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Huang CC, Liu HY, Hsu TW, Lee WC. Updates on the Pivotal Roles of Mitochondria in Urothelial Carcinoma. Biomedicines 2022; 10:biomedicines10102453. [PMID: 36289714 PMCID: PMC9599371 DOI: 10.3390/biomedicines10102453] [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: 09/06/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
Mitochondria are important organelles responsible for energy production, redox homeostasis, oncogenic signaling, cell death, and apoptosis. Deregulated mitochondrial metabolism and biogenesis are often observed during cancer development and progression. Reports have described the crucial roles of mitochondria in urothelial carcinoma (UC), which is a major global health challenge. This review focuses on research advances in the role of mitochondria in UC. Here, we discuss the pathogenic roles of mitochondria in UC and update the mitochondria-targeted therapies. We aim to offer a better understanding of the mitochondria-modulated pathogenesis of UC and hope that this review will allow the development of novel mitochondria-targeted therapies.
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Affiliation(s)
- Chiang-Chi Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Hui-Ying Liu
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Tsuen-Wei Hsu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Wen-Chin Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
- Correspondence: ; Tel.: +886-7-731-7123 (ext. 8306)
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Zhou M, Zhang J, Chen X, Wang Z, Liang W. Clinical features and prognostic indicators in upper-tract urothelial carcinoma with bone metastasis. Front Surg 2022; 9:928294. [PMID: 36111229 PMCID: PMC9468251 DOI: 10.3389/fsurg.2022.928294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose With the gradual increase in the incidence of upper-tract urothelial carcinoma (UTUC), its metastatic disease has attracted much attention. The prognosis of UTUC patients with bone metastasis is worse than that of UTUC patients with other metastases. Therefore, the current study is performed to analyze the clinicopathologic features and survival predictors among UTUC patients with bone metastasis. Patients and methods We reviewed the Surveillance, Epidemiology, and End Results (SEER) database to select cases diagnosed with UTUC and bone metastasis at present from 2010 to 2016. Overall survival (OS) and cancer-specific survival (CSS) were first performed by applying univariate Cox regression analysis. Then we performed multivariate Cox analysis to determine independent predictors of survival. Forest plots were drawn by GraphPad 8.0.1 and used to visually display the results of multivariate analysis. Kaplan-Meier method was applied to intuitively show the prognosis difference of each independent risk factor. Results We finally identified 380 UTUC patients with bone metastasis for survival analysis, of which 230 males (60.5%) and 150 females (39.5%). The mean and median age at diagnosis were 71 and 72 years, respectively. Simultaneous lung metastasis (33.4%) and liver metastasis (31.1%) were more common in UTUC patients with bone metastasis. The 1-year OS and CSS rates of this research population were 23.8% and 26.6%, respectively. Multivariate Cox proportional hazards modeling controlling for surgery, chemotherapy, brain metastasis, liver metastasis, lung metastasis, and marital status, revealed that surgery, chemotherapy, no liver metastasis, no lung metastasis, and married status predicted for better OS and CSS. Conclusion Surgery and chemotherapy are optimal management of UTUC patients with bone metastasis. Active treatments on lung and liver metastases should be performed. The prognosis of patients with unmarried status or others should be further improved.
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Affiliation(s)
- Mingping Zhou
- Department of Orthopedics, Lishui City People's Hospital, The Sixth Affiliated Hospital of Wenzhou Medical University, The First Affiliated Hospital of Lishui University, Lishui, China
| | - Jianxin Zhang
- Department of Orthopedics, Qingtian People’s Hospital, Qingtian, China
| | - Xiaowei Chen
- Department of Orthopedics, People’s Hospital of Jing Ning She Autonomous County, Jingning, China
| | - Zhan Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Correspondence: Zhan Wang Wei Liang
| | - Wei Liang
- Department of Orthopedics, Lishui City People's Hospital, The Sixth Affiliated Hospital of Wenzhou Medical University, The First Affiliated Hospital of Lishui University, Lishui, China
- Correspondence: Zhan Wang Wei Liang
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Li S, Chen X, Zheng J, Liu X. Reduced Preoperative Glomerular Filtration Rate Is Associated With Adverse Postoperative Oncological Prognosis in Patients Undergoing Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Retrospective Cohort Study. Front Surg 2022; 9:872273. [PMID: 35548184 PMCID: PMC9082599 DOI: 10.3389/fsurg.2022.872273] [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: 02/09/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate the association between perioperative estimated glomerular filtration rate (eGFR) and postoperative oncological outcomes in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU),and to evaluate the effect of sex on this association. Methods The medical records of patients with UTUC who underwent RNU between January 2012 and December 2017 at our hospital were retrospectively reviewed. Patients were divided into three groups based on preoperative eGFRs: normal eGFR (>60 mL/min/1.73 m2; n = 179), moderately reduced eGFR (45-60 mL/min/1.73 m2; n = 45), and severely reduced eGFR (≤ 45 mL/min/1.73 m2; n = 36). Statistical analyses were performed to evaluate the prognostic impact of preoperative eGFR on prognosis. Results Patient mean age was 66.7 ± 9.6 years, and 47.9% were female. Multivariate regression analysis based on Cox proportional risk models and Kaplan-Meier survival rates showed that lower preoperative eGFR was associated with decreased OS, PFS, and CSS. In the adjusted Cox regression model, patients with normal and moderately reduced eGFRs had a decreased hazard for mortality, with adjusted hazard ratios of 0.13 [95% confidence interval (CI): 0.07-0.26] and 0.36 (95% CI: 0.18-0.73), respectively (P < 0.001). The smooth fitting curve suggested a linear relationship between eGFR and prognostic survival. Additionally, sensitivity subgroup analyses verified an inverse relationship between the reduced eGFR and OS. Women had a lower eGFR and worse oncological outcomes than men. A nomogram for OS was developed based on multivariate analysis with a C-index of 0.754 (95% CI: 0.728-0.779). Conclusion Preoperative renal insufficiency is strongly associated with a higher risk of cancer progression and a lower survival probability. It is important to identify preoperative renal insufficiency in patients with UTUC, particularly female patients.
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Affiliation(s)
| | | | | | - Xuefeng Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
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Rodrigues Pessoa R, Morrison JC, Konety B, Gershman B, Maroni P, Kukreja JB, Cost N, Flaig T, Kessler E, Sharma P, Kim SP. National trends in clinical and pathologic staging for upper tract urothelial carcinoma: Implications for neoadjuvant chemotherapy. Urol Oncol 2021; 39:832.e9-832.e15. [PMID: 33820697 DOI: 10.1016/j.urolonc.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/01/2021] [Accepted: 03/14/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION With growing support of perioperative chemotherapy for upper tract urothelial carcinoma (UTUC), current biopsy methods are challenging, and little is known as to the degree to which patients would appropriately receive neoadjuvant chemotherapy (NAC) from biopsy alone. Herein, we sought to assess the rates of appropriate clinical use of NAC and identify clinicopathologic factors associated with aggressive UTUC amongst patients undergoing radical nephroureterectomy (RNU) for clinically localized disease. METHODS From 2004 to 2013, we identified all treatment naïve patients diagnosed with clinically localized, high grade UTUC (cTa-4Nx) who underwent RNU from the National Cancer Database (NCDB). Pathologic criteria for NAC (pT2-4N0,x; pTanyN1) from RNU represented the primary outcome. Bivariate and multivariable analyses were utilized to identify covariates associated with primary outcome to determine appropriate use of NAC. RESULTS During the study interval, 5,362 patients were diagnosed with clinically localized UTUC and underwent RNU. Overall, 49.1% of patients presented with an unknown primary tumor stage (Tx) and 24.5% had invasive UTUC from biopsy. On multivariable analysis, upper tract tumor size was associated with invasive UTUC eligible for NAC (all P < 0.05). Amongst patients with cTx UTUC from biopsy, half of patients had pathologic noninvasive UTUC (pTa,is,1) from RNU and would be overtreated with NAC. CONCLUSION Significant uncertainty persists in assigning primary upper tract tumor depth and represents a key barrier to widespread implementation of NAC for patients with high grade UTUC. Further research is needed to more accurately determine clinical criteria to identify patients for NAC.
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Affiliation(s)
| | - Jeffrey C Morrison
- University of Colorado Anschutz Medical Center, Division of Urology, Aurora, CO
| | - Badrinath Konety
- Rush University Medical Center, Division of Urology, Chicago, IL
| | - Boris Gershman
- Beth Israel Deaconess Medical Center, Division of Urologic Surgery, Boston, MA
| | - Paul Maroni
- University of Colorado Anschutz Medical Center, Division of Urology, Aurora, CO
| | - Janet B Kukreja
- University of Colorado Anschutz Medical Center, Division of Urology, Aurora, CO
| | - Nicholas Cost
- University of Colorado Anschutz Medical Center, Division of Urology, Aurora, CO; Children's Hospital of Colorado, Aurora, CO
| | - Thomas Flaig
- University of Colorado Anschutz Medical Center, Department of Medical Oncology, Aurora, CO
| | - Elizabeth Kessler
- University of Colorado Anschutz Medical Center, Department of Medical Oncology, Aurora, CO
| | - Pranav Sharma
- Texas Tech University Health Sciences Center, Department of Urology, Lubbock, TX
| | - Simon P Kim
- University of Colorado Anschutz Medical Center, Division of Urology, Aurora, CO; Yale University, Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT.
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Chung JW, Lee JN, Park KM, Byeon KH, Cheon H, Ha YS, Choi SH, Kim BS, Kim TH, Yoo ES, Kwon TG, Kim HT. Prognostic impact of perirenal fat stranding on oncologic outcomes in ureteral urothelial carcinoma. Investig Clin Urol 2020; 62:23-31. [PMID: 33314805 PMCID: PMC7801158 DOI: 10.4111/icu.20200125] [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: 04/04/2020] [Revised: 06/11/2020] [Accepted: 08/12/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Perirenal fat stranding (PRFS) is defined as linear areas of soft-tissue attenuation in the perirenal space that can result from ureteral obstruction. We analyzed the prognostic impact of PRFS on outcomes in patients with ureteral urothelial carcinoma (UC). MATERIALS AND METHODS Overall, 126 patients evaluated preoperatively by computerized tomography (CT) scan and diagnosed with ureteral UC following nephroureterectomy between January 2001 and May 2018 were included. We analyzed associations between oncologic outcomes and secondary signs such as hydronephrosis and PRFS. RESULTS Overall, 68 patients (54.0%) showed PRFS on preoperative CT scans. The patients' mean age was 66.33±9.49 years. A high pT stage (≥T3) was seen in 47 patients (37.3%) and high-grade tumors were seen in 90 patients (71.4%). Lymphovascular invasion (LVI) was seen in 15 patients (11.9%), and 5 (4.0%) were at the pN1 stage. Multivariate Cox analysis showed that cT stage≥3, PRFS, pT stage≥3, tumor grade, LVI, and pN1 stage were independent prognostic factors of recurrence-free survival (RFS) and cancer-specific survival (CSS) (all p<0.05). CONCLUSIONS PRFS was found to be an independent prognostic factor for RFS and CSS. PRFS is easily detectable in preoperative CT imaging and may be useful for improving the prediction of oncologic outcomes of ureteral UC. Therefore, PRFS along with other important preoperative CT findings can help urologists give preoperative advice to patients with ureteral UC before surgical management.
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Affiliation(s)
- Jae Wook Chung
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jun Nyung Lee
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyong Min Park
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyeong Hyeon Byeon
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyejin Cheon
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yun Sok Ha
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seock Hwan Choi
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Bum Soo Kim
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Tae Hwan Kim
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Eun Sang Yoo
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Tae Gyun Kwon
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.,Joint Institute for Regenerative Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Tae Kim
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.
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Tam AW, Liaw C, Li E, Katims AB, Say RK, Gul Z, Winoker JS, Martini A, Audenet F, Sfakianos JP. The effect of tumor location on overall survival for pT2-4 bladder and upper tract urothelial carcinoma following radical surgery. Can Urol Assoc J 2020; 15:E248-E255. [PMID: 33119498 DOI: 10.5489/cuaj.6698] [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 Historically, staging and treatment for upper tract urothelial carcinoma were extrapolated from bladder urothelial carcinoma literature. However, embryological, genetic, and anatomical differences exist between them. We sought to explore the relationship between location of urothelial cancer and overall survival (OS). METHODS Data was culled from the National Cancer Database from 2004-2015. Patients with pT2-pT4 treated with definitive surgery were included; those with metastatic disease or who received neoadjuvant or adjuvant treatment were excluded. Patients were stratified by tumor location and pathological stage. The primary outcome was OS. Secondary outcomes were predictors of mortality in each pT stage stratum. RESULTS A total of 11 330 patients with bladder, 954 patients with ureteral, and 1943 patients with renal pelvis urothelial carcinoma were analyzed. Mean followup was 43.3, 39.4, and 41.4 months for bladder, ureteral, and renal pelvis, respectively. On univariable analysis, ureteral pT2 was associated with worse OS compared to both bladder (61.3 vs. 80.4 months, p=0.007) and renal pelvis (61.3 vs. 80.5 months, p=0.014). Renal pelvis pT3 was associated with improved OS compared to both bladder (42.5 vs. 28.6 months, p=0.003) and ureteral (42.5 vs. 25.7 months, p<0.001). Renal pelvis pT4 had decreased survival compared to bladder (11.4 vs. 17.7 months, p<0.001). On multivariable Cox regression, only renal pelvis pT3 was associated with a 20% decreased risk of mortality compared to bladder pT3 (hazard ratio 0.80, 95% confidence interval 0.72-0.88, p<0.001). CONCLUSIONS Renal pelvis pT3 is associated with lower mortality. Mutational and embryological differences may play a role in this disparity.
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Affiliation(s)
- Andrew W Tam
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Christine Liaw
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Eric Li
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Andrew B Katims
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Rollin K Say
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Zeynep Gul
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jared S Winoker
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Alberto Martini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Francois Audenet
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Veccia A, Antonelli A, Martini A, Falagario U, Carrieri G, Grob MB, Guruli G, Simeone C, Wiklund P, Porpiglia F, Autorino R. Ureteral location is associated with survival outcomes in upper tract urothelial carcinoma: A population‐based analysis. Int J Urol 2020; 27:966-972. [DOI: 10.1111/iju.14336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/30/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Alessandro Veccia
- Division of Urology Department of Surgery VCU Health System Richmond Virginia USA
- Urology Unit ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia Brescia Italy
| | - Alessandro Antonelli
- Urology Unit AUOI Verona Department of Surgery, Dentistry, Pediatrics and Gynecology University of Verona Verona Italy
| | - Alberto Martini
- Department of Urology Vita Salute San Raffaele University Milan Italy
- Department of Urology Icahn School of Medicine at Mount Sinai New York City New York USA
| | - Ugo Falagario
- Division of Urology Department of Surgery VCU Health System Richmond Virginia USA
- Department of Urology Icahn School of Medicine at Mount Sinai New York City New York USA
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences University of Foggia Foggia Italy
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences University of Foggia Foggia Italy
| | - Mayer B Grob
- Division of Urology Department of Surgery VCU Health System Richmond Virginia USA
| | - Georgi Guruli
- Division of Urology Department of Surgery VCU Health System Richmond Virginia USA
| | - Claudio Simeone
- Urology Unit ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia Brescia Italy
| | - Peter Wiklund
- Department of Urology Icahn School of Medicine at Mount Sinai New York City New York USA
| | - Francesco Porpiglia
- Department of Urology “San Luigi Gonzaga” Hospital University of Turin Turin Italy
| | - Riccardo Autorino
- Division of Urology Department of Surgery VCU Health System Richmond Virginia USA
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Urothelial Carcinoma of the Renal Pelvis and Ureter: Does Location Make a Difference? Clin Genitourin Cancer 2019; 18:45-49.e1. [PMID: 31786118 DOI: 10.1016/j.clgc.2019.10.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/20/2019] [Accepted: 10/28/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is a paucity of data on outcomes of upper tract urothelial carcinoma (UTUC) arising from the renal pelvis (RPUC) versus UTUC arising from the ureter (UUC). The published literature is conflicting, and there is no consensus on patient prognosis based on disease location. The aim of this study is to compare clinical and survival outcomes based on location of primary tumor using a large national registry. MATERIALS AND METHODS The National Cancer Database was queried from 2010 to 2016 for patients with localized (cN0M0) UTUC. Patients were stratified based on location of tumor. Survival analysis was performed using Cox proportional hazard regression and inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier curves. We also performed exploratory analyses based on tumor stage. RESULTS We identified 11,922 patients who underwent surgical treatment. The median follow-up was 32.1 months. Patients with RPUC presented with higher tumor stage and grade. Patients with UUC were treated with less radical nephroureterectomy (56.4% vs. 84.3%; P < .01). IPTW-adjusted Kaplan-Meier curves demonstrated higher median overall survival for RPUC versus UUC (71.1 vs. 66.8 months, respectively; P = .01). This benefit was consistent across tumor stage subgroups, reaching statistical significance in patients with T1 disease. On multivariable analysis, ureteral location of tumor was a predictor of worse survival. CONCLUSION Patients with UUC were found to be treated with less radical surgery and to have worse survival than those with RPUC. These patients may suffer from poor initial staging and suboptimal treatments. Further studies are needed to evaluate potential biological differences of UTUC based on tumor location.
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Kumar R. What's inside. Indian J Urol 2018; 34:7-8. [PMID: 29343905 PMCID: PMC5769254 DOI: 10.4103/iju.iju_349_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Rajeev Kumar
- Editor, Indian Journal of Urology, All India Institute of Medical Sciences, New Delhi, India
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