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Culpan M, Cakici MC, Keser F, Yigit Yalcin M, Kargi T, Kayar R, Abay E, Ozenc G, Kumcu A, Pehlivanoglu M, Turk S, Kisa E, Sahin S, Ishak Ozturk M, Otunctemur A, Sobay R, Cihan Demirel H, Yilmaz O, Atis G, Imamoglu MA, Yildirim A, Yildirim A. Biopsy with Ureterorenoscopy Before Radical Nephroureterectomy is Associated with Increased Intravesical Recurrence in Urothelial Cancer Located in the Kidney. Turk J Urol 2022; 48:431-439. [PMID: 36416333 PMCID: PMC9797743 DOI: 10.5152/tud.2022.22143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Diagnostic ureterorenoscopy is used to identify upper tract urothelial cancer before radical nephro ureterectomy, especially for uncertain lesions in imaging modalities or urine cytology. However, diagnostic ureterorenoscopy can potentially cause intravesical tumor spillage and can increase intravesical recurrence rates. We aimed to investigate the impact of diagnostic ureterorenoscopy before radical nephroureterectomy, with and without biopsy, on intravesical recurrence rates of patients with upper tract urothelial cancer. MATERIAL AND METHODS Patients with localized upper tract urothelial cancer from 8 different tertiary referral centers, who underwent radical nephroureterectomy between 2001 and 2020, were included. Three groups were made: no URS (group 1); diagnostic ureterorenoscopy without biopsy (group 2); and diagnostic ure terorenoscopy with biopsy (group 3). Intravesical recurrence rates and survival outcomes were compared. Univariate and multivariate Cox regression analyses were performed to determine the factors that were asso ciated with intravesical recurrence-free survival. RESULTS Twenty-two (20.8%), 10 (24.4%), and 23 (39%) patients experienced intravesical recurrence in groups 1, 2, and 3, respectively (P=.037) among 206 patients. The 2-year intravesical recurrence-free sur vival rate was 83.1%, 82.4%, and 69.2%, for groups 1, 2, and 3, respectively (P=.004). Cancer-specific survival and overall survival were comparable (P=.560 and P=.803, respectively). Diagnostic ureterore noscopy+biopsy (hazard ratio: 6.88, 95% CI: 2.41-19.65, P < .001) was the only independent predictor of intravesical recurrence in patients with upper tract urothelial cancer located in the kidney, according to tumor location. CONCLUSION Diagnostic ureterorenoscopy+biopsy before radical nephroureterectomy significantly increased the rates of intravesical recurrence in tumors located in kidney. This result suggests tumor spillage with this type of biopsy, so further studies with different biopsy options or without biopsy can be designed.
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Affiliation(s)
- Meftun Culpan
- Department of Urology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Caglar Cakici
- Department of Urology, İstanbul Göztepe Prof. Dr. Süleyman Yalçın City Hospital, İstanbul, Turkey
| | - Ferhat Keser
- Department of Urology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey,Corresponding author:Ferhat KeserE-mail:
| | - Mehmet Yigit Yalcin
- Department of Urology, University of Health Sciences, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Taner Kargi
- Department of Urology, University of Health Sciences, Bakirkoy Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Rıdvan Kayar
- Department of Urology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, İstanbul, Turkey
| | - Erdal Abay
- Department of Urology, University of Health Sciences, Prof. Dr. Cemil Taşçıoğulu City Hospital, İstanbul, Turkey
| | - Gorkem Ozenc
- Department of Urology, University of Health Sciences, Diskapi Yıldırım Beyazıt Training and Research Hospital, İstanbul, Turkey
| | - Ali Kumcu
- Department of Urology, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Pehlivanoglu
- Department of Urology, University of Health Sciences, Sultan 2. Abdulhamid Han Training and Research Hospital, İstanbul, Turkey
| | - Semih Turk
- Department of Urology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Erdem Kisa
- Department of Urology, University of Health Sciences, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Selcuk Sahin
- Department of Urology, University of Health Sciences, Bakirkoy Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Metin Ishak Ozturk
- Department of Urology, University of Health Sciences, Haydarpaşa Training and Research Hospital, İstanbul, Turkey
| | - Alper Otunctemur
- Department of Urology, University of Health Sciences, Prof. Dr. Cemil Taşçıoğulu City Hospital, İstanbul, Turkey
| | - Resul Sobay
- Department of Urology, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Huseyin Cihan Demirel
- Department of Urology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Omer Yilmaz
- Department of Urology, University of Health Sciences, Sultan 2. Abdulhamid Han Training and Research Hospital, İstanbul, Turkey
| | - Gokhan Atis
- Department of Urology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Muhammet Abdurrahim Imamoglu
- Department of Urology, University of Health Sciences, Diskapi Yıldırım Beyazıt Training and Research Hospital, İstanbul, Turkey
| | - Asif Yildirim
- Department of Urology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
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