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Yamashita R, Nakamura M, Notsu A, Asakura K, Usui K, Sakura Y, Shinsaka H, Matsuzaki M, Sugino T, Mizuno R, Niwakawa M, Oya M. Cumulative incidence and risk factors for recurrence of upper tract urothelial carcinoma in patients undergoing radical cystectomy. BJUI COMPASS 2024; 5:483-489. [PMID: 38751952 PMCID: PMC11090764 DOI: 10.1002/bco2.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/31/2023] [Accepted: 01/31/2024] [Indexed: 05/18/2024] Open
Abstract
Objectives This study aimed to evaluate the cumulative incidence of upper tract urothelial carcinoma (UTUC) recurrence and identify its risk factors in patients who underwent radical cystectomy (RC). Patients and methods We performed RC on 385 patients between September 2002 and February 2020. After excluding 20 patients-13 with simultaneous nephroureterectomy, 6 with distal ureteral stump positivity and 1 with urachal cancer-365 patients were included in the analysis. To predict UTUC recurrence, we examined the cancer extension pattern in cystectomy specimens and categorized them into three types: cancer located only in the bladder (bladder-only type), cancer extending to the urethra or distal ureter (one-extension type) and cancer extending to both the urethra and distal ureter (both-extension type). We determined hazard ratios for UTUC recurrence for each covariate, including this cancer extension pattern. Results Of the 365 patients, 60% had the bladder-only type, 30% had the one-extension type and 10% had the both-extension type. During a median follow-up period of 72 months for survivors, UTUC recurred in 25 of the 365 patients, with cumulative incidences of 3.7% at 5 years and 8.3% at 10 years. The median interval from cystectomy to recurrence was 65 months (interquartile range: 36-92 months). In the multivariate analysis, the extension pattern was a significant predictor of UTUC recurrence. The hazard ratios for UTUC recurrence were 3.12 (95% confidence interval [CI] = 1.15-8.43, p = 0.025) for the one-extension type and 5.96 (95% CI = 1.98-17.91, p = 0.001) for the both-extension type compared with the bladder-only type. Conclusions The cancer extension pattern in cystectomy specimens is predictive of UTUC recurrence. A more extensive cancer extension in cystectomy specimens elevates the risk of subsequent UTUC recurrence. Intensive long-term monitoring is essential, particularly for patients with the both-extension type.
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Affiliation(s)
- Ryo Yamashita
- Division of UrologyShizuoka Cancer CenterShizuokaJapan
- Department of UrologyKeio UniversityTokyoJapan
| | | | - Akifumi Notsu
- Clinical Research Center, Shizuoka Cancer CenterShizuokaJapan
| | - Koiku Asakura
- Division of Diagnostic RadiologyShizuoka Cancer CenterShizuokaJapan
| | | | - Yuma Sakura
- Division of UrologyShizuoka Cancer CenterShizuokaJapan
| | | | | | - Takashi Sugino
- Division of PathologyShizuoka Cancer CenterShizuokaJapan
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Lee J, Yoo Y, Park S, Cho MS, Sung SH, Ro JY. Double cocktail immunostains with high molecular weight cytokeratin and GATA-3: useful stain to discriminate in situ involvement of prostatic ducts or acini from stromal invasion by urothelial carcinoma in the prostate. J Pathol Transl Med 2020; 54:146-153. [PMID: 32028755 PMCID: PMC7093285 DOI: 10.4132/jptm.2019.11.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/18/2019] [Accepted: 11/12/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Distinguishing prostatic stromal invasion (PSI) by urothelial carcinoma (UC) from in situ UC involving prostatic ducts or acini with no stromal invasion (in situ involvement) may be challenging on hematoxylin and eosin stained sections. However, the distinction between them is important because cases with PSI show worse prognosis. This study was performed to assess the utility of double cocktail immunostains with high molecular weight cytokeratin (HMWCK) and GATA-3 to discriminate PSI by UC from in situ UC involvement of prostatic ducts or acini in the prostate. METHODS Among 117 radical cystoprostatectomy specimens for bladder UCs, 25 cases showed secondary involvement of bladder UC in prostatic ducts/acini only or associated stromal invasion and of these 25 cases, seven cases revealed equivocal PSI. In these seven cases with equivocal PSI, HMWCK, and GATA-3 double immunohistochemical stains were performed to identify whether this cocktail stain is useful to identify the stromal invasion. RESULTS In all cases, basal cells of prostate glands showed strong cytoplasmic staining for HMWCK and UC cells showed strong nuclear staining for GATA-3. In cases with stromal invasion of UC, GATA-3-positive tumor cells in the prostatic stroma without surrounding HMWCK-positive basal cells were highlighted and easily recognized. Among seven equivocal cases, two cases showed PSI and five in situ UC in the prostate. In two cases, the original diagnoses were revised. CONCLUSIONS Our study suggested that HMWCK and GATA-3 double stains could be utilized as an adjunct method in the distinction between PSI by UC from in situ UC involving prostatic ducts or acini.
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Affiliation(s)
- Junghye Lee
- Department of Pathology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Youngeun Yoo
- Department of Pathology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Sanghui Park
- Department of Pathology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Min-Sun Cho
- Department of Pathology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Sun Hee Sung
- Department of Pathology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jae Y. Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Medical College of Cornell University, Houston, TX, USA
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Moschini M, Soria F, Susani M, Korn S, Briganti A, Roupret M, Seitz C, Gust K, Haitel A, Montorsi F, Wirth G, Robinson BD, Karakiewicz PI, Özsoy M, Rink M, Shariat SF. Impact of the Level of Urothelial Carcinoma Involvement of the Prostate on Survival after Radical Cystectomy. Bladder Cancer 2017; 3:161-169. [PMID: 28824943 PMCID: PMC5545907 DOI: 10.3233/blc-160086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Urothelial prostatic involvement (UPI) at the time of radical cystoprostatectomy (RCP) was found associated with worse survival outcomes by several previous reports. Our aim is to evaluate the impact of different levels of UPI on survival outcomes using a large series of male patients treated with RCP. Methods: Whole step section specimens from 995 male BCa patients were assessed for UPI defined as: no involvement vs. prostatic urethral carcinoma in situ (CIS) vs. lamina propria involvement vs. ductal CIS vs. prostate stromal involvement. Primary end point of the study was predictors of prostatic involvement at RCP and its impact on overall survival after surgery. Results: Prostatic involvement was recorded in 307 (30.9%) patients: 28% with prostatic urethral CIS, 12% with lamina propria involvement, 13% with ductal CIS and 47% with stromal involvement. Median follow-up was 70 months. Patients with stromal involvement had a worse 5-year survival (12%) than those with prostatic urethra CIS (40%), lamina propria involvement (36%), and ductal CIS (35%). Considering predictors of prostatic involvement, multifocal tumor (Odds Ratio [OR]: 6.60, p < 0.001), lymphovascular invasion (OR: 2.61, p < 0.001), lymph node metastases (OR: 2.02, p < 0.001) and CIS (OR: 2.02, p < 0.001) were found associated. Similar predictors were found assessing stromal involvement. Conclusions Approximately one third of RCP patients harbor prostatic involvement of urothelial carcinoma. While all UPI are associated with worse overall survival, stromal involvement confers the worst outcome supporting its classification as T4 in the TNM staging.
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Affiliation(s)
- Marco Moschini
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Soria
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Department of Surgical Sciences, Division of Urology, San Giovanni Battista Hospital, University of Studies of Torino, Italy
| | - Martin Susani
- Clinical Institute of Pathology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Stephan Korn
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Morgan Roupret
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, Paris 6 University, Paris, France
| | - Christian Seitz
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Killian Gust
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Andrea Haitel
- Clinical Institute of Pathology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Francesco Montorsi
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Gregory Wirth
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Department of Surgery, Division of Urology, Geneva University Hospital, Geneva, Switzerland
| | - Brian D Robinson
- Department of Pathology, Weill Cornell Medical College, New York, NY, USA
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada
| | - Mehmet Özsoy
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Michael Rink
- Division of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Kassouf W, Aprikian A, Black P, Kulkarni G, Izawa J, Eapen L, Fairey A, So A, North S, Rendon R, Sridhar SS, Alam T, Brimo F, Blais N, Booth C, Chin J, Chung P, Drachenberg D, Fradet Y, Jewett M, Moore R, Morash C, Shayegan B, Gotto G, Fleshner N, Saad F, Siemens DR. Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA), December 2015. Can Urol Assoc J 2016; 10:E46-80. [PMID: 26977213 DOI: 10.5489/cuaj.3583] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This initiative was undertaken in response to concerns regarding the variation in management and in outcomes of patients with bladder cancer throughout centres and geographical areas in Canada. Population-based data have also revealed that real-life survival is lower than expected based on data from clinical trials and/or academic centres. To address these perceived shortcomings and attempt to streamline and unify treatment approaches to bladder cancer in Canada, a multidisciplinary panel of expert clinicians was convened last fall for a two-day working group consensus meeting. The panelists included urologic oncologists, medical oncologists, radiation oncologists, patient representatives, a genitourinary pathologist, and an enterostomal therapy nurse. The following recommendations and summaries of supporting evidence represent the results of the presentations, debates, and discussions. Methodology
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Affiliation(s)
- Wassim Kassouf
- Department of urology, McGill University Health Centre, Montreal, QC, Canada
| | - Armen Aprikian
- Department of urology, McGill University Health Centre, Montreal, QC, Canada
| | - Peter Black
- Department of urology, University of British Columbia, Vancouver, BC, Canada
| | - Girish Kulkarni
- Department of surgery (urology) and surgical oncology, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jonathan Izawa
- Division of urology, Western University, London, ON, Canada
| | - Libni Eapen
- Division of radiation oncology, University of Ottawa, Ottawa, ON, Canada
| | - Adrian Fairey
- Division of urology, University of Alberta, Edmonton, AB, Canada
| | - Alan So
- Department of urology, University of British Columbia, Vancouver, BC, Canada
| | - Scott North
- Medical oncology, University of Alberta, Edmonton, AB, Canada
| | - Ricardo Rendon
- Division of urology, Dalhousie University, Halifax, NS, Canada
| | - Srikala S Sridhar
- Medical oncology, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
| | - Tarik Alam
- School of nursing, Dawson College, Montreal, QC, Canada
| | - Fadi Brimo
- Pathology, McGill University Health Centre, Montreal, QC, Canada
| | - Normand Blais
- Division of medical oncology, University of Montreal, Montreal, QC, Canada
| | - Chris Booth
- Departments of oncology, Queen's University, Kingston, ON, Canada
| | - Joseph Chin
- Division of urology, Western University, London, ON, Canada
| | - Peter Chung
- Radiation oncology, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Yves Fradet
- Division of urology, Laval University, Quebec City, QC, Canada
| | - Michael Jewett
- Department of surgery (urology) and surgical oncology, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ron Moore
- Division of urology, University of Alberta, Edmonton, AB, Canada
| | - Chris Morash
- Urology, University of Ottawa, Ottawa, ON, Canada
| | - Bobby Shayegan
- Division of urology, McMaster University, Hamilton, ON, Canada
| | - Geoffrey Gotto
- Division of urology, University of Calgary, Calgary, AB, Canada
| | - Neil Fleshner
- Department of surgery (urology) and surgical oncology, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
| | - Fred Saad
- Urology, University of Montreal, Montreal, QC, Canada
| | - D Robert Siemens
- Departments of oncology, Queen's University, Kingston, ON, Canada;; Urology, Queen's University, Kingston, ON, Canada
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von Rundstedt FC, Lerner SP, Godoy G, Amiel G, Wheeler TM, Truong LD, Shen SS. Usefulness of transurethral biopsy for staging the prostatic urethra before radical cystectomy. J Urol 2014; 193:58-63. [PMID: 25106902 DOI: 10.1016/j.juro.2014.07.114] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE We determined the likelihood that transurethral resection biopsy of the prostatic urethra adjacent to the verumontanum would detect prostatic involvement of urothelial carcinoma in patients with bladder carcinoma. MATERIALS AND METHODS We compared precystectomy transurethral resection biopsy specimens of the prostatic urethra with those of the matched radical cystoprostatectomy in 272 patients with urothelial carcinoma of the bladder. All prostates were evaluated by whole mount step sections. RESULTS Prostatic involvement by urothelial carcinoma was detected by transurethral resection biopsy or radical cystoprostatectomy in 101 patients (37.1%). Transurethral resection biopsy detected urothelial carcinoma in 72 cases with 71.3% sensitivity and 100% specificity. The overall accuracy of transurethral resection biopsy to detect urothelial carcinoma of the prostate was 89% (positive and negative predictive values 100% and 86%, respectively). Invasive prostatic urothelial carcinoma arising from the prostatic urethra was detected by transurethral resection biopsy in 21 of 26 patients (81%) while prostatic carcinoma in situ was detected in 39 of 52 (75%). Transurethral resection biopsy detected prostatic invasive urothelial carcinoma resulting from transmural invasion of a bladder tumor in 4 of 15 patients. CONCLUSIONS Prostatic involvement by urothelial carcinoma of the bladder was found in 37.1% of patients. Transurethral resection biopsy missed most tumors resulting from transmural invasion of the bladder primary lesion. Carcinoma in situ and invasive urothelial carcinoma arising from the prostatic urethra were detected in most cases. Transurethral resection biopsy of the prostatic urethra can complement staging and support clinical decision making with respect to neoadjuvant chemotherapy and planning for an orthotopic neobladder.
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Affiliation(s)
- Friedrich Carl von Rundstedt
- Scott Department of Urology, Department of Pathology, Baylor College of Medicine, Houston, Texas; Department of Pathology and Genomic Medicine, Houston Methodist Hospital (LDT, SSS), Houston, Texas
| | - Seth P Lerner
- Scott Department of Urology, Department of Pathology, Baylor College of Medicine, Houston, Texas; Department of Pathology and Genomic Medicine, Houston Methodist Hospital (LDT, SSS), Houston, Texas
| | - Guilherme Godoy
- Scott Department of Urology, Department of Pathology, Baylor College of Medicine, Houston, Texas; Department of Pathology and Genomic Medicine, Houston Methodist Hospital (LDT, SSS), Houston, Texas
| | - Gilad Amiel
- Scott Department of Urology, Department of Pathology, Baylor College of Medicine, Houston, Texas; Department of Pathology and Genomic Medicine, Houston Methodist Hospital (LDT, SSS), Houston, Texas
| | - Thomas M Wheeler
- Scott Department of Urology, Department of Pathology, Baylor College of Medicine, Houston, Texas; Department of Pathology and Genomic Medicine, Houston Methodist Hospital (LDT, SSS), Houston, Texas
| | - Luan D Truong
- Scott Department of Urology, Department of Pathology, Baylor College of Medicine, Houston, Texas; Department of Pathology and Genomic Medicine, Houston Methodist Hospital (LDT, SSS), Houston, Texas
| | - Steven S Shen
- Scott Department of Urology, Department of Pathology, Baylor College of Medicine, Houston, Texas; Department of Pathology and Genomic Medicine, Houston Methodist Hospital (LDT, SSS), Houston, Texas.
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Macek P, Sanchez-Salas R, Rozet F, Barret E, Galiano M, Hanus T, Cathelineau X. Prostate-Sparing Radical Cystectomy for Selected Patients with Bladder Cancer. Urol Int 2013; 91:89-96. [DOI: 10.1159/000348332] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 01/18/2013] [Indexed: 11/19/2022]
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Full analysis of the prostatic urethra at the time of radical cystoprostatectomy for bladder cancer: impact on final disease stage. Virchows Arch 2009; 455:449-53. [PMID: 19841937 DOI: 10.1007/s00428-009-0849-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 10/06/2009] [Accepted: 10/08/2009] [Indexed: 10/20/2022]
Abstract
Prostate involvement is a major prognostic element in urothelium carcinoma staging after radical cystoprostatectomy (RCP) for muscle invasive bladder cancer. While appropriate pTNM stage is necessary for adequate treatment, no standard procedure exists up to now for macroscopic sampling of the prostate in RCP in daily practice. We therefore propose a protocol where examination of the whole prostatic urethra (PU) is possible, without using whole mount sections. From 2008 to June 2009, RCP were sampled according to a macroscopic protocol permitting the whole length and the underlying stroma of PU to be visualized. Data were compared with our series or RCP from 2000-2007, when the PU was evaluated with a more simple protocol. One hundred and one specimens were examined between 2000-2007, 25 until June 2009. In the latter series, we found pT4 bladder cancer in 36% versus 21%, Cis in the PU in 28% versus 14%, and additional prostate cancer was seen in 44% compared with 13% (p = 0.0004) in the 2008-2009 group versus the 2000-2007 group, respectively. Our proposed protocol better detects prostate involvement by bladder cancer, therefore providing a better final stage of the patients. We propose a macroscopic protocol where the whole PU and the underlying stroma can be examined without the use of whole mount sections. Data are similar to those published in the recent literature, where whole mount sections were used. This protocol also permits better detection of concomitant prostate carcinomas.
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