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Wang J, Tang J, Liu X, He D. A web-based prognostic nomogram for the cancer specific survival of elderly patients with T1-T3N0M0 renal pelvic transitional cell carcinoma based on the surveillance, epidemiology, and end results database. BMC Urol 2022; 22:78. [PMID: 35610606 PMCID: PMC9131540 DOI: 10.1186/s12894-022-01028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 04/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background At present, there are few studies on renal pelvic transitional cell carcinoma (RPTCC) in elderly patients in the literature. The study aims to establish a new nomogram of cancer-specific survival (CSS) in elderly patients with T1-T3N0M0 RPTCC and validate its reliability. Methods This study downloaded the data of 1375 elderly patients with T1-T3N0M0 RPTCC in the Surveillance, Epidemiology, and Final Results (SEER) database from 2004 to 2018. Patients were randomly divided into training cohort (n = 977) and validation cohort (n = 398). Proportional subdistribution hazard analyse was applied to determine independent prognostic factors. Based on these factors, we constructed a compting risk model nomogram. We use the calibration plots, the area under the receiver operating characteristics curve (AUC), concordance index (C-index), and decision curve analysis (DCA) to validate predictive performance and clinical applicability. Patients were divided into low-risk group and high-risk group based on nomogram risk score. Kaplan–Meier curve was applied to analyze the difference in survival curve between the two groups of patients. Results We found that the risk factors affecting CSS in elderly patients with T1-T3N0M0 RPTCC are surgery, AJCC stage, laterality, tumor size, histological grade, and tumour laterality. Based on these factors, we established a nomogram to predict the CSS of RPTCC patients at 1-, 3-, and 5-year. The calibration plots showed that the predicted value was highly consistent with the observed value. In the training cohort and validation cohort, the C-index of the nomogram were 0.671(95% CI 0.622–0.72) and 0.679(95% CI 0.608–0.750), respectively, the AUC showed similar results. The DCA suggests that namogram performs better than the AJCC stage system. The Kaplan–Meier curve showed that CSS of patients was significantly higher in the low-risk group. Conclusions In this study, the SEER database was used for the first time to create and validate a new nomogram prediction model for elderly patients with T1-T3N0M0 RPTCC. Compared with the traditional AJCC stage system, our new nomogram can more accurately predict the CSS of elderly patients with T1-T3N0M0 RPTCC, which is helpful for patient prognosis assessment and treatment strategies selection. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-022-01028-1.
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Affiliation(s)
- Jinkui Wang
- Department of Urology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, 2 ZhongShan Rd, Chongqing, 400013, People's Republic of China
| | - Jie Tang
- Department of Epidemiology, Public Health School, Shenyang Medical College, Shenyang, China
| | - Xiaozhu Liu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dawei He
- Department of Urology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, 2 ZhongShan Rd, Chongqing, 400013, People's Republic of China.
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Li C, Yang J, Xu F, Han D, Zheng S, Kaaya RE, Wang S, Lyu J. A prognostic nomogram for the cancer-specific survival of patients with upper-tract urothelial carcinoma based on the Surveillance, Epidemiology, and End Results Database. BMC Cancer 2020; 20:534. [PMID: 32513124 PMCID: PMC7282122 DOI: 10.1186/s12885-020-07019-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/28/2020] [Indexed: 12/29/2022] Open
Abstract
Background The aim of this study was to establish a comprehensive nomogram for the cancer-specific survival (CSS) of patients with upper-tract urothelial carcinoma (UTUC) and compare it with the traditional American Joint Committee on Cancer (AJCC) staging system in order to determine its reliability. Methods This study analyzed 9505 patients with UTUC in the Surveillance, Epidemiology, and End Results (SEER) database. R software was used to randomly divided the patients in a 7-to-3 ratio to form a training cohort (n = 6653) and a validation cohort (n = 2852). Multivariable Cox regression was used to identify predictive variables. The new survival model was compared with the AJCC prognosis model using the concordance index (C-index), the area under the time-dependent receiver operating characteristics curve (AUC), the net reclassification improvement (NRI), the integrated discrimination improvement (IDI), calibration plotting, and decision-curve analysis (DCA). Results We have established a nomogram for determining the 3-, 5-, and 8-year CSS probabilities of UTUC patients. The nomogram indicates that the AJCC stage has the greatest influence on CSS in UTUC, followed by the age at diagnosis, surgery status, tumor size, radiotherapy status, histological grade, marital status, chemotherapy status, race, and finally sex. The C-index was higher for the nomogram than the AJCC staging system in both the training cohort (0.785 versus 0.747) and the validation cohort (0.779 versus 0.739). Calibration plotting demonstrated that the model has good calibration ability. The AUC, NRI, IDI, and DCA of the nomogram showed that it performs better than the AJCC staging system alone. Conclusions This study is the first to establish a comprehensive UTUC nomogram based on the SEER database and evaluate it using a series of indicators. Our novel nomogram can help clinical staff to predict the 3-, 5-, and 8-year CSS probabilities of UTUC patients more accurately than using the AJCC staging system.
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Affiliation(s)
- Chengzhuo Li
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Jin Yang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Fengshuo Xu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Didi Han
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Shuai Zheng
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.,School of Public Health, Shaanxi University of Chinese Medicine, Xi'an, Shaanxi, China
| | - Rahel Elishilia Kaaya
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Shengpeng Wang
- Cardiovascular Research Center, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, People's Republic of China. .,Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China. .,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.
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Lopera Toro AR, Saldarriaga Botero JP, Gallo Ríos JF, Velásquez Ossa DA, Federico EJ. Nefroureterectomía más linfadenectomía retroperitoneal laparoscópica. Rev Urol 2015. [DOI: 10.1016/j.uroco.2015.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hsieh TF, Chen CC, Yu AL, Ma WL, Zhang C, Shyr CR, Chang C. Androgen receptor decreases the cytotoxic effects of chemotherapeutic drugs in upper urinary tract urothelial carcinoma cells. Oncol Lett 2013; 5:1325-1330. [PMID: 23599788 PMCID: PMC3629091 DOI: 10.3892/ol.2013.1140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 01/09/2013] [Indexed: 11/06/2022] Open
Abstract
Upper urinary tract urothelial carcinomas (UUTUCs) represent relatively uncommon yet devastating tumors that affect more males than females. However, the correlation between gender difference and disease progression remains unclear. Androgen and the androgen receptor (AR) were previously hypothesized to account for the gender difference in the incidence of urothelial carcinomas; however, the role of AR in the development and progression of UUTUCs is not well understood. In addition, although UUTUCs are responsive to chemotherapy, various responses are presented among patients. Therefore, the aim of the present study was to determine the role of AR in the response of UUTUC cells to chemotherapeutic drugs. In this study, AR overexpression in UUTUC cells (BFTC 909) was identified to reduce the cytotoxic effect of chemotherapeutic drugs, including doxorubicin, cisplatin and mitomycin C and protected cells from drug-induced death. The expression of ABCG2, an ATP-binding cassette half-transporter associated with multidrug resistance, was increased in AR-overexpressing BFTC cells. In addition, use of the AR degradation enhancer, ASC-J9®, repressed the AR effect on increasing cell viability under drug treatment. In summary, results of the present study indicate that the status of AR expression levels in UUTUCs may be a significant factor in affecting the efficacy of chemotherapy and classic chemotherapeutic drugs and AR targeted therapy may provide a novel potential therapeutic approach to improve treatment of UUTUCs.
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Affiliation(s)
- Teng-Fu Hsieh
- Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung 40427
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5
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Maurice MJ, Madi R, Chuang DY, Abouassaly R. Retrograde chemoinfusion of the upper tract: standardizing the delivery of topical adjuvant therapy. J Endourol 2012; 27:540-4. [PMID: 23253199 DOI: 10.1089/end.2012.0608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Upper tract urothelial carcinoma has a high recurrence rate after endoscopic treatment. Immediate postoperative topical chemotherapy may reduce recurrences, as in bladder cancer. A reliable delivery method to the upper tract does not exist. We propose a new infusion pump technology for the delivery of topical chemotherapeutic agents to the upper tract. With the patient under general anesthesia, contrast is infused into the upper collecting system using a standard infusion pump. An optimal infusion rate is determined based on fluoroscopic filling of the upper collecting system and transduced intrapelvic pressures. Using this rate, the infusion is repeated postoperatively with the chemotherapeutic agent. We report one case of successful execution to demonstrate proof of concept. We are the first to describe retrograde upper tract chemotherapeutic irrigation with an intravenous pump. This technique may facilitate and standardize the delivery of intracavitary chemotherapy. Further investigation to determine whether it translates into improved safety and/or efficacy is warranted.
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Affiliation(s)
- Matthew J Maurice
- Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
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6
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Upper Urinary Tract Recurrence After Radical Cystectomy for Bladder Cancer—Who is at Risk? J Urol 2009; 182:2632-7. [DOI: 10.1016/j.juro.2009.08.046] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2009] [Indexed: 11/19/2022]
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Traitement conservateur dans les formes localisées des tumeurs de la voie excrétrice supérieure: Une nouvelle observation et revue de la littérature. AFRICAN JOURNAL OF UROLOGY 2009. [DOI: 10.1007/s12301-009-0012-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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8
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Adjuvant intraoperative electron radiotherapy and external beam radiotherapy for locally advanced transitional cell carcinoma of the ureter. Urol Oncol 2009; 27:14-20. [DOI: 10.1016/j.urolonc.2007.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 07/31/2007] [Accepted: 07/31/2007] [Indexed: 01/15/2023]
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9
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Irani J, Bernardini S, Bonnal JL, Chauvet B, Colombel M, Davin JL, Laurent G, Lebret T, Maidenberg M, Mazerolles C, Pfister C, Roupret M, Roy C, Rozet F, Saint F, Theodore C. [Urothelial tumors]. Prog Urol 2008; 17:1065-98. [PMID: 18153988 DOI: 10.1016/s1166-7087(07)74781-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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10
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Abstract
The histological appearance and the clinical behaviour of upper urinary tract urothelial tumours are almost identical to those of the bladder. Superficial papillary tumours rarely progress and turn to invasive disease despite a high frequency of recurrence. Technical developments in the endourology field have allowed full endoscopic access to upper tract tumours. Endoscopic resection or ablation of the tumour can be undertaken safely and effectively through ureteroscopy or percutaneous nephroscopy with low risk of extra-renal tumour seeding. For superficial (Ta, T1), low grade (I, II) tumours, a conservative approach can be selected without compromising survival and prognosis. For muscle invasive > T2 or high grade (III) tumours, nephroureterectomy remains the treatment of choice. Intracavitary BCG used after percutaneous resection reduces the risk of recurrence of upper tract urothelial tumours regardless of the grade. Finally, the world literature and our personal experience have shown that the tumour grade and stage are the two independent factors that affect survival of patients with upper urinary tract tumours.
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Affiliation(s)
- M E Jabbour
- Hôpital Saint-George, Université de Balamand, B.P 166 378, Achrafieh, Beyrouth 1100 2807, Liban
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Kurzer E, Leveillee RJ, Bird VG. Combining hand assisted laparoscopic nephroureterectomy with cystoscopic circumferential excision of the distal ureter without primary closure of the bladder cuff--is it safe? J Urol 2006; 175:63-7; discussion 67-8. [PMID: 16406870 DOI: 10.1016/s0022-5347(05)00046-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Revised: 06/08/2005] [Indexed: 12/22/2022]
Abstract
PURPOSE We have previously described our technique of combining HAL-NU using early ureteral ligation with simultaneous cystoscopic circumferential excision of the distal intramural ureter without primary closure of the bladder cuff. We report the oncological sequelae in patients who underwent HAL-NU using our technique of complete ureteral removal. MATERIALS AND METHODS We retrospectively evaluated all patients who underwent HAL-NU from April 1999 through July 2004. Cystograms were performed 1 week postoperatively in all patients. Pathological findings were reviewed. Cystoscopy was performed every 3 months to assess bladder recurrences. Upper tract imaging was performed postoperatively and then annually. The locations of recurrence and need for adjuvant treatment were assessed. RESULTS A total of 49 patients with an average age of 67 years underwent HAL-NU. Gravity cystography confirmed that bladder defects had completely sealed at 1 week in all patients. Mean followup was 10.6 months (median 10, range 1 to 52). Of the patients 20 (49%) had bladder tumors postoperatively. Two patients were found to have advanced stage disease, leading to chemotherapy with radiation therapy in 1 and radical cystectomy in the other at 4 and 14 months, respectively. A total of 25 patients had postoperative pelvic imaging. Four patients with pathological stage T2 (1) and T3 (3) had metastatic disease at followup. One patient was known to have pulmonary metastases preoperatively and HAL-NU was performed for refractory hematuria. Two patients were noted to have distant metastases to the liver, lung and bone at 1 and 3 months postoperatively, respectively. One patient was found to have distant metastases to the liver and retroperitoneal lymph nodes 2 years after surgery. No patients were found to have local pelvic or peritoneal metastases. CONCLUSIONS HAL-NU with cystoscopic excision of the distal ureter is feasible, safe and effective for upper tract transitional cell carcinoma. Oncological sequelae are comparable to results after open surgery. There is no evidence to suggest pelvic or peritoneal tumor seeding since no cases of pelvic or abdominal recurrence were discovered after surgery, while allowing the bladder defect to close spontaneously with catheter drainage. Our technique of ureterectomy ensures complete removal of the entire ureter, eliminating the possibility of ureteral stump recurrences. Early ligation of the ureter prevents tumor migration during renal manipulation, minimizing the risk of local tumor recurrences postoperatively.
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Affiliation(s)
- Eliecer Kurzer
- Division of Endourology and Laparoscopy, Department of Urology, University of Miami School of Medicine, Miami, Florida, USA.
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12
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Combining Hand Assisted Laparoscopic Nephroureterectomy With Cystoscopic Circumferential Excision of the Distal Ureter Without Primary Closure of the Bladder Cuff???Is it Safe? J Urol 2006. [DOI: 10.1097/00005392-200601000-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Czito B, Zietman A, Kaufman D, Skowronski U, Shipley W. Adjuvant radiotherapy with and without concurrent chemotherapy for locally advanced transitional cell carcinoma of the renal pelvis and ureter. J Urol 2004; 172:1271-5. [PMID: 15371822 DOI: 10.1097/01.ju.0000137910.38441.8a] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE Transitional cell carcinoma of the upper urinary tract is a relatively uncommon malignancy. The role of adjuvant radiation therapy and chemotherapy is not well defined. We retrospectively reviewed the records of 31 patients who underwent surgery followed by adjuvant radiotherapy with or without concurrent chemotherapy to determine overall outcome as well as impact of concurrent chemotherapy administration. MATERIALS AND METHODS Between 1970 and 1997, 31 patients with nonmetastatic transitional cell carcinoma of the upper urinary tract (renal pelvis in 13, ureter in 15, and renal pelvis and ureter in 3) were treated with radiotherapy following attempted curative resection. Most patients (28 of 31) had T3/4 and/or N+ disease. The median radiation dose was 46.9 Gy. Nine patients received methotrexate, cisplatin and vinblastine chemotherapy for 2 to 4 cycles, followed by concurrent cisplatin with radiation. RESULTS Median followup was 2.6 years in all patients and 8.5 years in survivors. Median survival in all patients was 2.4 years. Of the patients 16 (52%) experienced disease relapse, including 9 (29%) with distant metastases alone. Seven patients (23%) experienced locoregional failure with distant metastases developing in all except 1 within 8 months of locoregional failure diagnosis. Five-year actuarial overall survival, disease specific survival, locoregional control and metastasis-free survival rates were 39%, 52%, 67% and 48%, respectively. On univariate analysis patients had improved 5-year actuarial overall and disease specific survival with the administration of concurrent chemotherapy (27% vs 67%, p = 0.01 and 41% vs 76%, p = 0.06, respectively). CONCLUSIONS Our series suggests that the addition of concurrent cisplatin to adjuvant radiotherapy improves the ultimate outcome in patients with resected, locally advanced upper tract urothelial malignancies. This regimen should be considered in patients with T3/4 and/or node positive upper tract transitional cell carcinoma.
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MESH Headings
- Actuarial Analysis
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/pathology
- Carcinoma, Transitional Cell/radiotherapy
- Carcinoma, Transitional Cell/surgery
- Chemotherapy, Adjuvant
- Cisplatin/therapeutic use
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Kidney Neoplasms/drug therapy
- Kidney Neoplasms/pathology
- Kidney Neoplasms/radiotherapy
- Kidney Neoplasms/surgery
- Kidney Pelvis/pathology
- Male
- Middle Aged
- Neoplasm Metastasis/pathology
- Neoplasm Recurrence, Local/pathology
- Neoplasm Staging
- Neoplasm, Residual/drug therapy
- Neoplasm, Residual/pathology
- Neoplasm, Residual/radiotherapy
- Neoplasm, Residual/surgery
- Outcome and Process Assessment, Health Care
- Radiation-Sensitizing Agents/therapeutic use
- Radiotherapy, Adjuvant
- Survival Rate
- Ureter/pathology
- Ureter/surgery
- Ureteral Neoplasms/drug therapy
- Ureteral Neoplasms/pathology
- Ureteral Neoplasms/radiotherapy
- Ureteral Neoplasms/surgery
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Affiliation(s)
- Brian Czito
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Saika T, Nishiguchi J, Tsushima T, Nasu Y, Nagai A, Miyaji Y, Maki Y, Akaeda T, Saegusa M, Kumon H. Comparative study of ureteral stripping versus open ureterectomy for nephroureterectomy in patients with transitional carcinoma of the renal pelvis. Urology 2004; 63:848-52. [PMID: 15134963 DOI: 10.1016/j.urology.2003.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2003] [Accepted: 12/01/2003] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate the clinical outcome of nephroureterectomy with endoscopically assisted transurethral ureteral stripping for transitional cell carcinoma of the renal pelvis in a comparative study. METHODS Sixty patients with localized renal pelvic cancer were enrolled in a prospective comparative nonrandomized study. Of these, 28 patients underwent nephroureterectomy with endoscopically assisted transurethral ureteral stripping and 32 underwent conventional nephroureterectomy with a bladder cuff. Both short-term and long-term results were analyzed in this series. RESULTS The operating time for patients with ureteral stripping was significantly shorter than for those with a standard two-incision nephroureterectomy (median 183 versus 250 minutes, P = 0.0231), and the amount of blood loss was significantly less (median 150 versus 390 mL, P = 0.0002). Intravesical recurrence was detected in 10 (35.7%) of the 28 patients with ureteral stripping, and the 1-year and 3-year recurrence-free rate was 68.0% and 57.7%, respectively. Seven patients treated by the standard two-incision nephroureterectomy (21.9%) experienced intravesical recurrence, with a 1-year and 3-year recurrence-free rate of 96.8% and 75.0%, respectively. The recurrence rate was significantly greater in the group with ureteral stripping (P = 0.0287). CONCLUSIONS Compared with conventional nephroureterectomy with a bladder cuff, nephroureterectomy with transurethral stripping is a minimally invasive procedure with a shorter operating time and less blood loss, but a statistically significantly greater intravesical recurrence rate. Greater consideration should be taken before selecting this procedure.
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Affiliation(s)
- Takashi Saika
- Department of Urology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
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15
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Abstract
Transitional cell carcinoma (TCC) of ureter and renal pelvis is relatively uncommon. Smoking, occupational carcinogens, analgesic abuse, Balkan nephropathy are the risk factors. Cytogenetic studies revealed that the most frequent aberration is the partial or complete loss of chromosome 9. Approximately 20-50% of patients with upper urinary tract (UUT) TCC have bladder cancer at some point on their course, whereas the incidence of UUT TCC after primary bladder cancer is 0.7-4%. Excretory urography and retrograde pyelography are the conventional diagnostic tools; however, ureteropyeloscopy combined with cytology and biopsy is more accurate. Grade and stage of the disease have the most significant impact on survival. Nephroureterectomy with bladder cuff excision has been the mainstay of treatment. Local resection may be appropriate for distal ureteral lesions especially when the disease is low grade and stage. Advances in endourology have made it possible to treat many tumors conservatively. Ureteroscopic and to a certain extent percutaneous surgical approaches are widely used today especially in patients with low grade, low stage disease. Endoscopic close surveillance is mandatory for these patients. Adjuvant topical therapies appear to be safe but confirmation of any benefits awaits the results of further large studies. More recently, laparoscopic techniques have become a viable alternative to open surgery, but long term cancer control data are lacking. Aggressive surgical resection does not affect the outcome of patients with advanced disease. Adjuvant radiotherapy is ineffective, and systemic chemotherapy results in a low complete response rate for patients with metastases.
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Affiliation(s)
- Ziya Kirkali
- Department of Urology, Dokuz Eylul University School of Medicine, Inciralti, Izmir 35340, Turkey.
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Liatsikos EN, Dinlenc CZ, Kapoor R, Smith AD. Transitional-cell carcinoma of the renal pelvis: ureteroscopic and percutaneous approach. J Endourol 2001; 15:377-83; discussion 397. [PMID: 11394449 DOI: 10.1089/089277901300189385] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There are a variety of publications advocating the ureteroscopic or the percutaneous approach for the treatment of transitional cell carcinoma of the renal pelvis. The diagnostic tool of choice for the upper urinary tract and collecting system is the flexible ureteroscope. One of the major concerns about ureteroscopic management of renal disease initially was the lack of flexibility of the instruments and therefore the inability to deal with demanding sites. The advent of new ureteroscopic techniques, as well as the continuous evolution of the technology, have paved the way for safe and effective access to the upper urinary tract. In the hands of an experienced urologist, such procedures can provide reliable treatment options for small upper urinary tract lesions. Coupling minimal morbidity with ever-improving optics and flexibility, the ureteroscope of today leaves no area of the urinary tract unseen. In patients with bulky tumors or in whom easy access and resection is not possible ureteroscopically, the percutaneous approach to the renal pelvis, although more invasive, provides a better working environment. Clearly, the most difficult aspect of ureteroscopic access to the lower pole is not just visibility but the loss of deflection caused by passage of various instruments through the working channel. Direct access via percutaneous approach with a large resectoscope avoids these problems.
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Affiliation(s)
- E N Liatsikos
- Department of Urology, Albert Einstein College of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York 11042, USA
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Mills IW, Laniado ME, Patel A. The role of endoscopy in the management of patients with upper urinary tract transitional cell carcinoma. BJU Int 2001; 87:150-62. [PMID: 11167633 DOI: 10.1046/j.1464-410x.2001.00992.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- I W Mills
- Department of Urology, St. Mary's Hospital, London, UK
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20
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Jabbour ME, Smith AD. Primary percutaneous approach to upper urinary tract transitional cell carcinoma. Urol Clin North Am 2000; 27:739-50. [PMID: 11098771 DOI: 10.1016/s0094-0143(05)70122-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The optimal approach to upper tract TCC remains to be redefined. A routine nephroureterectomy for every filling defect in the upper urinary system, even in the case of a normal contralateral kidney, constitutes an unnecessary mutilation in more than two thirds of the cases. Nephroureterectomy does not reduce the need for a long-term cystoscopic follow-up because of the high rate of bladder tumor recurrence that may happen years later after nephroureterectomy. Relying solely on radiography and cytology, lacking sensitivity and specificity, to recommend a nephroureterectomy is against the principles of oncologic surgery, especially now that preoperative histologic proof is easy to obtain endoscopically without compromising cancer control. Ureteroscopy, rigid and flexible, provides a complete assessment of the upper urinary system. Biopsy specimens taken with ureteroscopy may be sufficient for grading but less adequate for staging of the tumor. The authors reserve ureteroscopy for ureteral tumors and small (< 1.5 cm) single tumors of the renal pelvis. They approach large or multiple tumors of the renal pelvis percutaneously, in which a full histologic assessment is possible along with a complete resection of the tumor. The decision on the therapeutic approach is made only after the final pathologic report is reviewed. Grade I and grade II superficial disease (Ta, T1) can be treated endoscopically with minimal morbidity and with an efficiency comparable with the standard more invasive nephroureterectomy (Table 5). The indications for endourologic treatment in these cases can be extended safely beyond a solitary kidney or a high surgical risk to include any healthy individual with a normal contralateral kidney who is willing to commit to a rigorous lifelong follow-up. Patients with grade II T1 lesions require a more vigilant follow-up. For grade III Ta disease, more caution should be exercised in selecting these patients for elective endourologic management. When criteria of good prognosis are found, such as absence of carcinoma in situ, presence of diploidy, low p53 expression and a single-tumor, endoscopic management can be offered [table: see text] with a closer follow-up and resorting always to immediate nephroureterectomy at the first evidence of upstaging. Because of the high incidence of recurrence and progression, elective endourologic management for grade III T1 tumors is not recommended. Endoscopic conservative surgery still can be offered in the cases of a solitary kidney or chronic renal insufficiency or for poor surgical candidates. Patients with localized stages (T2, T3) TCC should be offered immediate nephroureterectomy. The authors do not expect adequate endoscopic extirpation with muscle invasive tumors. Although the tissue removed may include deep layers, deep resection is precluded by the thin renal pelvic wall and the associated risk for perforation. Patients with more extensive disease (T3, T4) have a bad prognosis regardless of the form of therapy. Achieving local control percutaneously while preserving as many nephrons as possible for the future chemotherapy can be a reasonable option.
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Affiliation(s)
- M E Jabbour
- Department of Urology, Hotel Dieu Hospital, Saint Joseph University Faculty of Medicine, Beirut, Lebanon.
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See WA. Continuous antegrade infusion of adriamycin as adjuvant therapy for upper tract urothelial malignancies. Urology 2000; 56:216-22. [PMID: 10925081 DOI: 10.1016/s0090-4295(00)00612-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the feasibility, efficacy, and toxicity of antegrade chemotherapy delivered continuously as adjuvant treatment for patients with upper tract transitional cell carcinoma. METHODS During a 6-year interval, 12 patients with upper tract transitional cell malignancies underwent continuous antegrade intraluminal infusion chemotherapy (CAIIC) with adriamycin. After placement of percutaneous access and surgical treatment of the primary lesion, patients received 5-day cycles of CAIIC. Patients received between two and four treatment cycles at 2-week intervals. After therapy, patients with no evidence of residual disease were then monitored long-term with retrograde pyelography and upper tract cytology. RESULTS Twelve patients underwent a total of 35 5-day cycles of CAIIC. No patient experienced hematologic and/or local/regional toxicity during or after drug infusion. Three patients were treated for upper tract carcinoma in situ, and 9 patients had discrete exophytic tumors. Two patients died (treatment unrelated) before a final assessment of therapeutic outcome, leaving 10 patients available for evaluation of the therapeutic response. One patient with carcinoma in situ and 5 of 7 patients with discrete upper tract tumors remained disease free after surgery and adjuvant therapy. Both patients with discrete tumors in whom therapy failed had residual gross disease after primary surgical treatment. CONCLUSIONS CAIIC using adriamycin was well tolerated for periods of up to 5 days over multiple cycles. Early data suggest a limited efficacy in treating patients with gross residual disease. The efficacy of this approach in preventing the recurrence of upper tract disease after surgical ablation awaits further assessment.
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Affiliation(s)
- W A See
- Division of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
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PERCUTANEOUS MANAGEMENT OF GRADE II UPPER URINARY TRACT TRANSITIONAL CELL CARCINOMA: THE LONG-TERM OUTCOME. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67702-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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PERCUTANEOUS MANAGEMENT OF GRADE II UPPER URINARY TRACT TRANSITIONAL CELL CARCINOMA:. J Urol 2000. [DOI: 10.1097/00005392-200004000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Balaji KC, McGuire M, Grotas J, Grimaldi G, Russo P. Upper tract recurrences following radical cystectomy: an analysis of prognostic factors, recurrence pattern and stage at presentation. J Urol 1999; 162:1603-6. [PMID: 10524877 DOI: 10.1016/s0022-5347(05)68176-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We study the incidence and pattern of upper tract recurrences following radical cystectomy for bladder cancer, and analyze the prognostic factors. MATERIALS AND METHODS A retrospective study was performed on 529 patients who underwent radical cystectomy and urinary diversion at Memorial Sloan-Kettering Cancer Center between July 1989 and June 1997. Data related to upper tract recurrence were analyzed. RESULTS Of the 529 patients 16 (3%) had upper tract recurrence. Median followup was 16.9 months for the entire group and 49.1 months for patients with upper tract recurrence, with a median time to recurrence of 37.2 months. Of 12 upper tract recurrences 7 (58%) were locally advanced at surgery (p3a or greater with or without lymph node metastasis) and 5 of 16 patients with recurrence (31.3%) had bilateral tumors (2 synchronous and 3 metachronous). Overall survival from the time of diagnosis of upper tract recurrence after radical cystectomy was poor, with a median of 10 months (confidence interval 1 to 19). CONCLUSIONS The incidence of upper tract recurrence following radical cystectomy is low (3%). However, the incidence of bilateral tumors (31.3%) and locally advanced stage at the time of operation (58%) is higher than expected for upper tract tumors in the general population. Survival of patients with upper tract recurrence is poor, with a median of 10 months.
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Affiliation(s)
- K C Balaji
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Farley JH, Douglas TH, Mcleod DG, Harrison CR. Ureteral carcinoma presenting as a complex pelvic mass in a post menopausal patient. Gynecol Oncol 1998; 70:134-6. [PMID: 9698491 DOI: 10.1006/gyno.1998.5052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This is a report of a low-grade ureteral carcinoma presenting as a pelvic mass in a postmenopausal woman with a prolonged history of lower back pain. A right complex adnexal mass and right hydroureter and hydronephrosis in an atrophic nonfunctioning right kidney was found during evaluation for the back pain. Operative evaluation revealed a normal uterus and ovaries; however, a 2 x 3-cm mass in the right ureter was found at the level of the uterine arteries. A total abdominal hysterectomy, bilateral salpingo-oophorectomy, and right nephroureterectomy were performed with pathology returning grade I papillary transitional cell carcinoma of the ureter.
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Affiliation(s)
- J H Farley
- Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA
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Braslis KG. Use of a posterior Boari flap in ureteral replacement. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1998; 68:301-3. [PMID: 9572345 DOI: 10.1111/j.1445-2197.1998.tb02090.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Advances in ureteroscopic techniques have made it possible to treat many upper-tract tumors conservatively. Such treatment has demonstrated acceptable survival and renal preservation in high-risk patients, particularly those with a solitary kidney, bilateral tumors, poor renal function, or prohibitive operative risk. It is also preferred in patients with grade I TCC, particularly when located in the distal ureter. For patients with regionally extensive upper-tract urothelial neoplasms, use of endourologic techniques should be considered to control hemorrhage, relieve obstruction, and preserve as much functioning renal tissue as possible. Success with small, solitary, low-grade tumors allows the application of this technique to patients with a normal contralateral kidney on an elective basis. Adjuvant BCG or mitomycin C therapy appears to be safe, but confirmation of any benefits awaits the results of larger trials. Benign neoplasms can occur in the upper urinary tract and should be distinguished from TCC, thus avoiding more radical treatment for a benign lesion. Endoscopic surveillance should be maintained because recurrences can develop without radiographic evidence.
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Affiliation(s)
- E R Tawfiek
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Catton C, Warde P, Gospodarowicz M, Panzarella T, Catton P, McLean M, Milosevic M. Transitional cell carcinoma of the renal pelvis and ureter: Outcome and patterns of relapse in patients treated with postoperative radiation. Urol Oncol 1996; 2:171-6. [DOI: 10.1016/s1078-1439(96)00095-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Elliott DS, Blute ML, Patterson DE, Bergstralh EJ, Segura JW. Long-term follow-up of endoscopically treated upper urinary tract transitional cell carcinoma. Urology 1996; 47:819-25. [PMID: 8677570 DOI: 10.1016/s0090-4295(96)00043-x] [Citation(s) in RCA: 120] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES This report focuses on the long-term follow-up of patients with endoscopically treated upper tract transitional cell carcinoma (TCC) to determine the effectiveness of endoscopic therapy. METHODS From May 1983 to April 1994, 44 patients with TCC of the upper urinary tract underwent conservative endourologic treatment with either electrocautery fulguration or neodymium:yttrium-aluminum-garnet laser at our institution. The mean follow-up period was 5 years (range, 3 months to 11 years). RESULTS Renal pelvic tumor sizes ranged from 0.4 to 4.0 cm (mean, 1.5) and ureteral tumors from 0.2 to 1.0 cm (mean, 0.5). The majority of tumors were of pathologic grade 3 or less, and all were Stage T2 or less. Seventeen of 44 patients (38.6%) had local tumor recurrence (mean time to recurrence, 12.8 months; range 1.5 to 64). Mean recurrence time was 7.3 months for renal pelvic tumors and 17.8 months for ureteral tumors. Nineteen of 44 patients (43.2%) developed bladder tumors. The overall 5-year disease-free rate was 57%. No recurrent tumor was shown to have increased in grade, and one recurrent tumor was proved to have progressed in stage. Six patients (14%) ultimately required a nephroureterectomy for recurrence. There were no major complications as a result of endoscopic therapy. Six patients (14%) died of the effects of metastatic TCC, 5 of whom had known muscle invasive bladder TCC. CONCLUSIONS Endourologic techniques and the conservative treatment of upper urinary tract TCC is an evolving field and can be safely and effectively used as a first-line treatment for upper tract TCC in selected patients.
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Affiliation(s)
- D S Elliott
- Department of Urology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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Patel A, Soonawalla P, Shepherd SF, Dearnaley DP, Kellett MJ, Woodhouse CR. Long-term outcome after percutaneous treatment of transitional cell carcinoma of the renal pelvis. J Urol 1996. [PMID: 8583595 DOI: 10.1016/s0022-5347(01)66330-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE The application of conservative surgery has been established in the treatment of transitional cell tumors of the renal pelvis. We reviewed retrospectively the long-term outcome after percutaneous treatment of select patients referred to a tertiary center with transitional cell tumors of the renal pelvis. MATERIALS AND METHODS We studied 28 patients referred with a presumptive diagnosis of transitional cell carcinoma of the renal pelvis based on filling defects noted on excretory urograms. At percutaneous endoscopy tumor was resected in 26 patients, while no tumor was found in 2. All 19 men and 7 women smoked, and mean age at presentation was 65 years. Of the patients 18 presented with hematuria and 6 had bilateral upper tract tumors. After percutaneous resection, the access tract was irradiated either with iridium wire in 12 patients or a commercial high dose rate radiation delivery system in 12. Thiotepa was instilled into the nephrostomy tube without brachytherapy in 1 patient and 1 received no adjuvant treatment in all. All patients were followed by excretory urography and urine cytology. Cystoscopy and retrograde pyelography were performed when technically possible. RESULTS After percutaneous tumor resection 6 patients (23%) had local recurrence in the treated renal pelvis, including 3 at 44, 55 and 60 months, respectively. Further conservative treatment was initially possible in 4 of these patients but ultimately only 2 (both of whom had late recurrences) retained the treated kidney. Of the 11 patients with recurrence elsewhere in the urinary tract the bladder was invariably involved (11), while synchronous or metachronous ureteral recurrence was less common (3). Nine patients remained free of any urothelial recurrence in the upper or lower tract. No patient had recurrent tumor in the nephrostomy tract. Of the patients 7 suffered from procedure-related complications, including 1 who had a persistent urinary fistula that failed to heal after brachytherapy and required nephroureterectomy. There have been 6 deaths during followup, of which 2 were disease related. The 3-year estimated local recurrence-free survival rate was 86% (95% confidence interval 63 to 95%), cause-specific survival rate 91% (95% confidence interval 67 to 98%) and overall survival rate 78% (95% confidence interval 55 to 90%). Differences in recurrence-free survival, comparing those with recurrence in the treated renal pelvis or elsewhere in the urothelium and those remaining disease-free, did not translate to a significant overall survival difference (p < 0.5) between these groups. CONCLUSIONS Our results suggest that the combination of percutaneous local resection and tract irradiation offers an effective long-term alternative to radical extirpation in the management of select patients with superficial transitional cell carcinoma confined to the renal pelvis. When the postoperative nephrostogram demonstrates a leaking renal pelvis, tract irradiation should not be given.
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Affiliation(s)
- A Patel
- Department of Urology, Royal Marsden Hospital, London, United Kingdom
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Affiliation(s)
- P Ramchandani
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia 19104, USA
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Braslis KG, Soloway MS. MANAGEMENT OF URETERAL AND RENAL PELVIC RECURRENCE AFTER CYSTECTOMY. Urol Clin North Am 1994. [DOI: 10.1016/s0094-0143(21)00640-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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