scholarly journals Risk factor analysis of intravesical recurrence after retroperitoneoscopic nephroureterectomy for upper tract urothelial carcinoma

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masato Yanagi ◽  
Tsutomu Hamasaki ◽  
Jun Akatsuka ◽  
Yuki Endo ◽  
Hayato Takeda ◽  
...  
Keyword(s):  
Risk Factor ◽  
Urothelial Carcinoma ◽  
Urine Cytology ◽  
Upper Tract Urothelial Carcinoma ◽  
Fisher Exact Test ◽  
Related Factors ◽  
Exact Test ◽  
Upper Tract ◽  
Positive Urine

Abstract Background One of the major concerns of patients with upper tract urothelial carcinoma (UTUC) treated with nephroureterectomy is intravesical recurrence (IVR). The purpose of the present study was to investigate the predictive risk factors for IVR after retroperitoneoscopic nephroureterectomy (RNU) for UTUC. Methods Clinicopathological and surgical information were collected from the medical records of 73 patients treated with RNU for non-metastatic UTUC, without a history of or concomitant bladder cancer. The association between IVR after RNU and clinicopathological and surgery-related factors, including preoperative urine cytology and pneumoretroperitoneum time, was analyzed using the Fisher exact test. Results During the median follow-up time of 39.1 months, 18 (24.7%) patients had subsequent IVR after RNU. The 1- and 3-year IVR-free survival rates were 85.9% and 76.5%, respectively. The Fisher exact test revealed that prolonged pneumoretroperitoneum time of ≥ 210 min was a risk factor for IVR in 1 year after RNU (p = 0.0358) and positive urine cytology was a risk factor for IVR in 3 years after RNU (p = 0.0352). Conclusions In UTUC, the occurrences of IVR in 1 and 3 years after RNU are highly probable when the pneumoretroperitoneum time is prolonged (≥ 210 min) and in patients with positive urine cytology, respectively. Strict follow-up after RNU is more probable recommended for these patients.

scholarly journals Risk stratification by means of biological age-related factors better predicts cancer-specific survival than chronological age in patients with upper tract urothelial carcinoma: a multi-institutional database study

2018 ◽  
Vol 10 (12) ◽  
pp. 403-410 ◽  
Author(s):  
Teruo Inamoto ◽  
Hideyasu Matsuyama ◽  
Naokazu Ibuki ◽  
Kazumasa Komura ◽  
Kiyohide Fujimoto ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Clinical Response ◽  
Treatment Options ◽  
Upper Tract Urothelial Carcinoma ◽  
Biological Age ◽  
Chronological Age ◽  
Related Factors ◽  
Cancer Specific Survival ◽  
Upper Tract ◽  
Age Related

Background: Chronological age is an important factor in determining the treatment options and clinical response of patients with upper tract urothelial carcinoma (UTUC). Much evidence suggests that chronological age alone is an inadequate indicator to predict the clinical response to radical nephroureterectomy (RNU). Patients and methods: We retrospectively reviewed the data from 1510 patients with UTUC (Ta-4) treated by surgery. White blood cell (WBC) count, neutrophil-to-lymphocyte ratio, hemoglobin (Hb), platelets, albumin, alkaline phosphatase, lactate dehydrogenase, creatinine, and corrected calcium were tested by the Spearman correlation to indicate the direction of association with chronological age, which yielded significant, negative associations of Hb ( p < 0.001) and WBC ( p = 0.010) with chronological age. For scoring, we assigned points for these categories as follows; point ‘0’ for Hb >14 (reference) and 13–13.9 [odds ratio (OR): 1.533], point ‘1’ for 12–12.9 (OR: 2.391), point ‘2’ for 11–11.9 (OR: 3.015), and point ‘3’ for <11 (OR: 3.584). For WBC, point ‘1’ was assigned for >9200 (OR: 2.541) and ‘0’ was assigned for the rest; 9200–8500 (reference), 8499–6000 (OR: 0.873), 5999–4500 (OR: 0.772), 4499–3200 (OR: 0.486), and <3200 (OR: 1.277). Results: The 10-year cancer-specific survival (CSS) in the higher risk group with scores of 4 or higher in patients age <60 years was worse than a score of 0, or 1 in age >80 years [mean estimated survival 69.7 months, confidence interval (CI): 33.3–106 versus 103.5. CI: 91–115.9]. The concordance index between biological age scoring and chronological age was 0.704 for CSS and 0.798 for recurrence-free survival. The limitation of the present study is the retrospective nature of the cohort included. Conclusions: The biological age scoring developed for patients with UTUC undergoing RNU. It was applicable to those with localized disease and performed well in diverse age populations.

scholarly journals Preoperative positive voided urine cytology predicts poor clinical outcomes in patients with upper tract urothelial carcinoma undergoing nephroureterectomy

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Wen Liu ◽  
Zhankun Wang ◽  
Shuai Liu ◽  
Yu Yao ◽  
Yong Liu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Urothelial Carcinoma ◽  
Logistic Regression Analysis ◽  
Tumor Grade ◽  
Urine Cytology ◽  
Upper Tract Urothelial Carcinoma ◽  
Urinary Cytology ◽  
Upper Tract ◽  
The Impact

Abstract Background Performance of urinary cytology is recommended as the part of a standard diagnostic workup and base surveillance regimens in upper tract urothelial carcinoma (UTUC). However, the effect of positive voided urine cytology (VUC) on UTUC prognosis, compared with negative VUC, has not been fully demonstrated. This study aimed to evaluate the impact of preoperative VUC on predicting intravesical recurrence, disease recurrence, and mortality in patients with UTUC who underwent nephroureterectomy (RNU). Methods Clinicopathological information was collected from 315 UTUC patients treated with RNU. The association between VUC and oncological outcomes was analyzed using the Kaplan–Meier method with log-rank test and Cox proportional hazards regression models. Multiple logistic regression analysis was performed to identify the influence of VUC on tumor grade. Results Preoperative positive VUC, presenting in 101 patients (32%), was significantly associated with tumor multifocality (P = 0.017) and higher tumor grade (P = 0.010). On multivariable Cox regression analyses, preoperative positive VUC was an independent prognostic factor of intravesical recurrence-free survival (RFS) (hazard ratio [HR] = 2.21, 95% confidence interval [CI] 1.06–4.64; P = 0.035), RFS (HR = 1.80, 95% CI 1.08–2.99; P = 0.023), and cancer-specific survival (CSS) (HR = 1.87, 95% CI 1.10–3.18; P = 0.020), but not overall survival (HR = 1.32, 95% CI 0.80–2.18; P = 0.28). Logistic regression analysis revealed that VUC was related to high tumor grade in UTUC (odds ratio = 2.23, 95%CI 1.15–4.52). Conclusion Preoperative positive VUC significantly increases the risk of intravesical recurrence in UTUC patients undergoing RNU. In addition, positive VUC is an adverse predictor of RFS and CSS, which might be due to the association between positive VUC and high tumor grade.

UP-2.101: Endoscopic Management for Upper Tract Urothelial Carcinoma: Long-Term Follow-Up in a Single Center

Urology ◽  
2009 ◽  
Vol 74 (4) ◽  
pp. S262
Author(s):  
S. Uehara ◽  
T. Watanabe ◽  
T. Saika ◽  
M. Araki ◽  
K. Monden ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Upper Tract Urothelial Carcinoma ◽  
Endoscopic Management ◽  
Single Center ◽  
Upper Tract ◽  
Long Term Follow Up

scholarly journals Preoperative positive voided urine cytology predicts poor clinical outcomes in patients with upper tract urothelial carcinoma undergoing nephroureterectomy

2020 ◽  
Author(s):  
Wen Liu ◽  
Zhankun Wang ◽  
Shuai Liu ◽  
Yu Yao ◽  
Yong Liu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Urothelial Carcinoma ◽  
Logistic Regression Analysis ◽  
Tumor Grade ◽  
Urine Cytology ◽  
Upper Tract Urothelial Carcinoma ◽  
Urinary Cytology ◽  
Upper Tract ◽  
The Impact

Abstract Background: Performance of urinary cytology is recommended as the part of a standard diagnostic workup and base surveillance regimens in upper tract urothelial carcinoma (UTUC). However, the effect of positive voided urine cytology (VUC) on UTUC prognosis, compared with negative VUC, has not been fully demonstrated. This study aimed to evaluate the impact of preoperative VUC on predicting intravesical recurrence, disease recurrence, and mortality in patients with UTUC who underwent nephroureterectomy (RNU).Methods: Clinicopathological information was collected from 315 UTUC patients treated with RNU. The association between VUC and oncological outcomes was analyzed using the Kaplan–Meier method with log-rank test and Cox proportional hazards regression models. Multiple logistic regression analysis was performed to identify the influence of VUC on tumor grade.Results: Preoperative positive VUC, presenting in 101 patients (32%), was significantly associated with tumor multifocality (P = 0.017) and higher tumor grade (P = 0.010). On multivariable Cox regression analyses, preoperative positive VUC was an independent prognostic factor of intravesical recurrence-free survival (RFS) (hazard ratio [HR] = 2.21, 95% confidence interval [CI] 1.06–4.64; P = 0.035), RFS (HR = 1.80, 95% CI 1.08–2.99; P = 0.023), and cancer-specific survival (CSS) (HR = 1.87, 95% CI 1.10–3.18; P = 0.020), but not overall survival (HR = 1.32, 95% CI 0.80–2.18; P = 0.28). Logistic regression analysis revealed that VUC was related to high tumor grade in UTUC (odds ratio = 2.23, 95%CI 1.15–4.52).Conclusion: Preoperative positive VUC significantly increases the risk of intravesical recurrence in UTUC patients undergoing RNU. In addition, positive VUC is an adverse predictor of RFS and CSS, which might be due to the association between positive VUC and high tumor grade.

scholarly journals Tumor Multifocality is a Significant Risk Factor of Urinary Bladder Recurrence after Nephroureterectomy in Patients with Upper Tract Urothelial Carcinoma: A Single-Institutional Study

Diagnostics ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 201 ◽  
Author(s):  
Chuan-Shu Chen ◽  
Jian-Ri Li ◽  
Shian-Shiang Wang ◽  
Cheng-Kuang Yang ◽  
Chen-Li Cheng ◽  
...  
Keyword(s):  
Risk Factor ◽  
Urinary Bladder ◽  
Urothelial Carcinoma ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Upper Tract Urothelial Carcinoma ◽  
Significant Prognostic Factor ◽  
Upper Tract ◽  
Tumor Multifocality ◽  
Bladder Recurrence

The purpose of this study was to identify the significant risk factors of urinary bladder recurrence (UBR) after nephroureterectomy (NUx) in patients with upper tract urothelial carcinoma (UTUC). A total of 550 patients diagnosed with UTUC between January 2001 and December 2015 were included in this retrospective study. The median age of our patients was 68 (range 24–93) and the median follow-up time after NUx was 40.3 months (range 8–191). The most important censored point of this study was the first episode of UBR. Of the 550 patients, UBR occurred in 164 patients (29.8%). One hundred and forty-two (86.6%) patients with UBR were identified within two years after NUx for UTUC, with the median time interval between NUx and UBR being 8.4 months (range 3–59.8). Through univariate analysis, the positive surgical margin (p = 0.049) and tumor multifocality (p = 0.024) were both significant prognostic factors for UBR-free survival after NUx in patients with UTUC. However, only tumor multifocality (p = 0.037) remained a significant prognostic factor by multivariate analysis. In conclusion, tumor multifocality is a significant risk factor of UBR after nephroureterectomy in patients with upper tract urothelial carcinoma.

Perioperative chemotherapy for upper tract urothelial carcinoma: A microsimulation Markov model.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 508-508
Author(s):  
Diana E. Magee ◽  
Amanda Elizabeth Hird ◽  
Douglas Cheung ◽  
Beate Sander ◽  
Robert Nam ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Treatment Strategies ◽  
Cancer Recurrence ◽  
Upper Tract Urothelial Carcinoma ◽  
Base Case ◽  
Recurrence Rates ◽  
Treatment Pathways ◽  
Upper Tract

508 Background: Upper tract urothelial carcinoma (UTUC) accounts for less than 5% of all urothelial cancers. As a result, this disease is clinically understudied and there are no definitive recommendations regarding use and timing of peri-operative chemotherapy. The objective of this study was to create a decision model comparing three treatment pathways in UTUC: nephroureterectomy (NU) alone, neoadjuvant chemotherapy (NAC), and adjuvant chemotherapy (AC). Methods: A Markov microsimulation model was constructed using TreeAge Pro to compare treatment strategies for patients with newly diagnosed UTUC. Our primary outcome was quality adjusted life expectancy (QALE). Secondary outcomes included rates of adverse chemotherapy events, bladder cancer diagnoses, and crude survival. Markov cycle length was 3 months to mimic the follow up interval used in clinical practice for patients with UTUC. A systematic literature review was used to generate probabilities to populate the model. The base case was a 70-year-old patient with a radiographically localized upper tract tumor. Patients could have evidence of nodal disease, but no distant metastasis. Results: A total of 100,000 microsimulations were generated. NAC was preferred with an estimated QALE of 7.52 years versus 6.80 years with NU alone and 7.20 years with AC. Overall, 39.6% of patients in the AC group with invasive pathology received and were able to complete chemotherapy. A total of 37.5% of patients in the NAC group experienced an adverse chemotherapy event compared to 15.1% of patients in the AC group. Bladder cancer recurrence rates were 64.9%, 66.0%, and 67.1% over the patient’s lifetime in the NU, NAC, and AC groups, respectively. Conclusions: This study provides evidence to support the increased use of NAC in UTUC until robust randomized trials can be completed. While the use of NAC in this population appears favourable, the ultimate choice rests with the clinician and should be based on patient and tumor factors.

scholarly journals Complete retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma without patient repositioning: a single-center experience

2020 ◽  
Vol 48 (11) ◽  
pp. 030006052097391
Author(s):  
Gang Wu ◽  
Tianqi Wang ◽  
Jipeng Wang ◽  
Hejia Yuan ◽  
Yuanshan Cui ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Operation Time ◽  
Upper Tract Urothelial Carcinoma ◽  
Upper Tract ◽  
Single Center Experience ◽  
Hospitalization Period ◽  
Median Operation Time ◽  
Laparoscopic Nephroureterectomy

Objective This study was performed to evaluate the outcome of complete retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision (RLNU-BCE), which is performed to treat urothelial carcinomas in the renal pelvis or in the ureter higher than the crossing of the common iliac artery without patient repositioning. Methods We retrospectively analyzed the clinical data of 48 patients with upper tract urothelial carcinoma who underwent complete RLNU-BCE in our institution from May 2017 to September 2019. Results RLNU-BCE was successfully performed in all 48 patients. The median operation time was 110 minutes [interquartile range (IQR), 100–130 minutes], and the median postoperative anesthesia recovery time was 10 minutes (IQR, 7–15 minutes). The median postoperative hospitalization period was 5 days (IQR, 4–6 days). Pathologic examination revealed that the margin of all resected specimens was negative. After a median follow-up of 13 months (IQR, 7–20 months), no local recurrence or distant metastasis was found. No complications occurred during follow-up. Conclusion Based on our experience with this technique, RLNU-BCE deserves application and promotion in clinical practice. Long-term comparative studies are required to confirm its superiority over other techniques.

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