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Kanno T, Kobori G, Saito R, Ito K, Nakagawa H, Takahashi T, Koterazawa S, Takaoka N, Somiya S, Haitani T, Nagahama K, Ito M, Higashi Y, Moroi S, Akao T, Yamada H. Hydronephrosis severity as a predictor of postoperative renal function decline following laparoscopic radical nephroureterectomy. Int J Clin Oncol 2024; 29:464-472. [PMID: 38316710 DOI: 10.1007/s10147-024-02468-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND This study aimed to investigate factors, including the degree of hydronephrosis, that may be associated with decreased renal function after radical nephroureterectomy (RNU). METHODS This study included 252 patients who underwent laparoscopic RNU with an estimated glomerular filtration rate (eGFR) ≥ 30 ml/min/1.73 m2 in three institutions. We assessed the association between hydronephrosis grade and perioperative renal function and performed a stepwise multivariate linear regression analysis to identify factors associated with postoperative eGFR. Patients with preoperative eGFR ≥ 50 ml/min/1.73 m2 were divided into a training set and an independent external validation set to develop a predictive model for postoperative renal function. RESULTS The median preoperative and postoperative eGFR were 61.1 and 46.4 ml/min/1.73 m2, respectively. The eGFR preservation rates were 66.9%, 66.6%, 88.1%, and 100.0% in groups without, with mild, moderate, and severe hydronephrosis, respectively, and this difference was statistically significant (p < 0.001). Multivariate analysis revealed that factors predictive of postoperative eGFR included sex, preoperative eGFR, clinical T stage (cT3-4), and the presence of moderate or severe hydronephrosis. Our predictive model, based on these factors, positively correlated with actual postoperative renal function, and the similarity in categories with or without renal function insufficiency between predicted and actual postoperative renal functions was 78% in both training and validation sets. CONCLUSION Moderate or severe hydronephrosis is associated with a modest postoperative decline in renal function, while mild hydronephrosis is not. Our predictive model may be useful in predicting postoperative renal function insufficiency and guiding decision-making for perioperative medical treatment.
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Affiliation(s)
- Toru Kanno
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan.
- Department of Urology, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan.
| | - Go Kobori
- Department of Urology, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Ryoichi Saito
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Katsuhiro Ito
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | | | - Naoto Takaoka
- Department of Urology, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Shinya Somiya
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Takao Haitani
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Kanji Nagahama
- Department of Urology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Masaaki Ito
- Department of Urology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Yoshihito Higashi
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Seiji Moroi
- Department of Urology, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Toshiya Akao
- Department of Urology, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Hitoshi Yamada
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
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Wiberg E, Vega A, Eriksson V, Banday V, Svensson J, Eriksson E, Jahnson S, Sherif A. A Validation Study of cT-Categories in the Swedish National Urinary Bladder Cancer Register-Norrland University Hospital. J Pers Med 2023; 13:1163. [PMID: 37511776 PMCID: PMC10381347 DOI: 10.3390/jpm13071163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND In Sweden, all patients with urinary bladder cancer (UBC) are recorded in the Swedish National Register for Urinary Bladder Cancer (SNRUBC). The purpose of this study was to validate the registered clinical tumour categories (cT-categories) in the SNRUBC for Norrland University Hospital, Sweden, from 2009 to 2020, inclusive. METHODS The medical records of all 295 patients who underwent radical cystectomy for the treatment of UBC were reviewed retrospectively. Possible factors impacting the cT-categories were identified. To optimise cT-classification, computed tomography urography of all patients with suspected tumour-associated hydronephrosis (TAH) or suspected tumour in bladder diverticulum (TIBD) were retrospectively reviewed by a radiologist. Discrepancy was tested with a logistic regression model. RESULTS cT-categories differed in 87 cases (29.5%). Adjusted logistic regression analysis found TIBD and TAH as significant predictors for incorrect registration; OR = 7.71 (p < 0.001), and OR = 17.7, (p < 0.001), respectively. In total, 48 patients (68.6%) with TAH and 12 patients (52.2%) with TIBD showed discrepancy regarding the cT-category. Incorrect registration was mostly observed during the years 2009-2012. CONCLUSION The study revealed substantial incorrect registration of cT-categories in SNRUBC. A major part of the misclassifications was related to TAH and TIBD. Registration of these variables in the SNRUBC might be considered to improve correct cT-classification.
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Affiliation(s)
- Erik Wiberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 907 36 Umea, Sweden
| | - Andrés Vega
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 907 36 Umea, Sweden
| | - Victoria Eriksson
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 907 36 Umea, Sweden
| | - Viqar Banday
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 907 36 Umea, Sweden
| | - Johan Svensson
- Department of Statistics, Umea School of Business, Economics and Statistics (USBE), Umea University, 907 36 Umea, Sweden
| | - Elisabeth Eriksson
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, 907 36 Umea, Sweden
| | - Staffan Jahnson
- Department of Urology, Biomedical and Clinical Sciences (BKV), Linköping University, 581 83 Linköping, Sweden
| | - Amir Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 907 36 Umea, Sweden
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Chen IHA, Chang CH, Huang CP, Wu WJ, Li CC, Chen CH, Huang CY, Lo CW, Yu CC, Tsai CY, Wu WC, Tseng JS, Lin WR, Jiang YH, Lee YK, Jou YC, Cheong IS, Hsueh TY, Chiu AW, Chen YT, Chen JS, Chiang BJ, Tsai YC, Lin WY, Wu CC, Lin JT, Yu CC. Factors Predicting Oncological Outcomes of Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma in Taiwan. Front Oncol 2022; 11:766576. [PMID: 35096575 PMCID: PMC8793058 DOI: 10.3389/fonc.2021.766576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/21/2021] [Indexed: 12/30/2022] Open
Abstract
Background Taiwan is one of the endemic regions where upper tract urothelial carcinoma (UTUC) accounts for approximately a third of all urothelial tumors. Owing to its high prevalence, extensive experience has been accumulated in minimally invasive radical nephroureterectomy (RNU). Although a variety of predictive factors have been explored in numerous studies, most of them were on a single-center or limited institutional basis and data from a domestic cohort are lacking. Objective This study aims to identify significant predicting factors of oncological outcomes, including overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and intravesical recurrence-free survival (IVRFS), following RNU for UTUC in Taiwan. Methods A multicenter registry database, Taiwan UTUC Collaboration Group, was utilized to analyze oncological outcomes of 3,333 patients undergoing RNU from 1988 to 2021 among various hospitals in Taiwan. Clinicopathological parameters were recorded according to the principles established by consensus meetings. The Kaplan-Meier estimator was utilized to estimate the survival rates, and the curves were compared using the stratified log-rank test. Univariate and multivariate analyses were performed with the Cox proportional hazard model to explore potential predicting factors. Results With a median follow-up of 41.8 months in 1,808 patients with complete information, the 5-year IVRFS, DFS, CSS, and OS probabilities were 66%, 72%, 81%, and 70%, respectively. In total, 482 patients experienced intravesical recurrence, 307 died of UTUC, and 583 died of any cause. Gender predominance was female (57%). A total of 1,531 patients (84.7%) had high-grade tumors; preoperative hydronephrosis presented in 1,094 patients (60.5%). Synchronous bladder UC was identified in 292 patients (16.2%). Minimally invasive procedures accounted for 78.8% of all surgeries, including 768 hand-assisted laparoscopic (42.5%) and 494 laparoscopic (27.3%) approaches. Synchronous bladder UC was the dominant adverse predicting factor for all survival outcomes. Other independent predicting factors for OS, CSS, and DFS included age ≧70, presence of preoperative hydronephrosis, positive surgical margin, LVI, pathological T and N staging, and laparoscopic RNU. Conclusion Synchronous UC of the urinary bladder is an independent adverse prognostic factor for survival in UTUC. The presence of preoperative hydronephrosis was also corroborated as a disadvantageous prognostic factor. Our multivariate analysis suggested that laparoscopic RNU might provide better oncological control.
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Affiliation(s)
- I-Hsuan Alan Chen
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Hsin Chen
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Wen Lo
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Chih-Chin Yu
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Chung-You Tsai
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Department of Healthcare Information and Management, Ming Chuan University, Taipei, Taiwan
| | - Wei-Che Wu
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Jen-Shu Tseng
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Wun-Rong Lin
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Yu-Khun Lee
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Yeong-Chin Jou
- Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.,Department of Health and Nutrition Biotechnology, Asian University, Taichung, Taiwan
| | - Ian-Seng Cheong
- Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Thomas Y Hsueh
- Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan.,Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Allen W Chiu
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Tai Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Jih-Sheng Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Bing-Juin Chiang
- College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.,Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan.,Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
| | - Yao-Chou Tsai
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wei Yu Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan.,Chang Gung University of Science and Technology, Chia-Yi, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Chang Wu
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan.,TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Jen-Tai Lin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chia-Cheng Yu
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Zhao F, Qi N, Zhang C, Xue N, Li S, Zhou R, Chen Z, Yao R, Zhu H. Impact of Surgical Wait Time on Survival in Patients With Upper Urinary Tract Urothelial Carcinoma With Hydronephrosis. Front Oncol 2021; 11:698594. [PMID: 34290988 PMCID: PMC8287585 DOI: 10.3389/fonc.2021.698594] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/23/2021] [Indexed: 02/02/2023] Open
Abstract
Background and Objectives Due to the inevitability of waiting time for surgery, this problem seems to have become more pronounced since the outbreak of COVID-19, and due to the high incidence of preoperative hydronephrosis in upper urinary tract urothelial carcinoma (UTUC) patients, it is particularly important to explore the impact of preoperative waiting time and hydronephrosis on upper urinary urothelial carcinoma. Methods 316 patients with UTUC who underwent radical surgery at a high-volume center in China between January 2008 and December 2019 were included in this study. We retrospectively collected the clinicopathologic data from the medical records, including age, sex, smoking history, ECOG performance status (ECOG PS), body mass index (BMI), tumor location and size, number of lesions, T stage, N stage, surgical approach and occurrence of hydronephrosis, lymph node invasion, lymph node dissection, surgical margin, tumor necrosis, infiltrative tumor architecture, lymphovascular invasion and concomitant bladder cancer. Surgical wait time was defined as the interval between initial imaging diagnosis and radical surgery of UTUC. Hydronephrosis was defined as abnormal dilation of the renal pelvis and calyces due to obstruction of the urinary system. Firstly, all patients were divided into short-wait (<31 days), intermediate-wait (31-90 days) and long-wait (>90 days) groups according to the surgical wait time. The clinicopathological characteristics of each group were evaluated and the survival was compared. For patients with hydronephrosis, we subsequently divided them into two groups: short-wait (≤60 days) and long-wait (>60 days) groups according to the surgical wait time. Univariate and multivariate COX regression analysis were performed to evaluate the prognostic risk factor for patients with hydronephrosis. Results A total of 316 patients with UTUC were included in this study with a median surgical wait time of 22 days (IQR 11-71 days). Of the 316 patients, 173 were classified into the short-wait group (54.7%), 69 into the intermediate-wait group (21.8%) and 74 into the long-wait group (23.5%). The median follow-up time for all patients was 43 months (IQR 28-67months). The median surgical wait times of the short-wait, intermediate-wait and long-wait group were12 days (IQR 8-17days), 42days (IQR 37-65days) and 191days (IQR 129-372days), respectively. The 5-year overall survival (OS) of all patients was 54.3%. The 5-year OS of short-wait, intermediate-wait and long-wait groups were 56.4%, 59.3% and 35.1%, respectively (P=0.045). The 5-year cancer-specific survival (CSS) of short-wait, intermediate-wait and long-wait groups were 65.8%, 70.9% and 39.6%, respectively (P=0.032). In the subgroup analysis, we divided 158 UTUC patients with hydronephrosis into short-wait group (≤60 days) and long-wait group (> 60 days), 120 patients were included in the short-wait group and 38 patients in the long-wait group. The median surgical wait times of the short-wait and long-wait group were 14days (IQR 8-28days) and 174days (IQR 100-369days), respectively. The 5-year OS of long-wait group was significantly lower than the OS of short-wait group (44.2% vs. 55.1%, P =0.023). The 5-year CSS of long-wait and short-wait group were 49.1% and 61.7%, respectively (P=0.041). In multivariate Cox regression analysis of UTUC patients with hydronephrosis, surgical wait time, tumor grade, pathological T stage, and tumor size were independent risk factors for OS and CSS. Lymph node involvement was also a prognostic factor for CSS. Conclusion For patients with UTUC, the surgical wait time should be limited to less than 3 months. For UTUC patients with hydronephrosis, the OS and CSS of patients with surgical wait time of more than 60 days were relatively shorted than those of patients with surgical wait time of less than 60 days.
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Affiliation(s)
- Fangzheng Zhao
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Nienie Qi
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chu Zhang
- Department of Neurobiology, Xuzhou Key Laboratory of Neurobiology, Xuzhou Medical University, Xuzhou, China
| | - Ning Xue
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Shuaishuai Li
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Raorao Zhou
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zeyu Chen
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ruiqin Yao
- Department of Cell Biology and Neurobiology, Xuzhou Medical University, Xuzhou, China
| | - Haitao Zhu
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Prognostic value of preoperative hydronephrosis in patients with bladder cancer undergoing radical cystectomy: A meta-analysis. PLoS One 2019; 14:e0222223. [PMID: 31513614 PMCID: PMC6742405 DOI: 10.1371/journal.pone.0222223] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/23/2019] [Indexed: 12/23/2022] Open
Abstract
Background Hydronephrosis is a common finding in patients with bladder cancer. The aim of the study was to appraise the prognostic value of preoperative hydronephrosis in bladder cancer patients undergoing radical cystectomy. Methods We conducted a literature search using PubMed and Embase databases in Aug 2018. Summary hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using fixed-effect or random-effects models. The primary endpoint was overall survival (OS). Secondary endpoints were cancer-specific survival (CSS) and recurrence-free survival (RFS). Results Overall, 13 studies published between 2008 and 2018 including 4,820 patients were selected for the meta-analysis. The age of bladder cancer patients ranged from 27 to 90.4 years, and the overall proportion of males was 72.5%. Preoperative hydronephrosis was reported in 27.4% of patients. The pooled HR was statistically significant for OS (HR, 1.36; 95% CI [1.20–1.55]) and CSS (HR, 1.64; 95% CI [1.33–2.02]), with no heterogeneity among the enrolled studies. Patients with bilateral hydronephrosis showed a poorer CSS compared to those with no hydronephrosis (HR 5.43, 95% CI [3.14–9.40]). However, there was no difference in CSS between no hydronephrosis and unilateral hydronephrosis groups (HR 1.35, 95% CI [0.84–2.14]). Despite a tendency towards poorer RFS (HR, 1.27; 95% CI [0.96–1.96]), the results demonstrated no significant association between presence of preoperative hydronephrosis and RFS after radical cystectomy. Conclusion This meta-analysis indicates that preoperative hydronephrosis is significantly associated with poorer OS and CSS after radical cystectomy for patients with bladder cancer. Preoperative hydronephrosis has a stronger effect on CSS in patients with bilateral hydronephrosis. The presence of preoperative hydronephrosis not only predicts prognosis, but may also help to identify patients who benefit the most from neoadjuvant chemotherapy.
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Fukui T, Kanno T, Kobori G, Moroi S, Yamada H. Preoperative hydronephrosis as a predictor of postnephroureterectomy survival in patients with upper tract urothelial carcinoma: a two-center study in Japan. Int J Clin Oncol 2019; 25:456-463. [PMID: 31482240 DOI: 10.1007/s10147-019-01535-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/22/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate the predictive value of preoperative hydronephrosis for pathological outcome and prognosis in patients with upper tract urothelial carcinoma treated with nephroureterectomy. METHODS 167 patients with UTUC treated with nephroureterectomy at our two institutions in Japan between 2002 and 2017 were retrospectively analyzed. Preoperative computed tomography scans were evaluated for the presence of ipsilateral hydronephrosis. Preoperative hydronephrosis's associations with pathological outcome and postnephroureterectomy survival were assessed. RESULTS Ipsilateral hydronephrosis was present in 102 patients (61.1%). Preoperative hydronephrosis was not associated with higher pathological T stage (T3 or greater). Patients with preoperative hydronephrosis compared with patients without preoperative hydronephrosis had significantly worse recurrence-free survival (RFS) (5-year survival, 61.9% and 77.6%, respectively; p = 0.033), disease-specific survival (DSS) (5-year survival, 66.9% and 88.1%, respectively; p = 0.026), and overall survival (OS) (5-year survival, 54.5% and 80.6%, respectively; p = 0.030). A multivariate Cox regression model identified preoperative hydronephrosis and higher clinical T stage (T3 or greater) as an independent predictor of shorter RFS (p = 0.015 and 0.0009, respectively). We segregated the patients into three risk groups based on the number of these two prognostic factors: 0, favorable risk; 1, intermediate risk; 2, poor risk. The favorable-risk group had significantly better RFS (p = 0.0003), DFS (p = 0.0001), and OS (p = 0.0007) than the poor and intermediate-risk groups (RFS (p = 0.0011), DFS (p = 0.0017), and OS (p = 0.0043)). CONCLUSION The presence of preoperative hydronephrosis was a significant risk factor affecting survival. Our risk classification based on preoperative hydronephrosis and clinical T stage may be helpful for patient counselling and decision-making before nephroureterectomy.
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Affiliation(s)
- Tomohiro Fukui
- Department of Urology, Hamamatsu Rosai Hospital, 25 Shogen-machi, Higashi-ku, Hamamatsu, Shizuoka, 430-8525, Japan. .,Department of Urology, Rakuwakai Otowa Hospital, 2 Otowatinji-machi, Yamashina-ku, Kyoto, Kyoto, 607-8062, Japan.
| | - Toru Kanno
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminami-cho, Fushimi-ku, Kyoto, Kyoto, 601-1495, Japan
| | - Go Kobori
- Department of Urology, Hamamatsu Rosai Hospital, 25 Shogen-machi, Higashi-ku, Hamamatsu, Shizuoka, 430-8525, Japan
| | - Seiji Moroi
- Department of Urology, Hamamatsu Rosai Hospital, 25 Shogen-machi, Higashi-ku, Hamamatsu, Shizuoka, 430-8525, Japan
| | - Hitoshi Yamada
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminami-cho, Fushimi-ku, Kyoto, Kyoto, 601-1495, Japan
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7
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Shao IH, Chang YH, Pang ST. Recent advances in upper tract urothelial carcinomas: From bench to clinics. Int J Urol 2018; 26:148-159. [PMID: 30372791 DOI: 10.1111/iju.13826] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/10/2018] [Indexed: 12/16/2022]
Abstract
Urothelial carcinoma in the upper tract is rare and often discussed separately. Many established risk factors were identified for the disease, including genetic and external risk factors. Radiographic survey, endoscopic examination and urine cytology remained the most important diagnostic modalities. In localized upper tract urothelial carcinomas, radical nephroureterectomy with bladder cuff excision are the gold standard for large, high-grade and suspected invasive tumors of the renal pelvis and proximal ureter, whereas kidney-sparing surgeries should be considered in patients with low-risk disease. Advances in technology have given endoscopic surgery an important role, not only in diagnosis, but also in treatment. Although platinum-based combination chemotherapy is efficacious in advanced or metastatic disease, current established chemotherapy regimens are toxic and lack a sustained response. Immune checkpoint inhibitors have led to a new era of treatment for advanced or metastatic urothelial carcinomas. The remarkable results achieved thus far show that immunotherapy will likely be the future treatment paradigm. The combination of immune checkpoint inhibitors and other agents is another inspiring avenue to explore that could benefit even more patients. With respect to the high incidence rate and different clinical appearance of upper tract urothelial carcinomas in Taiwan, a possible correlation exists between exposure to certain external risk factors, such as arsenic in drinking water and aristolochic acid in Chinese herbal medicine. As more gene sequencing differences between upper tract urothelial carcinomas and various disease causes are detailed, this has warranted the era of individualized screening and treatment for the disease.
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Affiliation(s)
- I-Hung Shao
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Hsu Chang
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - See-Tong Pang
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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8
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Raman JD, Park R. Endoscopic management of upper-tract urothelial carcinoma. Expert Rev Anticancer Ther 2017; 17:545-554. [DOI: 10.1080/14737140.2017.1326823] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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