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Huang YC, Wang HJ, Sung MT, Chuang YC, Chen YT, Cheng YT, Kang CH, Liu HY, Chang YL, Chiang PH, Luo HL. The lowest level of tumor involvement is a significant prognostic factor for upper tract urothelial carcinoma after radical nephroureterectomy: A large retrospective cohort study. Front Oncol 2022; 12:1031774. [DOI: 10.3389/fonc.2022.1031774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/17/2022] [Indexed: 12/04/2022] Open
Abstract
PurposeTo evaluate the prognostic impact of the lowest level of tumor location for upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU).Materials and methodsData were collected from patients with UTUC treated with RNU (01/2005- 06/2020) at a single center in Taiwan. Patients were stratified by the lowest level of tumor location into three groups: renal pelvis only (RPO), above upper ureter (AUU), and below upper ureter (BUU). We compared characteristics between groups and examined the association of the lowest level of tumor involvement with intravesical recurrence (IVR), systemic metastasis (SM), and cancer-specific mortality (CSM).ResultsOverall, 1239 patients (542 RPO, 260 AUU, 437 BUU) were enrolled. Concurrent bladder cancer, multifocality, tumor architecture, lymphovascular invasion, carcinoma in situ, and variant histology were significantly different across different tumor locations. BUU had worse five-year intravesical recurrence (IVR), systemic metastasis (SM) and cancer-specific mortality (CSM) (p < 0.001, p = 0.056 and p = 0.13, respectively). In multivariable models, the lowest level of tumor involvement was an independent predictor of IVR (AUU hazard ratio (HR) = 1.52, p = 0.007; BUU HR = 1.75, p < 0.001), but only BUU was an independent predictor of SM (HR = 1.61, p = < 0.001) and CSM (HR = 1.51, p = 0.008).ConclusionThe lowest level of tumor involvement in UTUC, especially BUU, was associated with a higher risk of IVR, SM and CSM. Assessment of the lowest level of tumor involvement after RNU may help identify patients who require more intensive follow-up.
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Chen TS, Chen YT, Wang HJ, Chiang PH, Yang WC, Lee WC, Chuang YC, Cheng YT, Kang CH, Lee WC, Chen CH, Shen YC, Liu YY, Liu HY, Chang YL, Su YL, Huang CC, Luo HL. The Prognostic Impact of Tumor Location in pT3N0M0 Upper Urinary Tract Urothelial Carcinoma: A Retrospective Cohort Study. Front Oncol 2022; 12:850874. [PMID: 35372015 PMCID: PMC8964942 DOI: 10.3389/fonc.2022.850874] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background We aimed to evaluate the impact of tumor location on cancer outcomes in patients with pT3N0M0 upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU) with bladder cuff excision. Materials and Methods We retrospectively reviewed 302 patients with pT3N0M0 UTUC who underwent RNU with bladder cuff excision at our institution between 2005 and 2019, including 191 renal pelvis tumors and 111 ureteral tumors. Clinicopathologic characteristics were compared between renal pelvis and ureter urothelial carcinomas. Multivariate Cox proportional hazard regression was used to assess the association between outcomes and clinical factors. Outcomes of interest included intravesical recurrence-free survival (IVRFS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and cancer-specific survival (CSS), which were measured using the Kaplan-Meier curve with a log-rank test. Results A total of 302 patients underwent RNU with bladder cuff excision. During the median follow-up of 42.7 months, 70 (23.2%), 95 (31.5%), and 99 (32.8%) patients experienced intravesical recurrence, local recurrence, and distant metastasis, respectively. Seventy (23.2%) patients died from UTUC. Multivariate Cox regression analysis showed that tumor location was an independent predictor of local recurrence (HR = 2.05, p = 0.001), with borderline independent significance in intravesical recurrence (HR = 1.54, p = 0.074) and distant metastasis (HR = 1.45, p = 0.08). Kaplan-Meier analysis showed that ureter tumors had a worse 5-year local recurrence (log-rank p < 0.001) and borderline worse 5-year intravesical recurrence (log-rank p = 0.055) and 5-year distant metastasis (log-rank p = 0.073). Conclusion Ureter tumors seem to be associated with worse oncological outcomes, especially with local recurrence in UTUC. Further large and long-term studies are warranted for investigating biological differences based on tumor location.
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Affiliation(s)
- Tzu Shuang Chen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen Ta Chen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hung Jen Wang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | | | - Wen Chou Yang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei Ching Lee
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yao Chi Chuang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yuan Tso Cheng
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih Hsiung Kang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei Chia Lee
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien Hsu Chen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yuan Chi Shen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi Yang Liu
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hui Ying Liu
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yin Lun Chang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu Li Su
- Department of Hematology and Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun Chieh Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hao Lun Luo
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Tumor distribution affects bladder recurrence but not survival outcome of multifocal upper tract urothelial carcinoma treated with radical nephroureterectomy. Sci Rep 2021; 11:19059. [PMID: 34561545 PMCID: PMC8463529 DOI: 10.1038/s41598-021-98696-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/14/2021] [Indexed: 11/25/2022] Open
Abstract
Tumor multifocality and location are prognostic factors for upper tract urothelial carcinoma (UTUC). However, confounding effects can appear when these two factors are analyzed together. Therefore, we aimed to investigate the impact of tumor distribution on the outcomes of multifocal UTUC after radical nephroureterectomy. From the 2780 UTUC patients in the Taiwan UTUC Collaboration Group, 685 UTUC cases with multifocal tumors (defined as more than one tumor lesion in unilateral upper urinary tract) were retrospectively included and divided into three groups: multiple renal pelvic tumors, multiple ureteral tumors, and synchronous renal pelvic and ureteral tumors included 164, 152, and 369 patients, respectively. We found the prevalence of carcinoma in situ was the highest in the synchronous group. In multivariate survival analyses, tumor distribution showed no difference in cancer-specific and disease-free survival, but there was a significant difference in bladder recurrence-free survival. The synchronous group had the highest bladder recurrence rate. In summary, tumor distribution did not influence the cancer-specific outcomes of multifocal UTUC, but synchronous lesions led to a higher rate of bladder recurrence than multiple renal pelvic tumors. We believe that the distribution of tumors reflects the degree of malignant involvement within the urinary tract, but has little significance for survival or disease progression.
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Liu J, Wu P, Lai S, Song X, Fu C, Wang X, Liu S, Hou H, Liu M, Wang J. Preoperative Monocyte-to-lymphocyte Ratio Predicts for Intravesical Recurrence in Patients With Urothelial Carcinoma of the Upper Urinary Tract After Radical Nephroureterectomy Without a History of Bladder Cancer. Clin Genitourin Cancer 2020; 19:e156-e165. [PMID: 33121908 DOI: 10.1016/j.clgc.2020.09.004] [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: 04/16/2020] [Revised: 08/28/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study aimed to investigate the preoperative monocyte-to-lymphocyte ratio (MLR) as a biomarker for intravesical recurrence (IVR) in upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU) for the first time. PATIENTS AND METHODS This study involved the clinical data of 255 patients with UTUC without a history of bladder cancer who had undergone RNU from March 2004 to February 2019 at an academic institution. The associations between MLR and IVR were assessed with Kaplan-Meier method and Cox regression analysis. RESULTS The median follow-up was 43.93 months. Of the 255 patients, 37 developed IVR during the follow-up period. Kaplan-Meier analysis revealed that patients with high MLR (> 0.22) had poor IVR-free survival (P = .001); this prognostic value was in accordance with patients with high grade and more advanced stage UTUC. Cox regression preoperative models showed that ureteral tumor site (hazard ratio [HR], 2.784; P = .005), surgical approach (HR, 2.745; P = .008), and high MLR (HR, 4.085; P < .001) were an independent risk factor for IVR. These factors were used as a signature to establish a prognostic risk model, which revealed significant differences among the 3 subgroups of patients with low, intermediate, and high risk (P < .001). CONCLUSION Ureteral tumor site, surgical approach, and preoperative MLR are significant predictors for IVR in patients with UTUC after RNU. MLR may become a useful biomarker to predict IVR in patients with UTUC after RNU.
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Affiliation(s)
- Jianyong Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P. R. China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Pengjie Wu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Shicong Lai
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P. R. China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Xinda Song
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P. R. China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Chunlong Fu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P. R. China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Xuan Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Shengjie Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Huimin Hou
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P. R. China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China.
| | - Jianye Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P. R. China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China.
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Jiang Y, Yao Z, Zhu X, Wu B, Bai S. Risk factors and oncological outcome for intravesical recurrence in organ-confined upper urinary tract urothelial carcinoma patients after radical nephroureterectomy: A propensity score-matched case control study. Int J Surg 2020; 76:28-34. [PMID: 32081714 DOI: 10.1016/j.ijsu.2020.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/28/2020] [Accepted: 02/10/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Radical nephroureterectomy (RNU) is the primary treatment strategy for upper urinary tract urothelial carcinoma (UTUC); however, the prognosis is poor and recurrences are common. The risk factors for intravesical recurrence (IVR) remain inconsistent and unclear. Thus, we have identified the risk factors for IVR in patients with organ-confined UTUC. METHODS We retrospectively studied 229 patients with UTUC who underwent RNU combined with bladder cuff resection at our center between 1 January 2010 and 31 December 2015. After propensity score-matching, 204 patients were included in our study. Patient demographics, co-morbidities, and peri-operative data were recorded. Univariate and multivariate Cox proportional hazard regression were used to estimate the hazard ratio and 95% confidence intervals. Overall (OS) and cancer-specific survival (CSS) were measured using the Kaplan-Meier curve with a log-rank test. A p-value <0.05 was considered statistically significant. RESULTS Of the 229 patients, 42 (18.3%) had IVR after 40 months (range, 24-56 months) follow-up. In the matched group, the independent risk factors for IVR were tumor diameter (HR = 2.690, p = 0.038) and tumor stage (T3 vs. T1, HR = 3.363, p = 0.019; T2 vs. T1, HR = 2.835, p = 0.022). OS and CSS were poor in patients with IVR than patients without IVR (p < 0.0001). CONCLUSIONS In this propensity score-matched case-control study, tumor diameter and tumor stage were shown to be independent risk factors for IVR in patients with organ-confined UTUC. Moreover, patients with IVR had poor prognosis than patients without IVR. Thus, more active postoperative surveillance and treatment strategies should be adopted for these patients, which may help improve treatment outcomes.
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Affiliation(s)
- Yunzhong Jiang
- Department of Urology, ShengJing Hospital of China Medical University, Shenyang, 110004, China.
| | - Zichuan Yao
- Department of Urology, ShengJing Hospital of China Medical University, Shenyang, 110004, China.
| | - Xianqing Zhu
- Department of Urology, ShengJing Hospital of China Medical University, Shenyang, 110004, China.
| | - Bin Wu
- Department of Urology, ShengJing Hospital of China Medical University, Shenyang, 110004, China.
| | - Song Bai
- Department of Urology, ShengJing Hospital of China Medical University, Shenyang, 110004, China.
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Data Set for the Reporting of Carcinoma of the Renal Pelvis and Ureter—Nephroureterectomy and Ureterectomy Specimens. Am J Surg Pathol 2019; 43:e1-e12. [DOI: 10.1097/pas.0000000000001305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Jia Z, Gong YQ, Zhang CJ, Bao ZQ, Li XS, Hao H, Xiong GY, Zhang L, Fang D, He ZS, Zhou LQ. Segmental ureterectomy can be performed safely in patients with urothelial carcinoma of distal ureter. Can Urol Assoc J 2018; 13:E202-E209. [PMID: 30472983 DOI: 10.5489/cuaj.5555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to compare oncological outcomes by surgery type (segmental ureterectomy [SU] vs. radical nephroureterectomy [RNU]) in a large cohort of patients with upper tract urothelial carcinoma (UTUC) of the distal ureter. METHODS We performed a retrospective analysis of 219 patients with UTUC of the distal ureter among 931 patients with UTUC who underwent SU and RNU. Clinicopathological outcomes were evaluated. Cancer-specific survival (CSS), overall survival (OS), local recurrence-free survival (RFS), intravesical recurrence-free survival (IVRFS), contralateral recurrence-free survival, and distal metastasis-free survival were assessed by the Kaplan-Meier method and Cox regression, estimating hazard ratios (HR) and 95% confidence intervals (CIs). RESULTS A total of 179 (81.7%) patients underwent RNU and 40 (18.3%) underwent SU: 85 males (47.5%) with RNU and 17 (42.5%) with SU (p=0.568). The median age with RNU and SU was 71 years (range 31-86) and 70 years (range 46-90), respectively (p=0.499). The T stage of the two groups did not differ (p=0.122), nor did mean tumour length (3.35±2.62 vs. 3.25±2.14; p=0.953), grade (p=0.075), tumour necrosis (p=0.634), or followup time (months) (58.1±8.1 vs. 63.7±3.4; p=0.462). The two groups did not differ in CSS (p=0.358) or OS (p=0.206), and surgery type did not predict CSS (HR 0.862; 95% CI 0.469-1.585; p=0.633) or OS (HR 0.764; 95% CI 0.419-1.392; p=0.379). Local RFS was higher with RNU than SU (96.2% vs. 86.0%; p=0.02), but the groups did not differ in IVRFS (p=0.661), contralateral RFS (p=0.183), or distant metastasis-free survival (p=0.078). On multivariate analysis, SU was associated with local RFS (HR 5.069; 95% CI 1.029-24.968; p=0.046) and distant metastasis-free survival (HR 6.497; 95% CI 1.196-35.283; p=0.03). Local RFS was lower with SU than RNU for patients with pT3-4 stage (p=0.006). CONCLUSIONS Long-term oncological outcomes were equivalent with SU and RNU in patients with UTUC of the distal ureter. SU affected local recurrence survival, especially with advanced tumour stage, and distant metastasis survival.
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Affiliation(s)
- Zhuo Jia
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
| | - Yan-Qing Gong
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
| | - Cui-Jian Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
| | - Zheng-Qing Bao
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
| | - Xue-Song Li
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
| | - Han Hao
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
| | - Geng-Yan Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
| | - Lei Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
| | - Dong Fang
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
| | - Zhi-Song He
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
| | - Li-Qun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology and National Urological Cancer Center, Peking University, Peking University, Beijing, China
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