The Impact of Sex Differences on Renal Function Outcomes After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Retrospective Study

2021 ◽  
Author(s):  
Tsu-Ming Chien ◽  
Ching-Chia Li ◽  
Yen-Man Lu ◽  
Hsueh-Wei Chang ◽  
Yii-Her Chou ◽  
...  
Keyword(s):  
Renal Function ◽  
Sex Differences ◽  
Urothelial Carcinoma ◽  
Upper Tract Urothelial Carcinoma ◽  
Clinicopathological Parameters ◽  
Radical Nephroureterectomy ◽  
Upper Tract ◽  
Female Patients ◽  
Kaplan Meier ◽  
The Impact

Abstract Background: Upper tract urothelial carcinoma (UTUC) is a relatively rare type of urothelial carcinoma. Additionally, only few reports have examined the sex differences in patients with UTUC. Therefore, the present study aimed to identify the sex factors affecting renal function in patients with UTUC.Methods: Patients who underwent radical nephroureterectomy for non-metastatic UTUC between 2000 and 2013 were retrospectively reviewed and divided into two groups by sex. The Kaplan–Meier method was applied to evaluate the effects of sex on survival, whereas for the other clinicopathological parameters, hazard ratios were evaluated using the Cox regression model. The analyses were also performed in patients with different chronic kidney disease (CKD) stages.Results: A total of 368 patients were included, 147 men and 221 women. Female patients had a higher rate of anemia, advanced CKD stage, and dialysis. Male patients predominantly had a higher rate of smoking. The Kaplan–Meier analysis revealed no differences between sexes on metastasis-free survival (MFS) and cancer-specific survival. Multivariate analysis confirmed that ureteral tumors, advanced pathological tumor stage, and adjuvant chemotherapy indicated significantly worse survival outcomes in both sexes. However, only female patients with advanced CKD showed poorer MFS. After adjusting for renal function, the analysis found men had worse MFS.Conclusions: The female sex is significantly associated with a higher prevalence of advanced CKD among patients with UTUC in Taiwan. The impact of sex differences on renal function needs to be considered when evaluating survival.

Developing a nomogram for predicting intravesical recurrence after radical nephroureterectomy: a retrospective cohort study of mainland Chinese patients

2021 ◽  
Author(s):  
Shicong Lai ◽  
Xingbo Long ◽  
Pengjie Wu ◽  
Jianyong Liu ◽  
Samuel Seery ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Cox Regression ◽  
Upper Tract Urothelial Carcinoma ◽  
Chinese Patients ◽  
Clinicopathological Parameters ◽  
Radical Nephroureterectomy ◽  
Ki 67 ◽  
Data Set ◽  
Mainland Chinese ◽  
Upper Tract

Abstract Objective To evaluate the role of Ki-67 in predicting subsequent intravesical recurrence following radical nephroureterectomy and to develop a predictive nomogram for upper tract urothelial carcinoma patients. Methods This retrospective analysis involved 489 upper tract urothelial carcinoma patients who underwent radical nephroureterectomy with bladder cuff excision. The data set was randomly split into a training cohort of 293 patients and a validation cohort of 196 patients. Immunohistochemical analysis was used to assess the immunoreactivity of the biomarker Ki-67 in the tumor tissues. A multivariable Cox regression model was utilized to identify independent intravesical recurrence predictors after radical nephroureterectomy before constructing a nomographic model. Predictive accuracy was quantified using time-dependent receiver operating characteristic curve. Decision curve analysis was performed to evaluate the clinical benefit of models. Results With a median follow-up of 54 months, intravesical recurrence developed in 28.2% of this sample (n = 137). Tumor location, multifocality, pathological T stage, surgical approach, bladder cancer history and Ki-67 expression levels were independently associated with intravesical recurrence (all P < 0.05). The full model, which intercalated Ki-67 with traditional clinicopathological parameters, outperformed both the basic model and Xylinas’ model in terms of discriminative capacity (all P < 0.05). Decision-making analysis suggests that the more comprehensive model can also improve patients’ net benefit. Conclusions This new model, which intercalates the Ki-67 biomarker with traditional clinicopathological factors, appears to be more sensitive than nomograms previously tested across mainland Chinese populations. The findings suggest that Ki-67 could be useful for determining risk-stratified surveillance protocols following radical nephroureterectomy and in generating an individualized strategy based around intravesical recurrence predictions.

Preoperative predictors of renal function decline after radical nephroureterectomy for upper tract urothelial carcinoma

2014 ◽  
Vol 114 (5) ◽  
pp. 674-679 ◽  
Author(s):  
Matthew Kaag ◽  
Landon Trost ◽  
R. Houston Thompson ◽  
Ricardo Favaretto ◽  
Vanessa Elliott ◽  
...  
Keyword(s):  
Renal Function ◽  
Urothelial Carcinoma ◽  
Upper Tract Urothelial Carcinoma ◽  
Radical Nephroureterectomy ◽  
Renal Function Decline ◽  
Upper Tract ◽  
Preoperative Predictors

The Impact of Hospital Volume on Short-term and Long-term Outcomes for Patients Undergoing Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

Urology ◽  
2021 ◽  
Vol 147 ◽  
pp. 135-142
Author(s):  
Wilson Sui ◽  
Christopher J.D. Wallis ◽  
Amy N. Luckenbaugh ◽  
Daniel A. Barocas ◽  
Sam S. Chang ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Hospital Volume ◽  
Upper Tract Urothelial Carcinoma ◽  
Radical Nephroureterectomy ◽  
Long Term Outcomes ◽  
Short Term ◽  
Upper Tract ◽  
The Impact

scholarly journals Renal Function and Oncologic Outcomes of Parenchymal Sparing Ureteral Resection Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

2012 ◽  
Vol 187 (2) ◽  
pp. 429-434 ◽  
Author(s):  
Jonathan L. Silberstein ◽  
Nicholas E. Power ◽  
Caroline Savage ◽  
Tatum V. Tarin ◽  
Ricardo L. Favaretto ◽  
...  
Keyword(s):  
Renal Function ◽  
Urothelial Carcinoma ◽  
Upper Tract Urothelial Carcinoma ◽  
Oncologic Outcomes ◽  
Radical Nephroureterectomy ◽  
Upper Tract

scholarly journals Tumor distribution affects bladder recurrence but not survival outcome of multifocal upper tract urothelial carcinoma treated with radical nephroureterectomy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Zai-Lin Sheu ◽  
Chi-Ping Huang ◽  
Chao-Hsiang Chang ◽  
Chung-Hsin Chen ◽  
Jian-Hua Hong ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urothelial Carcinoma ◽  
Upper Tract Urothelial Carcinoma ◽  
Radical Nephroureterectomy ◽  
Free Survival ◽  
Upper Tract ◽  
Pelvic Tumors ◽  
Tumor Distribution ◽  
The Impact ◽  
Bladder Recurrence

AbstractTumor multifocality and location are prognostic factors for upper tract urothelial carcinoma (UTUC). However, confounding effects can appear when these two factors are analyzed together. Therefore, we aimed to investigate the impact of tumor distribution on the outcomes of multifocal UTUC after radical nephroureterectomy. From the 2780 UTUC patients in the Taiwan UTUC Collaboration Group, 685 UTUC cases with multifocal tumors (defined as more than one tumor lesion in unilateral upper urinary tract) were retrospectively included and divided into three groups: multiple renal pelvic tumors, multiple ureteral tumors, and synchronous renal pelvic and ureteral tumors included 164, 152, and 369 patients, respectively. We found the prevalence of carcinoma in situ was the highest in the synchronous group. In multivariate survival analyses, tumor distribution showed no difference in cancer-specific and disease-free survival, but there was a significant difference in bladder recurrence-free survival. The synchronous group had the highest bladder recurrence rate. In summary, tumor distribution did not influence the cancer-specific outcomes of multifocal UTUC, but synchronous lesions led to a higher rate of bladder recurrence than multiple renal pelvic tumors. We believe that the distribution of tumors reflects the degree of malignant involvement within the urinary tract, but has little significance for survival or disease progression.

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