based mortality, survival, and treatment of upper tract urothelial carcinoma (UTUC) from 2004 to 2019 and investigate whether patients would benefit from adjuvant chemotherapy. METHODS Within the Surveillance, Epidemiology, and End Results (SEER) database, we identified 18,422 patients diagnosed with UTUC from 2004 to 2019. Joinpoint regression analyses were used to test the trends in annual percentage change (APC) for statistical significance. RESULTS From 2004 to 2019, the incidence of all UTUC decreased from 1.46 to 1.27 per 100,000 person-years [APC: -1.11, P<0.001]. In subgroup analysis, the incidence decreased for localized, regional and stage I-II, but increased for distant. Over the study period, changes in trend for 5-year cancer specific survival [APC: -0.21, P=0.676] and 5-year overall survival [APC: 0.18, P=0.751] of all UTUC were not significant. The 5-year cancer specific survival and 5-year overall survival for regional and stage III cancer improved significantly from 2004 to 2014. Since 2004, rates of treatment with nephroureterectomy combined with chemotherapy increased significantly [APC: 7.38, P<0.001], while rates of treatment with nephroureterectomy alone decreased significantly [APC: -1.89, P<0.001]. CONCLUSION The overall incidence of UTUC is reduced, with a significant reduction in the incidence of early stage UTUC but an increase in the incidence of late stage UTUC. No significant change in IBM was observed over the study period. No significant improvement in survival for early stage UTUC. Significant improvements in regional and stage III survival were observed with active adjuvant chemotherapy. There is also an excess of combination therapy. LEVEL OF EVIDENCE 8.
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Affiliation(s)
- Zecong Ma
- Department of Urology, Longyan First Hospital Affiliated to Fujian Medical University, Longyan, Fujian Province, China
| | - Yi Yi
- Department of Urology, Longyan First Hospital Affiliated to Fujian Medical University, Longyan, Fujian Province, China.
| | - Zini Qiu
- Minxi Vocational and Technical College, Longyan, Fujian Province, China
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Deb AA, Chitteti P, Naushad N, Asaad W, Leung S, Hartley A, Serag H. Role of Neoadjuvant Chemotherapy on Pathological, Functional, and Survival Outcomes of Upper Tract Urothelial Carcinoma Patients: A Systematic Review and Meta-Analysis. UROLOGY RESEARCH & PRACTICE 2024; 50:13-24. [PMID: 38451126 PMCID: PMC11059980 DOI: 10.5152/tud.2024.23214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/08/2024] [Indexed: 03/08/2024]
Abstract
The role of neoadjuvant chemotherapy (NAC) in upper tract urothelial cancer (UTUC) is not yet confirmed. Therefore, we conducted this review to pool the available evidence in this regard. We analyzed 14117 UTUC patients reported in 21 studies after searching 5 databases. The NAC was administered in 1983 patients and the remaining 12134 controls underwent radical nephroureterectomy (RNU) alone. Efficacy endpoints included pathological, functional, and survival outcomes. Safety was determined by overall and grade 3-4 complications. For dichotomous outcomes, the log odds ratio (logOR) was pooled, and for continuous variables, the crude mean difference was calculated along with its 95% CI. The NAC was associated with 10% complete pathological response (CPR), 42% pathological downstaging, 31% post-NAC advanced disease (pT3-4), 6% positive surgical margin, 18% lymph node metastasis (pN+), 24% lymphovascular invasion, and 29% mortality and recurrence at 5 years. Compared to controls, NAC resulted in increased risk of CPR [logOR=1.67; 95% CI, 0.11-3.23] and downstaging [logOR=1.30; 95% CI, 0.41-2.18] and reduced risk of advanced disease [logOR=-0.81; 95% CI, -1.51--0.11]. Renal function did not improve from baseline; however, it increased significantly after RNU. The NAC was associated with good survival/low mortality in the short term, with a sustained increase over time. Overall and grade 3-4 complications occurred in 25% and 7% of patients, respectively. Our findings support the potential benefits of NAC in enhancing pathological outcomes and possibly improving survival in UTUC patients undergoing RNU. The variability in response and associated complications underscore the importance of careful patient selection and tailored treatment approaches.
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Affiliation(s)
- Abdalla Ali Deb
- Department of Urology, James Cook University Hospital, Middlesbrough, UK
| | - Pragnitha Chitteti
- Department of Urology, James Cook University Hospital, Middlesbrough, UK
| | - Naufal Naushad
- Department of Urology, North Tees University Hospital, Stockton, UK
| | - Wael Asaad
- Department of Urology, James Cook University Hospital, Middlesbrough, UK
| | - Steve Leung
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Alice Hartley
- Department of Urology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Hosam Serag
- Department of Urology, University Hospitals Birmingham, Birmingham, UK
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Barton GJ, Tan WP, Inman BA. The nephroureterectomy: a review of technique and current controversies. Transl Androl Urol 2020; 9:3168-3190. [PMID: 33457289 PMCID: PMC7807352 DOI: 10.21037/tau.2019.12.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The nephroureterectomy (NU) is the standard of care for invasive upper tract urothelial carcinoma (UTUC) and has been around for well over one hundred years. Since then new operative techniques have emerged, new technologies have developed, and the surgery continues to evolve and grow. In this article, we review the various surgical techniques, as well as present the literature surrounding current areas of debate surrounding the NU, including the lymphatic drainage of the upper urinary tract, management of UTUC involvement with the adrenals and caval thrombi, surgical management of the distal ureter, the use of intravesical chemotherapy as well as perioperative systemic chemotherapy, as well as various outcome measures. Although much has been studied about the NU, there still is a dearth of level 1 evidence and the field would benefit from further studies.
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Affiliation(s)
- Gregory J Barton
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Wei Phin Tan
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Brant A Inman
- Division of Urology, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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5
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Qiu D, Hu J, He T, Li H, Hu J, Yi Z, Chen J, Zu X. Effect of neoadjuvant chemotherapy on locally advanced upper tract urothelial carcinoma: a pooled analysis. Transl Androl Urol 2020; 9:2094-2106. [PMID: 33209672 PMCID: PMC7658168 DOI: 10.21037/tau-20-933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The outcome of neoadjuvant chemotherapy (NAC) has been established in bladder cancer but remains controversial in upper tract urothelial carcinoma (UTUC). In this work, we explored the therapeutic effect of NAC in patients with locally advanced UTUC. Methods We conducted a literature search on articles published from 1995 up to April 2020 in PubMed/Medline, the Cochrane Library, Embase, Google Scholar. A total of 19 eligible studies with 6,283 patients were identified, from which the overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), disease-free survival (DFS), pathological complete response (pCR) rate and pathological partial response (pPR) rate were extracted. All analyses were conducted using Review Manager 5.3 and Stata statistical software (version 15). Results In total, 6,283 UTUC patients were included from 19 eligible studies out of which 1,474 patients received NAC and subsequent radical nephroureterectomy (RNU), whereas 4,809 patients received RNU only. Compared with single RNU, patients with NAC and subsequent RNU exhibited longer OS, CSS, PFS, DFS by hazard ratio (HR) 2.14 [95% confidence interval (CI): 1.75–2.63; P<0.001], HR 2.07 (95% CI: 1.49–2.87; P<0.001), HR 2.00 (95% CI: 1.42–2.83; P<0.001), and HR 3.76 (95% CI: 2.16–6.56; P<0.001). pCR rate and pPR rate of NAC are 0.10 (0.07–0.13) and 0.40 (95% CI: 0.32–0.49, P <0.001) respectively. Conclusions This work revealed that NAC and subsequent RNU provided better survival outcomes in patients with locally advanced UTUC when compared with single RNU.
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Affiliation(s)
- Dongxu Qiu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Jiao Hu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Tongchen He
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Huihuang Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Hu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhenglin Yi
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Jinbo Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiongbing Zu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
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6
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Kocher NJ, Canes D, Bensalah K, Roupret M, Lallas C, Margulis V, Shariat S, Colin P, Matin S, Tracy C, Xylinas E, Wagner A, Roumiguie M, Kassouf W, Klatte T, Raman JD. Incidence and preoperative predictors for major complications following radical nephroureterectomy. Transl Androl Urol 2020; 9:1786-1793. [PMID: 32944541 PMCID: PMC7475660 DOI: 10.21037/tau.2020.01.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background Radical nephroureterectomy (RNU) is the referent standard for managing bulky, invasive, or high grade upper-tract urothelial carcinoma (UTUC). The UTUC patient population, however, generally harbor medical comorbidities thereby placing them at risk of surgical complications. This study reviews a large international cohort of RNU patients to define the risk of major complications and preoperative factors associated with their occurrence. Methods Patients undergoing RNU at 14 academic medical centers between 2002 and 2015 were retrospectively reviewed. Preoperative clinical, demographic, operative, and comorbidity indices were recorded. The modified Clavien-Dindo index was used to grade complications occurring within 30 days of surgery. The association between preoperative variables and major complications occurring after RNU was determined by multivariable logistic regression. Results One thousand two hundred and sixty-six patients (707 men; 559 women) with a median age of 70 years and BMI of 27 kg/m2 were included. Over three-quarters of the cohort was white, 50.1% had baseline chronic kidney disease (CKD) ≥ stage III, 22.4% had a Charlson comorbidity index (CCI) score >5, and 17.1% had an Eastern Cooperative Oncology Group (ECOG) performance status ≥2. Overall, 413 (32.6%) experienced a complication including 103 (8.1%) with a major event. Specific distribution of major complications included 49 Clavien III, 44 Clavien IV, and 10 Clavien V. On univariate analysis, patient age (P=0.006), hypertension (P=0.002), diabetes mellitus (P=0.023), CKD stage (P<0.001), American Society of Anesthesiologists (ASA) score (P=0.022), ECOG (P<0.001), and CCI (P<0.001) all were associated with major complications. On multivariate analysis, ECOG ≥2 (OR 2.38, 95% CI, 1.46–3.90), P=0.001), CCI >5 (OR 3.45, 95% CI, 1.41–8.33, P=0.007), and CKD stage ≥3 (OR 3.64, P=0.008) were independently associated with major complications. Conclusions Major complications following RNU occurred in almost 10% of patients. Impaired preoperative performance status and baseline CKD are preoperative variables associated with these major post-surgical adverse event. These easily measurable indices warrant consideration and discussion prior to proceeding with RNU.
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Affiliation(s)
- Neil J Kocher
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - David Canes
- Department of Urology, Lahey Clinic Hospital and Medical Center, Burlington, MA, USA
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | - Morgan Roupret
- Department of Urology, Pierre and Marie Curie University, Paris, France
| | - Costas Lallas
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Vitaly Margulis
- Department of Urology, The University of Texas Southwestern, Dallas, TX, USA
| | - Shahrokh Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Pierre Colin
- Department of Urology, La Louviere Private Hospital, Lille, France
| | - Surena Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chad Tracy
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Andrew Wagner
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mathieu Roumiguie
- Department of Urology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Wassim Kassouf
- Department of Urology, McGill University Health Center, Montreal, Quebec, Canada
| | - Tobias Klatte
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Jay D Raman
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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7
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Khan AI, Taylor BL, Al Hussein Al Awamlh B, Posada Calderon L, Fainberg J, Elahjji R, Shoag J, Scherr DS. Survival Outcomes in Neoadjuvant Chemotherapy for High-grade Upper Tract Urothelial Carcinoma: A Nationally Representative Analysis. Urology 2020; 146:158-167. [PMID: 32896584 DOI: 10.1016/j.urology.2020.06.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/20/2020] [Accepted: 06/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the impact of neoadjuvant chemotherapy (NAC) on survival outcomes in a contemporary cohort of patients with in upper tract urothelial carcinoma (UTUC). METHODS The National Cancer Database was queried from 2004 to 2015 to identify subjects who underwent nephroureterectomy for UTUC. Kaplan-Meier method with log-rank test was performed to compare all-cause mortality between patients who received preoperative chemotherapy to those who did not at each pathologic (p) TNM stage group: T1-4N0, N+, and M+ disease. Associations for all-cause mortality were identified using an adjusted Cox regression analysis. RESULTS A total of 10,315 chemoeligible subjects were included in the analysis. A total of 296 (2.9%) of patients received NAC prior to NU. Kaplan-Meier survival curves of the entire cohort demonstrated an overall survival advantage associated with administration of NAC (P = .017). Stratified by clinical staging, subjects with nonorgan-confined tumors had improved overall survival outcomes with NAC administration (P = .012). On multivariate analysis there was a statistically significant improvement in overall survival between in patients who received NAC. Of patients in the preoperative chemotherapy group who had clinically nonorgan-confined disease, 27.1% had organ-confined disease at time of surgery compared to 1.4% of those who underwent surgery as initial therapy. CONCLUSION In a contemporary cohort of subjects who underwent nephroureterectomy for UTUC, administration of NAC in patients with high-grade nonorgan-confined disease led to higher rates of pathologic downstaging and was associated with improved overall survival.
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Affiliation(s)
- Aleem I Khan
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY; Weill Cornell Medical College, New York, NY
| | | | | | | | | | - Rahmi Elahjji
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY
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Duquesne I, Ouzaid I, Loriot Y, Moschini M, Xylinas E. Lymphadenectomy for Upper Tract Urothelial Carcinoma: A Systematic Review. J Clin Med 2019; 8:jcm8081190. [PMID: 31398895 PMCID: PMC6722659 DOI: 10.3390/jcm8081190] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/15/2019] [Accepted: 08/05/2019] [Indexed: 12/20/2022] Open
Abstract
Background: The role of lymphonodal dissection during surgery for a tumor of the urinary tract remains controversial. Objective: To analyze anatomical bases of lymphonodal dissection in tumors of the upper urinary tract and analyze its impact on survival, recurrence, and staging. Acquisition of data: A web-based search for scientific articles using Medline/Pubmed was carried out to identify and analyze articles on the practice and the role of lymphonodal dissection in this indication. Data Synthesis: The lymphatic drainage of the upper urinary tract has rarely been studied and is poorly understood. The lymphonodal metastatic extension is the most common extension in upper urinary tract urothelial carcinoma. Lymphnode invasion is a clear independent poor prognostic factor. Therefore, it seems legitimate to offer an extended lymphonodal dissection to patients undergoing surgery to cure these tumors. When lymphnodes dissection respects clear anatomical principles based on the location of the primary tumor and its extension, it improves both survival and recurrence rates. This result could be secondary to the treatment of subclinical metastatic disease. Conclusion: An extended lymphadenectomy during surgery for upper urinary tract urothelial carcinoma following strict anatomical pattern improves staging with a highly probable therapeutic benefit.
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Affiliation(s)
- Igor Duquesne
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 75014 Paris, France
- Department of Cancer Medicine, Gustave Roussy Institute, Cancer Campus, Grand Paris, University of Paris-Sud, 94800 Villejuif, France
| | - Idir Ouzaid
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris Diderot University, 75018 Paris, France
| | - Yohann Loriot
- Department of Cancer Medicine, Gustave Roussy Institute, Cancer Campus, Grand Paris, University of Paris-Sud, 94800 Villejuif, France
| | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, 6004 Lucerne, Switzerland
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 75006 Paris, France.
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9
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Aragon-Ching JB, Choudhury A, Margulis V, Yu EY. Formidable Scenarios in Urothelial and Variant Cancers of the Urinary Tract. Am Soc Clin Oncol Educ Book 2019; 39:262-275. [PMID: 31099661 DOI: 10.1200/edbk_237451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Diagnostic and therapeutic challenges in the field of bladder and upper tract cancers provide opportunities for multidisciplinary care. Urothelial cancers make up the majority of the histologic subtype of bladder and upper tract cancers. Although the existence of variant histology, nonurothelial cancers, and urethral cancers is rare, these cancers pose a challenging clinical dilemma given the lack of well-defined consensus treatment guidelines. This review focuses on key issues of treatment: cisplatin ineligibility with emphasis on the definition, nuances of chemotherapy and frontline immune checkpoint inhibitor therapy, use of radiation in bladder-preservation strategies, upper tract urothelial cancer management, and highlights of urothelial variants and nonurothelial tumors and management.
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Affiliation(s)
| | - Ananya Choudhury
- 2 The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Vitaly Margulis
- 3 The Univeristy of Texas Southwestern Medical Center, Dallas, TX
| | - Evan Y Yu
- 4 University of Washington, Seattle, WA
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Abstract
BACKGROUND Similar to bladder cancer, more than 95% tumors of the upper urinary tract are urothelial carcinoma. At initial diagnosis approximately 60% of the tumors are already invasive. In case of distant metastasis (M+) there is no benefit of radical nephroureterectomy. In those cases, systemic therapy is indicated. OBJECTIVES The aim of this article is to present a systematic overview of different therapies in patients with metastatic upper tract urothelial carcinoma (UTUC). RESULTS Currently there are insufficient data upon which the recommendations for treatment of locally advanced and metastatic UTUC can be based. Cisplatin-based chemotherapy is the gold standard in first-line treatment of metastatic UTUC. Due to a lower toxicity compared to MVAC (methotrexate, vinblastine, adriamycin plus cisplatin), gemcitabine and cisplatin have become standard. However, carboplatin-based chemotherapies should not be considered interchangeable. Immunomodulatory therapies using checkpoint inhibition, particularly with antibodies directed against PD-1 (programmed cell death 1), PD-L1 (programmed cell death ligand 1) or CTLA-4 (cytotoxic T‑lymphocyte antigen-4) have shown significant antitumor activity with tolerable safety profiles and durable responses in patients with locally advanced and metastatic urothelial carcinoma. In those patients, unfit for cisplatin-based chemotherapy, good response rates have been reported in case of a positive PD-L1 status. However, preliminary data of the KEYNOTE-361 and IMvigor130 studies showed a reduced survival in case of low PD-L1 expression.
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Hosogoe S, Hatakeyama S, Kusaka A, Hamano I, Iwamura H, Fujita N, Yamamoto H, Tobisawa Y, Yoneyama T, Yoneyama T, Hashimoto Y, Koie T, Ohyama C. Platinum-based Neoadjuvant Chemotherapy Improves Oncological Outcomes in Patients with Locally Advanced Upper Tract Urothelial Carcinoma. Eur Urol Focus 2018; 4:946-953. [DOI: 10.1016/j.euf.2017.03.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/10/2017] [Accepted: 03/21/2017] [Indexed: 12/25/2022]
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Freifeld Y, Krabbe LM, Clinton TN, Woldu SL, Margulis V. Therapeutic strategies for upper tract urothelial carcinoma. Expert Rev Anticancer Ther 2018; 18:765-774. [PMID: 29848133 DOI: 10.1080/14737140.2018.1481395] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Many controversies exist regarding the appropriate management of patients with upper tract urothelial carcinoma (UTUC), including staging, surgical management, use of systemic therapy, and prevention of bladder recurrence. Due to the rarity of this condition, high-level evidence is often lacking and in many cases guidelines are extrapolated from existing evidence on urothelial bladder cancer. Areas covered: This review paper summarizes the evidence on proper diagnosis and staging, surgical techniques, prevention of bladder recurrences, the use of local or systemic treatments in both neoadjuvant and adjuvant settings as well as special consideration for hereditary UTUC. Expert commentary: UTUC is a rare malignancy and slow progress is being made in the acquisition of high-quality evidence in this field. Treatments that facilitate preservation of the kidney are being explored such as advanced endoscopic techniques or partial resection of ureteral disease with seemingly acceptable oncological results. Further prospective evidence is needed.
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Affiliation(s)
- Yuval Freifeld
- a Department of Urology , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Laura-Maria Krabbe
- a Department of Urology , University of Texas Southwestern Medical Center , Dallas , TX , USA.,b Department of Urology , University of Muenster Medical Center , Muenster , Germany
| | - Timothy N Clinton
- a Department of Urology , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Solomon L Woldu
- a Department of Urology , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Vitaly Margulis
- a Department of Urology , University of Texas Southwestern Medical Center , Dallas , TX , USA
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13
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Kubota Y, Hatakeyama S, Tanaka T, Fujita N, Iwamura H, Mikami J, Yamamoto H, Tobisawa Y, Yoneyama T, Yoneyama T, Hashimoto Y, Koie T, Ito H, Yoshikawa K, Sasaki A, Kawaguchi T, Ohyama C. Oncological outcomes of neoadjuvant chemotherapy in patients with locally advanced upper tract urothelial carcinoma: a multicenter study. Oncotarget 2017; 8:101500-101508. [PMID: 29254181 PMCID: PMC5731891 DOI: 10.18632/oncotarget.21551] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/21/2017] [Indexed: 11/25/2022] Open
Abstract
Objective The clinical impact of neoadjuvant chemotherapy (NAC) on oncological outcomes in patients with locally advanced upper tract urothelial carcinoma (UTUC) remains unclear. We investigated the oncological outcomes of platinum-based NAC for locally advanced UTUC. Results Of 234 patients, 101 received NAC (NAC group) and 133 did not (Control [Ctrl] group). The regimens in the NAC group included gemcitabine and carboplatin (75%), and gemcitabine and cisplatin (21%). Pathological downstagings of the primary tumor and lymphovascular invasion were significantly improved in the NAC than in the Ctrl groups. NAC for locally advanced UTUC significantly prolonged recurrence-free and cancer-specific survival. Multivariate Cox regression analysis using an inverse probability of treatment weighted (IPTW) method showed that NAC was selected as an independent predictor for prolonged recurrence-free and cancer-specific survival. However, the influence of NAC on overall survival was not statistically significant. Materials and Methods A total of 426 patients who underwent radical nephroureterectomy at five medical centers between January 1995 and April 2017 were examined retrospectively. Of the 426 patients, 234 were treated for a high-risk disease (stages cT3–4 or locally advanced [cN+] disease) with or without NAC. NAC regimens were selected based on eligibility of cisplatin. We retrospectively evaluated post-therapy pathological downstaging, lymphovascular invasion, and prognosis stratified by NAC use. Multivariate Cox regression analysis was performed for independent factors for prognosis. Conclusions Platinum-based NAC for locally advanced UTUC potentially improves oncological outcomes. Further prospective studies are needed to clarify the clinical benefit of NAC for locally advanced UTUC.
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Affiliation(s)
- Yuka Kubota
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Toshikazu Tanaka
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiromichi Iwamura
- Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Jotaro Mikami
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tohru Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuya Koie
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroyuki Ito
- Department of Urology, Aomori Rosai Hospital, Hachinohe, Japan
| | | | - Atsushi Sasaki
- Department of Urology, Tsugaru General Hospital, Goshogawara, Japan
| | - Toshiaki Kawaguchi
- Department of Urology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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14
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Li P, Tao J, Deng X, Qin C, Cheng Y, Li P, Zhang J, Cao Y, Yang X, Yang C, Lu Q. Extraperitoneal Laparoscopic Radical Nephroureterectomy and Lymph Node Dissection in Modified Supine Position. Urology 2017; 107:126-131. [DOI: 10.1016/j.urology.2017.05.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 05/07/2017] [Accepted: 05/30/2017] [Indexed: 11/25/2022]
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15
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Leow JJ, Chong KT, Chang SL, Bellmunt J. Upper tract urothelial carcinoma: a different disease entity in terms of management. ESMO Open 2017; 1:e000126. [PMID: 28848663 PMCID: PMC5419214 DOI: 10.1136/esmoopen-2016-000126] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/22/2016] [Indexed: 12/24/2022] Open
Abstract
Upper tract urothelial carcinomas (UTUCs) consist of 5%–10% of all urothelial carcinomas, the rest being urothelial carcinomas of the bladder (UCB). There is increasing evidence to show that UTUC is a distinct disease entity from UCB based on phenotypical and genotypical (genetic and epigenetic) differences. This may account for why the natural history of UTUC is different from that of UCB, with >60% of UTUCs and only 15%–25% of UCB presenting with invasion at diagnosis. Management of UTUC is thus different from UCB in a variety of ways, ranging from surgical management, postoperative instillation therapy, postoperative surveillance and medical management (neoadjuvant and adjuvant chemotherapy). This review paper aims to highlight these differences with an emphasis on the distinct management of UTUC, along with the latest updates.
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Affiliation(s)
- Jeffrey J Leow
- Department of Urology, Tan Tock Seng Hospital,; Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School,.
| | | | - Steven L Chang
- Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School,; Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School
| | - Joaquim Bellmunt
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School
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16
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Song W, Sung HH, Han DH, Jeong BC, Seo SI, Jeon SS, Lee HM, Choi HY, Jeon HG. The effect of contralateral kidney volume on renal function after radical nephroureterectomy: Implications for eligibility for neoadjuvant chemotherapy for upper tract urothelial cancer. Urol Oncol 2016; 35:114.e1-114.e7. [PMID: 27908680 DOI: 10.1016/j.urolonc.2016.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 09/10/2016] [Accepted: 10/31/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE We investigated the effect of preoperative contralateral kidney (CK) volume on renal function after radical nephroureterectomy (RNU). METHODS We reviewed 630 patients who underwent RNU between September 1994 and December 2013. Of these 630 patients, 135 patients with advanced upper tract urothelial cancer were ultimately included. Preoperative CK volume was measured from computed tomography images of the venous phase using a specialized volumetric program. Glomerular filtration rate (GFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations and checked preoperatively, 7 days, 1, 3, and 12 months postoperatively. RESULTS The mean age at surgery was 62.1 (10.1) years and the mean CKD-EPI GFR was 73.8 (75.5) ml/min/1.73m2. After RNU, new-onset CKD was identified in 69 (51.1%) patients. On multivariate logistic regression analysis, high body mass index (95% CI: 1.08-1.51, P = 0.005), low preoperative CKD-EPI GFR (95% CI: 0.92-0.98, P = 0.037), and low CK volume (95% CI: 0.96-0.99, P<0.001) were associated with new-onset CKD at 1 month after RNU. There was a positive correlation between CK volume and CKD-EPI GFR at 1 month after RNU (Spearman ρ = 0.495, P<0.001). When stratified according to CK volume, CK volume less than 150ml was significantly associated with new-onset CKD after RNU (95% CI: 2.49-26.29, P = 0.001). CONCLUSIONS High body mass index, low preoperative CKD-EPI GFR, and low CK volume are significantly associated with new-onset CKD. Therefore, they could be used to identify patients eligible for neoadjuvant chemotherapy in upper tract urothelial cancer.
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Affiliation(s)
- Wan Song
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Deok Hyun Han
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Han Yong Choi
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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17
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Abstract
Radical nephroureterectomy (RNU) is the gold standard treatment strategy for bulky, high-grade, or muscle-invasive upper tract urothelial carcinoma (UTUC). Many patients with UTUC who require RNU are elderly, comorbid, and at risk for perioperative complications. Recognition of likelihood and extent of such complications guides preoperative counseling, decision-making process for major surgery, and perioperative care. A critical review of such data is essential, given the inevitable impact of complications on hospital duration, need for readmission, resource utilization, and costs associated with management.
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Affiliation(s)
- Jay D Raman
- Division of Urology, Penn State Milton S. Hershey Medical Center, 500 University Drive, c4830B, Hershey, PA, 17033, USA.
| | - Syed M Jafri
- Division of Urology, Penn State Milton S. Hershey Medical Center, 500 University Drive, c4830B, Hershey, PA, 17033, USA
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Interplay between chronic kidney disease (CKD) and upper tract urothelial carcinomas (UUC): foe or friend? Oncotarget 2016; 7:53951-53958. [PMID: 27256983 PMCID: PMC5288235 DOI: 10.18632/oncotarget.9753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 05/23/2016] [Indexed: 02/07/2023] Open
Abstract
Although upper tract urothelial carcinomas (UUC) is curable through nephrectomy or nephroureterectomy, progression of chronic kidney disease (CKD) and CKD-related mortality have been highlighted as clinical challenges in recent years owing to the loss of a large number of nephrons. While CKD can promote the development of UUC, other risk factors such as hypertension, diabetes mellitus, advanced age, and anemia can facilitate the progression of CKD. Conversely, CKD is especially prevalent in UUC patients. However, the relationship between CKD and UUC, mechanisms for CKD causing UUC, and gender disparity of UUC of CKD patients have so far not been well-reviewed. As UUC gradually grows, the cancer can be a physical obstacle in the urinary tract. It will cause an increased tract pressure, subsequently resulting in the dysfunction of both nephrons and kidney. At the molecular level, reduced level of oxidative stress was observed in female UUC patients. Furthermore, radical nephrectomy therapy for UUC patients accelerates the progress of chronic kidney dysfunction. Incidentally, the remedies for CKD containing aristolochic acid (AA) are carcinogenic. Our present review offers a comprehensive look at the relationship between CKD and UUC from multiple perspectives. Early and precise identification of progression of CKD and UUC will benefit the patients at high-risk of CKD or UUC, which will also be instructive in directing timely and effective therapeutic interventions whenever necessary. It may also shed light on unveiling the underlying mechanisms of carcinogenesis of UUC, preventing CKD progression, and prolonging the patients' overall survival.
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Raman JD, Lin YK, Shariat SF, Krabbe LM, Margulis V, Arnouk A, Lallas CD, Trabulsi EJ, Drouin SJ, Rouprêt M, Bozzini G, Colin P, Peyronnet B, Bensalah K, Bailey K, Canes D, Klatte T. Preoperative nomogram to predict the likelihood of complications after radical nephroureterectomy. BJU Int 2016; 119:268-275. [PMID: 27322735 DOI: 10.1111/bju.13556] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To construct a nomogram based on preoperative variables to better predict the likelihood of complications occurring within 30 days of radical nephroureterectomy (RNU). PATIENTS AND METHODS The charts of 731 patients undergoing RNU at eight academic medical centres between 2002 and 2014 were reviewed. Preoperative clinical, demographic and comorbidity indices were collected. Complications occurring within 30 days of surgery were graded using the modified Clavien-Dindo scale. Multivariate logistic regression determined the association between preoperative variables and post-RNU complications. A nomogram was created from the reduced multivariate model with internal validation using the bootstrapping technique with 200 repetitions. RESULTS A total of 408 men and 323 women with a median age of 70 years and a body mass index of 27 kg/m2 were included. A total of 75% of the cohort was white, 18% had an Eastern Cooperative Oncology Group (ECOG) performance status ≥2, 20% had a Charlson comorbidity index (CCI) score >5 and 50% had baseline chronic kidney disease (CKD) ≥ stage III. Overall, 279 patients (38%) experienced a complication, including 61 events (22%) with Clavien grade ≥ III. A multivariate model identified five variables associated with complications, including patient age, race, ECOG performance status, CKD stage and CCI score. A preoperative nomogram incorporating these risk factors was constructed with an area under curve of 72.2%. CONCLUSIONS Using standard preoperative variables from this multi-institutional RNU experience, we constructed and validated a nomogram for predicting peri-operative complications after RNU. Such information may permit more accurate risk stratification on an individual cases basis before major surgery.
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Affiliation(s)
- Jay D Raman
- Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Yu-Kuan Lin
- Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Laura-Maria Krabbe
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alex Arnouk
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Costas D Lallas
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Edouard J Trabulsi
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Sarah J Drouin
- Department of Urology, Pitie Salpétrière Hospital, AP-HP, University Paris 6, Paris, France
| | - Morgan Rouprêt
- Department of Urology, Pitie Salpétrière Hospital, AP-HP, University Paris 6, Paris, France
| | - Gregory Bozzini
- Department of Urology, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | - Pierre Colin
- Department of Urology, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | | | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | - Kari Bailey
- Department of Urology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - David Canes
- Department of Urology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Tobias Klatte
- Department of Urology, Medical University of Vienna, Vienna, Austria
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20
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Jinzaki M, Kikuchi E, Akita H, Sugiura H, Shinmoto H, Oya M. Role of computed tomography urography in the clinical evaluation of upper tract urothelial carcinoma. Int J Urol 2016; 23:284-98. [DOI: 10.1111/iju.13032] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/15/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Masahiro Jinzaki
- Department of Diagnostic Radiology; Keio University School of Medicine; Tokyo Japan
| | - Eiji Kikuchi
- Department of Urology; Keio University School of Medicine; Tokyo Japan
| | - Hirotaka Akita
- Department of Diagnostic Radiology; Keio University School of Medicine; Tokyo Japan
| | - Hiroaki Sugiura
- Department of Diagnostic Radiology; Keio University School of Medicine; Tokyo Japan
| | - Hiroshi Shinmoto
- Department of Radiology; National Defense Medical College; Tokorozawa Saitama Japan
| | - Mototsugu Oya
- Department of Urology; Keio University School of Medicine; Tokyo Japan
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21
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Shao IH, Lin YH, Hou CP, Juang HH, Chen CL, Chang PL, Tsui KH. Risk factors associated with ineligibility of adjuvant cisplatin-based chemotherapy after nephroureterectomy. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:1985-90. [PMID: 25364228 PMCID: PMC4211848 DOI: 10.2147/dddt.s72197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE Radical nephroureterectomy (RNU) is a standard treatment for upper urinary tract urothelial carcinoma. However, RNU can result in decreased renal function and cannot be treated with adjuvant chemotherapy. We performed a risk group stratification analysis to determine the preoperative factors that are predictive of diminished renal function after RNU. MATERIALS AND METHODS We retrospectively evaluated the medical records of all patients who underwent nephroureterectomy for upper urinary tract urothelial carcinoma at the Chang Gung Memorial Hospital from 2001 to 2008. We analyzed the association between perioperative glomerular filtration rate and preoperative parameters including cancer characteristics, serum creatinine level, and kidney size measured on computed tomographic images. RESULTS A total of 242 patients fulfilled the inclusion criteria. The average decrease in renal function 1 month after RNU was 19.7%. Using 60 mL/min/1.73 m(2) as the eligibility cutoff for cisplatin-based chemotherapy, 42.1% of the population was eligible prior to nephroureterectomy, whereas following surgery only 15.2% remained eligible. Using a cutoff of 45 mL/min/1.73 m(2), 59.9% of the cohort was eligible for fractionated cisplatin dosing preoperatively, whereas only 32.6% remained above the cutoff postoperatively. The most significant predictors of poor postoperative renal function were body mass index >25 kg/m(2), age >65 years, contralateral kidney length less than 10 cm, and absence of ipsilateral hydronephrosis. CONCLUSION Our results suggest that older age, higher body mass index, smaller contralateral renal length, and absence of ipsilateral hydronephrosis are predictive of decreased renal function after RNU.
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Affiliation(s)
- I-Hung Shao
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taiwan, Republic of China ; Department of Urology, Lotung Poh-Ai Hospital, Chang Gung University, Taiwan, Republic of China
| | - Yu-Hsiang Lin
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taiwan, Republic of China
| | - Chen-Pang Hou
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taiwan, Republic of China
| | - Horng-Heng Juang
- Department of Anatomy, Chang Gung University, Taiwan, Republic of China ; Bioinformation Center, Chang Gung Memory Hospital, Kwei-Shan, Tao-Yuan, Taiwan, Republic of China
| | - Chien-Lun Chen
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taiwan, Republic of China
| | - Phei-Lang Chang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taiwan, Republic of China ; Bioinformation Center, Chang Gung Memory Hospital, Kwei-Shan, Tao-Yuan, Taiwan, Republic of China
| | - Ke-Hung Tsui
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taiwan, Republic of China ; Bioinformation Center, Chang Gung Memory Hospital, Kwei-Shan, Tao-Yuan, Taiwan, Republic of China
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Oya M, Kikuchi E. Evidenced-based clinical practice guideline for upper tract urothelial carcinoma (summary--Japanese Urological Association, 2014 edition). Int J Urol 2014; 22:3-13. [PMID: 25243652 DOI: 10.1111/iju.12630] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 08/28/2014] [Indexed: 01/24/2023]
Abstract
Upper tract urothelial carcinoma is more rare than bladder cancer, although they are both categorized as urothelial carcinoma. Because of the low incidence, little clinical evidence is available regarding the treatment of the former. However, recently such evidence has slowly begun to accumulate. The guideline presented herein was compiled for the purpose of ensuring proper diagnosis and treatment by physicians involved in the treatment of upper tract urothelial carcinoma. We carefully selected 16 clinical questions essential for daily clinical practice and grouped them into four major categories: epidemiology, diagnosis, surgery and systemic chemotherapy/other matters. Related literature was searched using PubMed and Japan Medical Abstracts Society databases for articles published between 1987 and 2013. If the judgment was made on the basis of insufficient or inadequate evidence, the grade of recommendation was determined on the basis of committee discussions and resultant consensus statements. Here, we present a short English version of the original guideline, and overview its key clinical issues.
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Affiliation(s)
- Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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23
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Marshall S, Stifelman M. Robot-assisted surgery for the treatment of upper urinary tract urothelial carcinoma. Urol Clin North Am 2014; 41:521-37. [PMID: 25306164 DOI: 10.1016/j.ucl.2014.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Robot-assisted laparoscopic surgery is increasingly used in urologic oncologic surgery. Robotic nephroureterectomy is still a relatively new technique. As upper tract urothelial carcinoma is a rare disease, intermediate- and long-term outcome data are scarce. However, robotic nephroureterectomy does seem to offer advantages to open and laparoscopic counterparts, with comparable short-term oncologic and functional outcomes. Here the authors review the robotic surgical management of upper tract urothelial carcinoma, with a review of the steps and tips on making this approach more widely adoptable.
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Affiliation(s)
- Susan Marshall
- Department of Urology, NYU Langone Medical Center, 150 East 32nd Street, 2nd Floor, New York, NY 10016, USA.
| | - Michael Stifelman
- Department of Urology, NYU Langone Medical Center, 150 East 32nd Street, 2nd Floor, New York, NY 10016, USA
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24
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Affiliation(s)
- Jong Chul Park
- Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - Deborah E. Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Piyush K. Agarwal
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrea B. Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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25
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Lin YK, Kaag M, Raman JD. Rationale and timing of perioperative chemotherapy for upper-tract urothelial carcinoma. Expert Rev Anticancer Ther 2014; 14:543-51. [PMID: 24666189 DOI: 10.1586/14737140.2014.882774] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Radical surgery alone for high-risk upper-tract urothelial carcinoma (UTUC) is often inadequate for long-term cancer control. Numerous studies implicate failure presumably attributable to metastatic disease. Therefore, multimodal therapy by way of perioperative chemotherapy is integral to improve cancer outcomes and disease-specific survival. Despite this apparent reality, there is lack of consensus regarding which patients will need additional therapy, optimal timing for delivery of agents, and specific regimens to be utilized. Progress is being made, however, to explore these issues both by extrapolation from the bladder cancer literature as well as studying outcomes from retrospective UTUC series. Prospectively accruing studies for both neoadjuvant and adjuvant chemotherapy will likely mature in the next 5 years thereby providing higher level data to better guide standard of care.
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Affiliation(s)
- Yu-Kuan Lin
- Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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26
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Colin P, Ghoneim TP, Nison L, Seisen T, Lechevallier E, Cathelineau X, Ouzzane A, Zerbib M, Long JA, Ruffion A, Crouzet S, Cussenot O, Audouin M, Irani J, Gardic S, Gres P, Audenet F, Roumiguié M, Valeri A, Rouprêt M. Risk stratification of metastatic recurrence in invasive upper urinary tract carcinoma after radical nephroureterectomy without lymphadenectomy. World J Urol 2013; 32:507-12. [DOI: 10.1007/s00345-013-1116-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 06/07/2013] [Indexed: 10/26/2022] Open
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Xylinas E, Rink M, Margulis V, Clozel T, Lee RK, Comploj E, Novara G, Raman JD, Lotan Y, Weizer A, Roupret M, Pycha A, Scherr DS, Seitz C, Ficarra V, Trinh QD, Karakiewicz PI, Montorsi F, Zerbib M, Shariat SF. Impact of renal function on eligibility for chemotherapy and survival in patients who have undergone radical nephro-ureterectomy. BJU Int 2013; 112:453-61. [PMID: 23464979 DOI: 10.1111/j.1464-410x.2012.11649.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
UNLABELLED What's known on the subject? and what does the study add?: Radical nephroureterectomy (RNU), the standard of care treatment for high-risk urothelial carcinoma of the upper tract (UTUC), results in loss of a renal unit. Loss of renal function decreases eligibility for systemic chemotherapies and results in decreased overall survival in various malignancies. The study shows that only a small proportion of patients had a preoperative renal function that would allow cisplatin-based chemotherapy. Moreover, eGFR significantly decreased after RNU, thereby lowering the rate of cisplatin eligibility to only 16 and 52% of patients based on the thresholds of 60 and 45 mL/min/1.73 m(2) , respectively. Taken together with the rest of the literature, the findings of the study support the use of cisplatin-based chemotherapy, when indicated, in the neoadjuvant rather than adjuvant setting. OBJECTIVE To report (i) the estimated glomerular filtration rate (eGFR) changes in patients undergoing radical nephro-ureterectomy (RNU) for upper tract urothelial carcinoma (UTUC); (ii) the rate of change in eGFR in patients eligible for cisplatin-based chemotherapy; and (iii) the association of preoperative, postoperative and rate of change of renal function variables with survival outcomes. PATIENT AND METHODS We performed a retrospective analysis of 666 patients treated with RNU for UTUC at seven international institutions from 1994 to 2007. The eGFR was calculated at baseline and at 3-6 months (Modification of Diet in Renal Disease formula (MDRD) and Chronic Kidney Disease Epidemiology Collaboration formula (CKD-EP) equations). RESULTS The median (interquartile range) eGFR decreased by 18.2 (8-12)% after RNU. A total of 37% of patients had a preoperative eGFR ≥ 60 mL/min/1.73 m(2) , which decreased to 16% after RNU (P < 0.001); 72% of patients had a preoperative eGFR ≥ 45 mL/min/1.73 m(2) , which decreased to 52% after RNU (P < 0.001). The distributions were similar when analyses were restricted to patients with locally advanced disease (pT3-pT4) and/or lymph node metastasis. Patients older than the median age of 70 years were more likely to have a decrease in eGFR after RNU (P < 0.001). None of the renal function variables was associated with clinical outcomes such as disease recurrence, cancer-specific and overall mortality; however, when analyses were restricted to patients who had no adjuvant chemotherapy and did not experience disease recurrence (n = 431), a preoperative eGFR ≥ 60 mL/min/1.73 m(2) (P = 0.03) and a postoperative eGFR ≥ 45 mL/min/1.73 m(2) (P = 0.04) were associated with better overall survival in univariable analyses. CONCLUSIONS In patients who had UTUC, eGFR was low and furthermore, it significantly decreased after RNU. Renal function did not affect cancer-specific outcomes after RNU.
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Affiliation(s)
- Evanguelos Xylinas
- Department of Urology, Division of Medical Oncology (SFS), Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10065, USA
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Yafi FA, Tanguay S, Rendon R, Jacobsen N, Fairey A, Izawa J, Kapoor A, Black P, Lacombe L, Chin J, So A, Lattouf JB, Bell D, Fradet Y, Saad F, Matsumoto E, Drachenberg D, Cagiannos I, Kassouf W. Adjuvant chemotherapy for upper-tract urothelial carcinoma treated with nephroureterectomy: assessment of adequate renal function and influence on outcome. Urol Oncol 2013; 32:31.e17-24. [PMID: 23428535 DOI: 10.1016/j.urolonc.2012.11.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 11/13/2012] [Accepted: 11/19/2012] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Upper-tract urothelial carcinoma (UTUC) is associated with poor outcomes. Our aim was to assess adequacy of renal function and evaluate the role of adjuvant chemotherapy (AC) in patients with UTUC treated by radical nephroureterectomy (RNU) in a universal health care system. MATERIALS AND METHODS Retrospective data from 1,029 patients treated with RNU across 10 Canadian academic centers were collected. Tested variables included various clinico-pathological parameters, the use of perioperative chemotherapy, preoperative and postoperative creatinine values, and estimated glomerular filtration rates (eGFR). Univariable and multivariable Cox regression models addressed overall survival and disease-specific survival after surgery. Kaplan-Meier survival curves were used to compare outcomes in patients who received or did not receive AC. RESULTS Median age of patients was 70 years with a median follow-up of patients who were alive of 26 months. The median preoperative and postoperative eGFR rates were 59 mL/min/1.73 m(2) and 47 mL/min/1.73 m(2), respectively. Using a cutoff eGFR of 60, 49% of all the patients and 48% of the patients with ≥ pT3 or pTxN+ or both diseases would have been eligible for cisplatin-based chemotherapy preoperatively and only 18% and 21% of the patients, respectively remained eligible postoperatively. Of the patients who received AC, 75% had an eGFR<60. On multivariate analysis, AC was not prognostic for improved overall survival or disease-specific survival. CONCLUSIONS Chronic kidney disease is common in patients with UTUC. Following RNU, 57% of the high-risk patients with good preoperative renal function became ineligible for cisplatin-based chemotherapy. Use of AC did not translate into improved survival. Whether this is due to inherent biases of retrospective analysis, limited efficacy of AC in patients with UTUC, or use of suboptimal regimen or dose because of poor postoperative renal function requires further evaluation.
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Affiliation(s)
- Faysal A Yafi
- Department of Surgery (Urology), McGill University, Montreal, Quebec, Canada
| | - Simon Tanguay
- Department of Surgery (Urology), McGill University, Montreal, Quebec, Canada
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Niels Jacobsen
- Department of Surgery (Urology), University of Alberta, Edmonton, Alberta, Canada
| | - Adrian Fairey
- Department of Surgery (Urology), University of Alberta, Edmonton, Alberta, Canada
| | - Jonathan Izawa
- Department of Surgery (Urology), University of Western Ontario, London, Ontario, Canada
| | - Anil Kapoor
- Department of Surgery (Urology), McMaster University, Hamilton, Ontario, Canada
| | - Peter Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Louis Lacombe
- Department of Surgery (Urology), Laval University, Quebec, Quebec, Canada
| | - Joe Chin
- Department of Surgery (Urology), University of Western Ontario, London, Ontario, Canada
| | - Alan So
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - David Bell
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Yves Fradet
- Department of Surgery (Urology), Laval University, Quebec, Quebec, Canada
| | - Fred Saad
- Department of Surgery (Urology), University of Montreal, Montreal, Quebec, Canada
| | - Edward Matsumoto
- Department of Surgery (Urology), McMaster University, Hamilton, Ontario, Canada
| | - Darrel Drachenberg
- Department of Surgery (Urology), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ilias Cagiannos
- Department of Surgery (Urology), University of Ottawa, Ottawa, Ontario, Canada
| | - Wassim Kassouf
- Department of Surgery (Urology), McGill University, Montreal, Quebec, Canada.
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Kitamura H, Igarashi M, Tanaka T, Shindo T, Masumori N, Tamakawa M, Kawaai Y, Tsukamoto T. A Role for Preoperative Systemic Chemotherapy in Node-positive Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy. Jpn J Clin Oncol 2012; 42:1192-6. [DOI: 10.1093/jjco/hys166] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zhang H, Jiang H, Wu Z, Fang Z, Fan J, Ding Q. Primary adenocarcinoma of the urinary bladder: a single site analysis of 21 cases. Int Urol Nephrol 2012; 45:107-11. [PMID: 23054322 DOI: 10.1007/s11255-012-0305-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 09/18/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate whether there is a difference between urachal and non-urachal adenocarcinomas in terms of patient survival and to determine the significant prognostic factors. METHODS Thirty-four patients with histologically proven adenocarcinoma of the urinary bladder were treated at Huashan hospital between 1999 and 2010. 13 cases were excluded, including 12 patients with metastatic involvement from gastrointestinal or reproductive tracts and one without follow-up data after the initial consultation. Life tables, Kaplan-Meier, Cox regression analysis and log-rank test were used. RESULTS The difference between patients with urachal adenocarcinoma and patients with non-urachal adenocarcinoma was not statistically significant using the Kaplan-Meier estimates (P = 0.0763). Clinical stage had a significant influence on survival (P = 0.0320, Fig. 2). Patients with surgical resection including partial and radical cystectomy did not have a better prognosis (P = 0.7992, Fig. 3). However, the difference is statistically significant between patients who received partial cystectomy and patients who received radical cystectomy (P = 0.0123, Fig. 4). CONCLUSION Survival of Patients with adenocarcinoma is correlated with clinical stage. Patients with urachal adenocarcinoma and non-urachal adenocarcinoma may have similar survival outcome. Tumor stage was a highly significant predictor of outcome (P = 0.0320). Surgical resection seems to be more important than chemotherapy in the cases of adenocarcinoma of the urinary bladder. We are in favor of radical cystectomy for all patients.
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Affiliation(s)
- Hu Zhang
- Department of Urology, Huashan Hospital, Fudan University, No. 12, WuLuMuQi Middle Road, Shanghai, China
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Rink M, Ehdaie B, Cha EK, Green DA, Karakiewicz PI, Babjuk M, Margulis V, Raman JD, Svatek RS, Fajkovic H, Lee RK, Novara G, Hansen J, Daneshmand S, Lotan Y, Kassouf W, Fritsche HM, Pycha A, Fisch M, Scherr DS, Shariat SF. Stage-Specific Impact of Tumor Location on Oncologic Outcomes in Patients With Upper and Lower Tract Urothelial Carcinoma Following Radical Surgery. Eur Urol 2012; 62:677-84. [PMID: 22349570 DOI: 10.1016/j.eururo.2012.02.018] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 02/05/2012] [Indexed: 11/26/2022]
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Cordier J, Sonpavde G, Stief CG, Tilki D. Oncologic outcomes obtained after neoadjuvant and adjuvant chemotherapy for the treatment of urothelial carcinomas of the upper urinary tract: a review. World J Urol 2012; 31:77-82. [PMID: 23053212 DOI: 10.1007/s00345-012-0960-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 09/18/2012] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Nephroureterectomy with excision of a bladder cuff is the gold standard in the treatment of upper urinary tract carcinomas (UTUC). But especially for patients suffering from advanced tumor stages, life expectancy has not improved over the years with local recurrence or distant metastases being the main reasons for treatment failure. Chemotherapy in an adjuvant or neoadjuvant setting seems therefore to be a promising approach. METHODS The literature of the last 20 years was searched using Medline. Articles were chosen by using the given abstracts. Only articles written in English and not older than 20 years were considered. RESULTS Most information concerning chemotherapy of urothelial carcinomas is gained from studies comprising patients suffering from lower urinary tract carcinomas. The combination of methotrexate, adriamycin, vinblastine and cisplatin as well as the combination of gemcitabine and cisplatin are the most used chemotherapy regimens in advanced UCC and have shown beneficial results. The summarized data of studies for UTUC contained no level one information. Down staging effects as well as prolongation of survival have been shown for some patients treated with neoadjuvant chemotherapy, but because of the small study groups and the retrospective design, no definite conclusions can be drawn from these results. In addition, there exists an uncertainty for preoperative staging. Results for adjuvant chemotherapy are lacking. CONCLUSION No definite recommendations for peri-operative chemotherapy in UTUC can be derived from the current literature. Current therapy is largely based on extrapolation from the bladder cancer literature. Prospective studies dedicated to UTUC are needed.
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Affiliation(s)
- Jan Cordier
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
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Rao SR, Correa JJ, Sexton WJ, Pow-Sang JM, Dickinson SI, Lin HY, Spiess PE. Prospective clinical trial of the feasibility and safety of modified retroperitoneal lymph node dissection at time of nephroureterectomy for upper tract urothelial carcinoma. BJU Int 2012; 110:E475-80. [PMID: 22564727 DOI: 10.1111/j.1464-410x.2012.11170.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
UNLABELLED What's known on the subject? and What does the study add? Very little is known about the safety and potential oncological benefit of performing a retroperitoneal lymph node dissection at time of nephroureterectomy for upper tract tumours. This study is the first clinical trial to prospectively validate the safety and feasibility of a retroperitoneal lymph node dissection at time of nephroureterectomy for upper tract tumours. The onus is now on the scientific community at large to conduct adequately powered multicentre clinical trials to evaluate the potential oncological benefit it may impart to patients with upper tract tumours. OBJECTIVE • To determine the safety and feasibility of modified retroperitoneal lymph node dissection (RPLND) at the time of radical nephroureterectomy (RNU). PATIENTS AND METHODS • Between 2009 and 2011, 20 patients with suspected upper urinary tract urothelial carcinoma (UUT-UC) underwent open (n= 10), laparoscopic (n= 4), or robot-assisted (n= 6) RNU with modified RPLND. • Demographic, clinical and pathological data, histological nodal status, peri-operative complications and recurrence data were collected. RESULTS • On histopathological review, one patient had a benign angioma and was excluded from the final data analysis. Of the remaining 19 patients, 10 had pTa, five had pT1, one had pT2, and three pT3 disease. • The mean (range) lymph node count was 7 (2-17), with one patient having pathologically proven lymph node metastasis. The mean (range) operating time was 279 (146-500) min. The mean EBL was 396 (100-1100) mL, with the mean (range) hospital stay 7.1 (4-18) days. The mean (range) duration of follow-up after surgery was 12 (2-24) months. • Overall, nine patients developed postoperative complications, which included eight minor (Clavien Grade I-II) and one major complication (Clavien grade IIIb). The major complication was a postoperative chylous lymphatic leak requiring surgical exploration. CONCLUSION • The present results indicate that modified RPLND during RNU for UUT-UC is a feasible procedure with acceptable morbidity. A larger prospective clinical trial is needed to adequately assess its potential therapeutic benefit.
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Affiliation(s)
- Sandhya R Rao
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
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Reply from Authors re: Mark S. Soloway, Michael Garcia-Roig, Michael A. Gorin and Rajinikanth Ayyathurai. How Can We Improve Outcomes for Upper Tract Urothelial Carcinoma? Eur Urol 2012;61:254–6. Eur Urol 2012. [DOI: 10.1016/j.eururo.2011.10.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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