Prognostic Analysis of Diagnostic Ureteroscopic Biopsy for Intravesical Recurrence of Upper Urinary Tract Urothelial Carcinoma

2021 ◽  
pp. 1-9
Author(s):  
Han Chen ◽  
Ming Wang ◽  
Tonghui Weng ◽  
Yu Wei ◽  
Lei Yang ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urothelial Carcinoma ◽  
Cox Regression ◽  
Bladder Tumour ◽  
Upper Urinary Tract ◽  
Cox Regression Analysis ◽  
Prognostic Analysis ◽  
Kaplan Meier ◽  
High Risk Factor ◽  
Urinary Tract Urothelial Carcinoma

<b><i>Objective:</i></b> The aim of this study was to investigate whether diagnostic ureteroscopy (URS) biopsy is unfavourable for bladder tumour recurrence in upper urinary tract urothelial carcinoma (UTUC). <b><i>Materials and Methods:</i></b> We performed a retrospective analysis of 195 patients diagnosed with UTUC, who were divided into a diagnostic URS group (URS+) and a nondiagnostic URS group (URS–) according to whether diagnostic ureteroscopic biopsy was performed. A Cox regression model was used to analyse the risk factors for intravesical recurrence (IVR)-free survival (IRFS) and overall survival (OS) in UTUC after radical nephroureterectomy (RNU). Kaplan-Meier analysis was used to estimate the influence of factors on the incidence of IVR and the cumulative survival rate of UTUC. <b><i>Results:</i></b> Patients with a maximum tumour diameter of less than 3.1 cm, low-stage tumours, and ureteral tumours were more likely to undergo diagnostic URS before radical surgery. Multivariate Cox regression analysis showed that tumour pathological stage and diagnostic ureteroscopic biopsy can be used as predictors of IVR after RNU (<i>p</i> = 0.019, 0.033). Kaplan-Meier survival analysis found that diagnostic ureteroscopic biopsy was a high-risk factor for IRFS (<i>p</i> = 0.034). Subcomponent analysis showed that pTa/Tis/T1, pT2, pT3/pT4 stage, and diagnostic ureteroscopic biopsy with pTa/Tis/T1 stage were unfavourable for IVR (<i>p</i> = 0.047). <b><i>Conclusion:</i></b> Diagnostic ureteroscopic biopsy before RNU should be carefully selected for patients with atypical preoperative UTUC. We believe that intravesical chemotherapy drug perfusion can be used after surgery to prevent IVR if biopsy is unavoidable, but this still requires further prospective studies.

scholarly journals Impact of nephron sparing surgery on survival in upper urinary tract urothelial carcinoma patients stratified by tumor characteristics

2020 ◽  
Author(s):  
Liang Jin ◽  
Ting-shuai Zhai ◽  
Zhen Zhou ◽  
Xiang Liu ◽  
Jia-xin Zhang ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urothelial Carcinoma ◽  
Cox Regression ◽  
Survival Rates ◽  
Upper Urinary Tract ◽  
Regression Analyses ◽  
Ajcc Stage ◽  
Kaplan Meier ◽  
Nephron Sparing ◽  
Urinary Tract Urothelial Carcinoma

Abstract Background: We aimed to evaluate the impact of nephron sparing surgery (NSS) on survival in upper urinary tract urothelial carcinoma (UTUC) patients stratified by tumor grade and stage compared to radical nephroureterectomy (RNU) or no surgery. Methods: Overall, 10319 UTUC patients between 2004 and 2015 were extracted from the SEER database. Patients were divided into no surgery group, NSS group and RNU group. Kaplan-Meier plots illustrated survival rates according to surgical method. Multivariable Cox regression analyses assessed the effect of different surgical methods on survival rates. Result: Among the 10319 UTUC patients. Kaplan-Meier plots showed that NSS was associated with a higher overall survival (OS) and cancer-specific survival (CSS) in grade Ⅲ and Ⅳ and AJCC stage Ⅳ patients (all p <0.05). In multivariable Cox regression analyses, NSS was prone to a higher OS or CSS in grade Ⅲ ( p > 0.05). Moreover, NSS predisposed to a higher OS only in AJCC stage Ⅳ ( p <0.05). Conclusion: The beneficial effect of NSS was evident in grade Ⅲ or AJCC stage Ⅳ. NSS can be considered in grade Ⅲ or stage Ⅳ, for other grades or stages remains to be seen, both of which will be verified by further prospective research.

scholarly journals Methylation of SPARCL1 Is Associated with Oncologic Outcome of Advanced Upper Urinary Tract Urothelial Carcinoma

2019 ◽  
Vol 20 (7) ◽  
pp. 1653 ◽  
Author(s):  
Hao-Lun Luo ◽  
Po-Huang Chiang ◽  
Chun-Chieh Huang ◽  
Yu-Li Su ◽  
Min-Tse Sung ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urothelial Carcinoma ◽  
Cox Regression ◽  
Upper Urinary Tract ◽  
Oncologic Outcomes ◽  
Matricellular Proteins ◽  
Cox Regression Analysis ◽  
Normal Urothelium ◽  
Urinary Tract Urothelial Carcinoma

Advanced upper urinary tract urothelial carcinoma (UTUC) is often associated with poor oncologic outcomes. The secreted protein acidic and rich in cysteine-like 1 (SPARCL1) protein, belongs to the SPARC-related family of matricellular proteins. Much literature has been published describing the role of SPARCL1 in the prognosis many cancers. In this study, methylated promoter regions in high-grade and high-stage upper urinary urothelial tumours compared with normal urothelium were analyzed and revealed that SPARCL1 was the most significantly hypermethylated gene in UTUC tissues. Then we prospectively collected UTUC samples and adjacent normal urothelium for pyrosequencing validation, identifying significant CpG site methylation in UTUC tissues. In addition, SPARCL1 RNA levels were significantly lower in UTUC samples. Multivariate Cox regression analysis from 78 patients with solitary renal pelvic or ureteral pT3N0M0 urothelial carcinomas revealed that only negative SPARCL1 expression and nonpapillary tumour architecture were independently associated with systemic recurrence (p = 0.011 and 0.008, respectively). In vitro studies revealed that the behaviour of BFTC-909 cells was less aggressive and more sensitive to radiation or chemotherapy after SPARCL1 overexpression. Thus, SPARCL1 could be considered as a prognostic marker and help decision-making in clinical practice.

scholarly journals Impact of nephron sparing surgery on survival in upper urinary tract urothelial carcinoma patients stratified by tumor characteristics

2020 ◽  
Author(s):  
Liang Jin ◽  
Ting-shuai Zhai ◽  
Zhen Zhou ◽  
Xiang Liu ◽  
Jia-xin Zhang ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urothelial Carcinoma ◽  
Cox Regression ◽  
Survival Rates ◽  
Upper Urinary Tract ◽  
Regression Analyses ◽  
Ajcc Stage ◽  
Kaplan Meier ◽  
Nephron Sparing ◽  
Urinary Tract Urothelial Carcinoma

Abstract Background : We aimed to evaluate the impact of nephron sparing surgery (NSS) on survival in upper urinary tract urothelial carcinoma (UTUC) patients stratified by tumor grade and stage compared to radical nephroureterectomy (RNU) or no surgery. Methods : Overall, 10319 UTUC patients between 2004 and 2015 were extracted from the SEER database. Patients were divided into no surgery group, NSS group and RNU group. Kaplan-Meier plots illustrated survival rates according to surgical method. Multivariable Cox regression analyses assessed the effect of different surgical methods on survival rates. Result : Among the 10319 UTUC patients. Kaplan-Meier plots showed that NSS was associated with a higher overall survival (OS) and cancer-specific survival (CSS) in grade Ⅲ and Ⅳ and AJCC stage Ⅳ patients (all p <0.05). In multivariable Cox regression analyses, NSS was prone to a higher OS or CSS in grade Ⅲ ( p > 0.05). Moreover, NSS predisposed to a higher OS only in AJCC stage Ⅳ ( p <0.05). Conclusion : The beneficial effect of NSS was evident in grade Ⅲ or AJCC stage Ⅳ. NSS can be considered in grade Ⅲ or stage Ⅳ, for other grades or stages remains to be seen, both of which will be verified by further prospective research.

scholarly journals Impact of Surgical Wait Time on Survival in Patients With Upper Urinary Tract Urothelial Carcinoma With Hydronephrosis

2021 ◽  
Vol 11 ◽  
Author(s):  
Fangzheng Zhao ◽  
Nienie Qi ◽  
Chu Zhang ◽  
Ning Xue ◽  
Shuaishuai Li ◽  
...  
Keyword(s):  
Lymph Node ◽  
Urothelial Carcinoma ◽  
Cox Regression ◽  
Radical Surgery ◽  
Wait Time ◽  
Upper Urinary Tract ◽  
Wait Times ◽  
Cox Regression Analysis ◽  
Urinary Tract Urothelial Carcinoma ◽  
Surgical Wait Time

Background and ObjectivesDue 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.Methods316 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 (&lt;31 days), intermediate-wait (31-90 days) and long-wait (&gt;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 (&gt;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.ResultsA 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 (&gt; 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.ConclusionFor 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.

scholarly journals Native Kidney Hydronephrosis Is Associated with Upper Urinary Tract Urothelial Carcinoma in Post-Kidney Transplantation Patients

2021 ◽  
Vol 10 (19) ◽  
pp. 4474
Author(s):  
Cheng-Ju Ho ◽  
Yu-Hui Huang ◽  
Tzuo-Yi Hsieh ◽  
Min-Hsin Yang ◽  
Shao-Chuan Wang ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Kidney Transplantation ◽  
Urinary Tract ◽  
Urothelial Carcinoma ◽  
Female Gender ◽  
Upper Urinary Tract ◽  
Native Kidney ◽  
Kaplan Meier ◽  
Bilateral Lesions ◽  
Urinary Tract Urothelial Carcinoma

Background: Upper urinary tract urothelial carcinoma (UTUC) is the most common malignancy occurring after kidney transplantation (KT) in Taiwan. The aim of this study was to investigate the association between native kidney hydronephrosis and UTUC in post-KT patients. Methods: From 2003 to 2018, we conducted a retrospective cohort study that enrolled 1005 post-KT patients, 67 of whom were subsequently diagnosed with UTUC. We divided patients into two groups based on whether or not they had UTUC. Multivariate analysis and Kaplan-Meier plot were used to evaluate if native kidney hydronephrosis was associated with post-KT UTUC. Results: The total cohort consisted of 612 men (60.9%) and 393 women (39.1%) with a mean age of 48.2 ± 12.0 at KT. The mean follow-up time was 118.6 ± 70.2 months, and mean time from KT to UTUC was 7.53 years. There was a significant gender difference with a female predominance among the UTUC patients (73.1% versus 26.9%, p < 0.001). Native kidney hydronephrosis occurred more frequently in the UTUC group (68.7% versus 4.8%, p < 0.001). Multivariate analysis showed that native kidney hydronephrosis and female gender were significantly associated with UTUC with odds ratios of 35.32 (95% CI, 17.99–69.36; p < 0.001) and 3.37 (95% CI, 1.55–7.29; p = 0.002), respectively. UTUC in the post-KT patients also showed aggressive pathological characteristics and a tendency toward bilateral lesions (41.8%). Conclusions: Native kidney hydronephrosis is significantly associated with post-KT UTUC patients in Taiwan. Native kidney hydronephrosis may be a deciding factor for standard nephroureterectomy and bladder cuff excision in selected patients. Nevertheless, almost half of the patients with kidney hydronephrosis do not present with UTUC at the end of our study.

scholarly journals Effect of lymph node dissection on stage-specific survival in patients with upper urinary tract urothelial carcinoma treated with nephroureterectomy

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ting-Shuai Zhai ◽  
Liang Jin ◽  
Zhen Zhou ◽  
Xiang Liu ◽  
Huan Liu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Urinary Tract ◽  
Lymph Nodes ◽  
Urothelial Carcinoma ◽  
Cox Regression ◽  
Upper Urinary Tract ◽  
Regression Analyses ◽  
Node Dissection ◽  
Regional Lymph Nodes ◽  
Urinary Tract Urothelial Carcinoma

Abstract Background We aimed to estimate the stage-specific impact of lymph node dissection (LND) on survival for upper urinary tract urothelial carcinoma (UTUC) patients treated with nephroureterectomy (NU). Methods Overall, 7278 UTUC patients undergoing NU within the SEER database from 2004 to 2015 were identified. Kaplan-Meier plots illustrated overall survival (OS) and cancer-specific survival (CSS) rates according to LND status. Multivariable Cox regression analyses assessed the effect of LND on OS and CSS rates stratified by pathological tumor stage. Results LND was performed in 26.9% of patients, and in 18.6, 23.3, 31.2 and 45.9% for pT1, pT2, pT3 and pT4 patients, respectively (P <  0.001). In multivariable Cox regression analyses, LND was associated with a higher OS or CSS in UTUC patients with pT3 and pT4 disease (all P <  0.05), but failed to achieve independent predictor status in patients with pT1 and pT2 disease (all P > 0.05). LND with 1 to 3 regional lymph nodes removed was prone to a higher OS or CSS only in pT4 compared to no LND (both P <  0.01). LND with 4 or more regional lymph nodes removed predisposed to a higher OS or CSS in pT3 or pT4 (all P <  0.05). Conclusions The beneficial effect of LND especially LND with 4 or more regional lymph nodes removed on survival was evident in pT3/4 patients. LND can be considered for pT3 and pT4, for pT1/2 remains to be seen, both of which will be verified by further prospective studies.

scholarly journals Effect of lymph node dissection on stage-specific survival in patients with upper urinary tract urothelial carcinoma treated with nephroureterectomy

2019 ◽  
Author(s):  
Ting-Shuai Zhai ◽  
Liang Jin ◽  
Zhen Zhou ◽  
Xiang Liu ◽  
Huan Liu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Urinary Tract ◽  
Lymph Nodes ◽  
Urothelial Carcinoma ◽  
Cox Regression ◽  
Upper Urinary Tract ◽  
Regression Analyses ◽  
Node Dissection ◽  
Regional Lymph Nodes ◽  
Urinary Tract Urothelial Carcinoma

Abstract Objectives To estimate the stage-specific impact of lymph node dissection (LND) on survival for upper urinary tract urothelial carcinoma (UTUC) patients treated with nephroureterectomy (NU). Methods Overall, 7278 UTUC patients undergoing NU within the SEER database from 2004 to 2015 were identified. Kaplan-Meier plots illustrated overall survival (OS) and cancer-specific survival (CSS) rates according to LND status. Multivariable Cox regression analyses assessed the effect of LND on OS and CSS rates stratified by pathological tumor stage. Results LND was performed in 26.9% of patients, and in 18.6, 23.3, 31.2 and 45.9% for pT1, pT2, pT3 and pT4 patients, respectively (P < 0.001). In multivariable Cox regression analyses, LND was associated with a higher OS or CSS in UTUC patients with pT3 and pT4 disease (all P < 0.05), but failed to achieve independent predictor status in patients with pT1 and pT2 disease (all P > 0.05). LND with 1 to 3 regional lymph nodes removed was prone to a higher OS or CSS only in pT4 compared to no LND (both P < 0.01). LND with 4 or more regional lymph nodes removed predisposed to a higher OS or CSS in pT3 or pT4 (all P < 0.05). Conclusion The beneficial effect of LND especially LND with 4 or more regional lymph nodes removed on survival was evident in pT3/4 patients. LND can be considered for pT3 and pT4, for pT1/2 remains to be seen, both of which will be verified by further prospective studies.

scholarly journals Effect of lymph node dissection on stage-specific survival in patients with upper urinary tract urothelial carcinoma treated with nephroureterectomy

2019 ◽  
Author(s):  
Ting-Shuai Zhai ◽  
Liang Jin ◽  
Zhen Zhou ◽  
Xiang Liu ◽  
Huan Liu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Urinary Tract ◽  
Lymph Nodes ◽  
Urothelial Carcinoma ◽  
Cox Regression ◽  
Upper Urinary Tract ◽  
Regression Analyses ◽  
Node Dissection ◽  
Regional Lymph Nodes ◽  
Urinary Tract Urothelial Carcinoma

Abstract Objectives To estimate the stage-specific impact of lymph node dissection (LND) on survival for upper urinary tract urothelial carcinoma (UTUC) patients treated with nephroureterectomy (NU). Methods Overall, 7278 UTUC patients undergoing NU within the SEER database from 2004 to 2015 were identified. Kaplan-Meier plots illustrated overall survival (OS) and cancer-specific survival (CSS) rates according to LND status. Multivariable Cox regression analyses assessed the effect of LND on OS and CSS rates stratified by pathological tumor stage. Results LND was performed in 26.9% of patients, and in 18.6, 23.3, 31.2 and 45.9% for pT1, pT2, pT3 and pT4 patients, respectively (P < 0.001). In multivariable Cox regression analyses, LND was associated with a higher OS or CSS in UTUC patients with pT3 and pT4 disease (all P < 0.05), but failed to achieve independent predictor status in patients with pT1 and pT2 disease (all P > 0.05). LND with 1 to 3 regional lymph nodes removed was prone to a higher OS or CSS only in pT4 compared to no LND (both P < 0.01). LND with 4 or more regional lymph nodes removed predisposed to a higher OS or CSS in pT3 or pT4 (all P < 0.05). Conclusion The beneficial effect of LND especially LND with 4 or more regional lymph nodes removed on survival was evident in pT3/4 patients. LND can be considered for pT3 and pT4, for pT1/2 remains to be seen, both of which will be verified by further prospective studies.

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