scholarly journals Conditional Intravesical Recurrence-free Survival Rate after Radical Nephroureterectomy with Bladder Cuff Excision for Upper Urothelial Carcinoma

2020 ◽  
Author(s):  
Jae Hoon Chung ◽  
Wan Song ◽  
Minyong Kang ◽  
Hwang Gyun Jeon ◽  
Byong Chang Jeong ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Survival Rate ◽  
Urothelial Carcinoma ◽  
Multivariable Analysis ◽  
Survival Period ◽  
Radical Nephroureterectomy ◽  
Free Survival ◽  
Factors Affecting ◽  
Number Of Patients ◽  
History Of

Abstract To evaluate the incidence and risk factors of (intravesical recurrence) IVR by analyzing a relatively large number of patients who underwent radical nephroureterectomy with bladder cuff excision (RNUx) for upper urothelial carcinoma (UTUC). Additionally, conditional IVR-free survival in patients with UTUC who had no history of bladder cancer and no concomitant bladder cancer was evaluated. We retrospectively analyzed the data of 1,095 patients with UTUC who underwent RNUx. The baseline characteristics, bladder tumor history, and UTUC characteristics were analyzed to evaluate oncological outcomes. To determine the factors affecting IVR, surgical modality, use of preoperative ureteroscopic examination (URS), TNM stage, and pathological outcomes were evaluated. Multivariable Cox regression analyses were performed to evaluate factors affecting IVR, and conditional IVR-free survival rate was analyzed using Kaplan–Meier curves. Among the 1,095 patients, 462 patients developed IVR and mean time of IVR was 13.08 ± 0.84 months after RNUx. A total of 30.74% of the IVR group and 15.32% of the without IVR group had a past history of bladder cancer (p < 0.001). In the multivariable analysis, a previous history of bladder cancer, multifocal tumors, the use of preoperative URS, the extravesical bladder cuffing method, lymph node involvement, positive surgical margins, and the use of adjuvant chemotherapy were determined to affect the IVR. The conditional IVRF rate at 12 months after RNUx was 74.0%, for those who IVRF for 12 months, the IVRF rate was 87.1% for the next 12 months (24 months after RNUx), and for the patients who IVRF for 24 months, the IVRF rate was 93.6% for the next 12 months (36 months after RNUx) and the IVRF rate was 97.3% for the next 12 months in IVRF of 60 months patients. The mean IVRF survival period of all patients was 136.84 months, 156.24 months in the patients with 6 months IVRF, 175.38 months for the patients with 12 months IVRF, 189.14 months for the patients with 36 months IVRF, and mean IVRF survival period was 178.21 months in 60 months IVRF patients. In 24 months IVRF patients after RNUx, only URS was evaluated to independently affect IVR (HR 1.945, p = 0.040). In patients with 36 months or more IVRF, there was no significant factor affecting IVR. Active IVR assessment is required until 36 months after RNUx. In addition, patient education and regular screening test such as urine analysis and cytology are required for patients who had IVRF for 36 months or longer.

scholarly journals Conditional Intravesical Recurrence-Free Survival Rate After Radical Nephroureterectomy With Bladder Cuff Excision for Upper Tract Urothelial Carcinoma

2021 ◽  
Vol 11 ◽  
Author(s):  
Jae Hoon Chung ◽  
Wan Song ◽  
Minyong Kang ◽  
Hwang Gyun Jeon ◽  
Byong Chang Jeong ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Survival Rate ◽  
Urothelial Carcinoma ◽  
Upper Tract Urothelial Carcinoma ◽  
Screening Tests ◽  
Radical Nephroureterectomy ◽  
Factors Affecting ◽  
Upper Tract ◽  
Number Of Patients ◽  
History Of

BackgroundTo evaluate the conditional intravesical recurrence (IVR)–free (IVRF) survival rate in patients with upper tract urothelial carcinoma (UTUC) who had no history of bladder cancer and no concomitant bladder cancer. Hence, we aimed to analyze a relatively large number of patients with UTUC who underwent radical nephroureterectomy with bladder cuff excision (RNUx).MethodsWe retrospectively analyzed the data of 1,095 patients with UTUC who underwent RNUx. Their baseline characteristics, bladder tumor history, and UTUC features were analyzed to evaluate oncological outcomes. To determine the factors affecting IVR, surgical modality, use of preoperative ureteroscopy, TNM stage, and pathological outcomes were evaluated. Multivariable Cox regression analyses were performed to evaluate the factors affecting IVR. Conditional IVRF survival rate was analyzed using Kaplan–Meier curves.ResultsAmong the 1,095 patients, 462 patients developed IVR, and the mean time to the development of IVR was 13.08 ± 0.84 months after RNUx. A total of 30.74% of patients with IVR and 15.32% of those without IVR had a history of bladder cancer (p &lt; 0.001). Multivariable analysis showed that a history of bladder cancer, multifocal tumors, use of preoperative ureteroscopy, extravesical bladder cuffing method, lymph node involvement, positive surgical margins, and use of adjuvant chemotherapy were determined to be risk factors for IVR. The conditional IVRF rate was 74.0% at 12 months after RNUx, 87.1% at 24 months after RNUx, 93.6% at 36 months after RNUx, and 97.3% at 60 months after RNUx. The median IVRF survival period was 133.00 months for all patients. In patients with IVRF at 24 months after RNUx, only ureteroscopy was an independent risk factor for IVR [hazard ratio (HR) 1.945, p = 0.040]. In patients with IVRF at ≥36 months, there was no significant factor affecting IVR.ConclusionsActive IVR assessment is required until 36 months after RNUx. In addition, patient education and regular screening tests, such as urine analysis and cytology, are required for patients with IVRF for ≥36 months.

scholarly journals A retrospective multicenter comparison of conditional cancer-specific survival between laparoscopic and open radical nephroureterectomy in locally advanced upper tract urothelial carcinoma

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0255965
Author(s):  
Sung Han Kim ◽  
Mi Kyung Song ◽  
Ja Hyeon Ku ◽  
Seok Ho Kang ◽  
Byong Chang Jeong ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Urinary Tract ◽  
Propensity Score ◽  
Urothelial Carcinoma ◽  
Locally Advanced ◽  
Radical Nephroureterectomy ◽  
Cancer Specific Survival ◽  
History Of ◽  
Urinary Tract Urothelial Carcinoma

Background Upper urinary tract urothelial carcinomas are relatively rare and have a cancer-specific survival rate of 20%–30%. The current gold standard treatment for nonmetastatic high-grade urinary tract urothelial carcinoma is radical nephroureterectomy with bladder cuff resection. Objective This study aimed to compare conditional cancer-specific survival between open radical nephroureterectomy and laparoscopic radical nephroureterectomy in patients with nonmetastatic stage pT3-4 or TxN(+) locally advanced urinary tract urothelial carcinoma from five tertiary centers. Methods The medical records of 723 patients were retrospectively reviewed. The patients had locally advanced and nodal staged tumors and had undergone open radical nephroureterectomy (n = 388) or laparoscopic radical nephroureterectomy (n = 260) at five tertiary Korean institutions from January 2000 and December 2012. To control for heterogenic baseline differences between the two modalities, propensity score matching and subgroup analysis were conducted. Conditional survival analysis was also conducted to determine survival outcome and to overcome differences in follow-up duration between the groups. Results During the median 50.8-month follow up, 255 deaths occurred. In univariate analysis, significant factors affecting cancer-specific survival (e.g., age, history of bladder cancer, American Society of Anesthesiologists score, pathological N stage, and presence of lymphovascular invasion and carcinoma in situ) differed in each subsequent year. The cancer-specific survival between patients treated with open radical nephroureterectomy and laparoscopic radical nephroureterectomy was not different between patients with and without a history of bladder cancer. After adjusting baseline differences between the two groups by using propensity score matching, both groups still had no significant differences in cancer-specific survival. Conclusion The two surgical modalities showed no significant differences in the 5-year cancer-specific survival in patients with locally advanced urinary tract urothelial carcinoma.

scholarly journals Comparison of oncologic and functional outcomes between radical nephroureterectomy and segmental ureterectomy for upper urinary tract urothelial carcinoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tae Heon Kim ◽  
Chung Un Lee ◽  
Minyong Kang ◽  
Hwang Gyun Jeon ◽  
Byong Chang Jeong ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urothelial Carcinoma ◽  
Functional Outcomes ◽  
Upper Urinary Tract ◽  
Rank Test ◽  
Radical Nephroureterectomy ◽  
Free Survival ◽  
Significant Difference ◽  
Segmental Ureterectomy ◽  
Urinary Tract Urothelial Carcinoma

AbstractThis study aims to compare oncologic and functional outcomes after radical nephroureterectomy (RNU) and segmental ureterectomy (SU) in patients with upper urinary tract urothelial carcinoma (UTUC). We retrospectively collected data on patients who underwent either RNU or SU of UTUC. Propensity score matching was performed among 394 cases to yield a final cohort of 40 RNU and 40 SU cases. Kaplan–Meier analysis and the log-rank test were used to compare overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), and intravesical recurrence-free survival (IVRFS) between the groups. We also compared the change in postoperative estimated glomerular filtration rate (eGFR). There was no significant difference in terms of CSS, PFS, and IVRFS between the RNU and SU groups, but the RNU group had a better OS than the SU group (p = 0.032). Postoperative eGFR was better preserved in the SU group than in the RNU group (p < 0.001). SU provides comparable CSS, PFS, and IVRFS for patients with UTUC compared to RNU, even in patients with advanced-stage and/or high-grade cancer. Further, SU achieves better preservation of renal function.

scholarly journals Prognostic value of ALDH1 and Nestin in advanced cancer: a systematic meta-analysis with trial sequential analysis

2019 ◽  
Vol 11 ◽  
pp. 175883591983083 ◽  
Author(s):  
Susu Han ◽  
Tao Huang ◽  
Xing Wu ◽  
Xiyu Wang ◽  
Wen Li ◽  
...  
Keyword(s):  
Survival Rate ◽  
Advanced Cancer ◽  
Subgroup Analysis ◽  
Sequential Analysis ◽  
Multivariable Analysis ◽  
Chinese Patients ◽  
Trial Sequential Analysis ◽  
Tumor Type ◽  
Term Survival ◽  
Free Survival

Background: Novel prognostic markers and therapeutic targets for advanced cancer are urgently needed. This report with trial sequential analysis (TSA) was first conducted to provide robust estimates of the correlation between aldehyde dehydrogenase 1 (ALDH1) and Nestin and clinical outcomes of advanced cancer patients. Methods: Hazard ratios (HRs) with 95% confidence intervals (CIs) were summarized for overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), cancer-specific survival (CSS), relapse/recurrence-free survival (RFS), and metastasis-free survival (MFS) from multivariable analysis. TSA was performed to control for random errors. Results: A total of 20 studies with 2050 patients (ALDH1: 15 studies with 1557 patients and Nestin: 5 studies with 493 patients) were identified. ALDH1 (HR = 2.28, p < 0.001) and Nestin (HR = 2.39, p < 0.001) were associated with a worse OS, as confirmed by TSA. Nestin positivity was linked to a poor PFS (HR = 2.08, p < 0.001), but ALDH1 was not linked to DFS, RFS, MFS, or PFS, and TSA showed that more studies were needed. Subgroup analysis by tumor type indicated that ALDH1 positivity may be associated with shorter OS in breast, head and neck cancers, but there was no association with colorectal cancer. Subgroup analysis by study source showed that ALDH1 positivity was correlated with a worse OS for Japanese (HR = 1.94, p = 0.002) and European patients (HR = 4.15, p < 0.001), but there was no association for Chinese patients. Subgroup analysis by survival rate showed that ALDH1 positivity correlated with poor OS at ⩾ 5 years (HR = 2.33, p < 0.001) or 10 years (HR = 1.76, p = 0.038). Conclusions: ALDH1 may be more valuable as an effective therapeutic target than Nestin for improving the long-term survival rate of advanced cancer. Additional prospective clinical trials are needed across different cancer types.

scholarly journals Risk factors and survival outcomes of metachronous contralateral upper tract urothelial carcinoma

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Kan Wu ◽  
Jiayu Liang ◽  
Yiping Lu
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
Regression Model ◽  
Urothelial Carcinoma ◽  
Large Population ◽  
Multivariable Analysis ◽  
Population Based ◽  
Upper Tract Urothelial Carcinoma ◽  
Competing Risk ◽  
Upper Tract

Abstract Because population-based risk estimates for metachronous contralateral UTUC are lacking. In this study, we aimed to evaluate the risk and survival of metachronous contralateral upper tract urothelial carcinoma (UTUC) on a large population-based level. A total of 23,075 patients were identified from the Surveillance, Epidemiology, and End Results database (1973–2015), 144 (0.6%) patients developed metachronous contralateral UTUC (median of 32 months after diagnosis). The cumulative incidence at 10, 20, and 30 years of follow-up was 1.1%, 1.6%, and 2.6%, respectively. We applied Fine and Gray’s competing risk regression model to determine the risk factors of a new contralateral, metachronous UTUC. The competing risk regression model demonstrated that older age (hazard ratio [HR] 0.75; 95% CI 0.67–0.85) and larger tumor size (HR 0.61; 95% CI 0.39–0.97) were associated with a significantly decreased risk of metachronous contralateral UTUC. However, bladder cancer presence was an independent risk factor for the development of contralateral tumors (HR 2.42; 95% CI 1.73–3.37). In addition, we demonstrated developing contralateral UTUC was not associated with poor prognosis by using Kaplan–Meier and multivariable analysis. Our findings suggest that metachronous contralateral UTUC is comparatively rare, and has not impact on survival. Importantly, patients with younger age, small tumours, and the presence of bladder cancer were more likely to develop a contralateral tumor, which may provide a rationale for lifelong surveillance in high-risk patients.

scholarly journals Natural history of pT3-4 or node positive bladder cancer treated with radical cystectomy and no neoadjuvant chemotherapy in a contemporary North-American multi-institutional cohort

2012 ◽  
Vol 6 (6) ◽  
pp. 217 ◽  
Author(s):  
Nicholas E. Power ◽  
Wassim Kassouf ◽  
David Bell ◽  
Armen Aprikian ◽  
Yves Fradet ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Natural History ◽  
Radical Cystectomy ◽  
Node Positive ◽  
Number Of Patients ◽  
History Of ◽  
Modern Era

Background: The present study documents the natural history and outcomes of high-risk bladder cancer after radical cystectomy (RC) in patients who did not receive neoadjuvant chemotherapy during a contemporary time period.Methods: We analyzed 1180 patients from 1993 to 2008 with >pT3N0 or pT0-4N+ bladder cancer who underwent RC ± standard (sLND) or extended (eLND) lymph node dissection from 8 Canadian centres.Results: Of the 1180 patients, 55% (n = 643) underwent sLND, 34% (n = 402) underwent ePLND and 11% did not undergo a formal LND. Of the total number of patients, 321 (27%) received adjuvant chemotherapy. The median follow-up was 2.1 years (range: 0.6 to 12.9). Overall 30-day mortality was 3.2%. Clinical and pathological stages T3-4 were present in 6.1% and 86.7% of the patients, respectively; this demonstrates a dramatic understaging. Overall survival (OS) at 2 and 5 years was 60% and 43%, respectively. Patients who received adjuvant chemotherapy hada 2- and 5-year disease-specific survival (DSS) of 72% and 57% versus 64% and 51% for those who did not (log-rank p = 0.0039). The 2- and 5-year OS for high-risk node-negative disease was 67%and 52%, respectively, whereas for node-positive patients, the OS was 52% and 32%, respectively (p < 0.001). The OS, DSS and RFS for patients with pN0 were significantly improved compared to those who did not undergo a LND (log-rank p = 0.0035, 0.0241 and 0.0383, respectively).Interpretation: This series suggests that bladder cancer outcomes inadvanced disease have improved in the modern era. The need for improved staging investigations, use of neoadjuvant chemotherapyand performance of complete LND is emphasized.

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