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 < 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 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 Presence of secondary bladder cancer following radical nephroureterectomy for upper tract urothelial carcinoma: Characteristics, Risk Factors, and Predictive Value

2021 ◽  
Author(s):  
Shicong Lai ◽  
Pengjie Wu ◽  
Shengjie Liu ◽  
Samuel Seery ◽  
Jianyong Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Survival Data ◽  
Upper Tract Urothelial Carcinoma ◽  
Recurrence Time ◽  
Time Interval ◽  
Radical Nephroureterectomy ◽  
Cox Regression Analysis ◽  
Upper Tract

Abstract Objective To assess the characteristics, predictive risk factors, and prognostic effect of secondary bladder cancer (BCa) following radical nephroureterectomy (RNU) in upper tract urothelial carcinoma (UTUC). Methods Using the Surveillance, Epidemiology, and End Results (SEER) database, the authors analyzed clinicopathologic characteristics and survival data from 472 UTUC patients with secondary BCa after RNU between 2004 and 2017. Cox’s proportional hazard regression model was implemented to identify independent predictors associated with post-recurrence outcomes. The threshold for statistical significance was p < 0.05. Results In total, 200 Ta-3N0M0 localized UTUC patients with complete data were finally included. With a median follow-up of 71 months (interquartile ranges [IQR] 36 -103.75 months), 52.5% (n = 105) had died, with 30.5% (n = 61) dying of UTUC. The median time interval from UTUC to BCa was 13.5 months (IQR 6–40.75 months). According to multivariable Cox regression analysis, patients with intravesical recurrence (IVR) located at multiple sites, advanced BCa stage, higher BCa grade, elderly age and a shorter recurrence time, encountered worse cancer-specific survival (CSS) (all p ༜0.05). Conclusions For primary UTUC patients experiencing IVR after radical surgery, advanced age, multiple IVR sites, shorter recurrence time, higher BCa stage, and grade proved to be significant independent prognostic factors of CSS. We ought to pay more attention to IVR prevention as well as to earlier signs which may increase the likelihood of early detection. Having the ability to manage what may be seen as the superficial BCa signs may enable us to improve survival but further research is required.

scholarly journals Bladder Recurrence Following the Treatment of Upper Tract Urothelial Carcinoma

2021 ◽  
Author(s):  
Takarn Itsaranujareankul ◽  
Kanrapee Nuwatkrisin ◽  
Kamol Panumatrassamee ◽  
Dutsadee Sowanthip ◽  
Julin Opanuraks ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Tumor Location ◽  
Upper Tract Urothelial Carcinoma ◽  
P Value ◽  
Distal Ureter ◽  
Upper Tract ◽  
History Of ◽  
The Mean ◽  
Bladder Recurrence

Objective: Although, upper tract urothelial carcinoma (UTUC) is rare it is associated with a high mortality rate and frequently, followed by bladder recurrence after radical surgery. Hence, this study aimed to identify the rate of bladder recurrence and its predictive factors.Material and Methods: We reviewed the medical records of 104 patients, who were diagnosed with UTUC and had radical nephroureterectomy (RNU), at the King Chulalongkorn Memorial Hospital. We excluded patients who have concurrent bladder cancer, or had a history of bladder cancer. Various clinicopathological factors were analyzed using the log-rank test and Cox proportional hazard model.Results: The mean age at diagnosis of UTUC was 68 years, and one-third of the patients were diagnosed with pathological T3 (33.7%). The mean follow-up duration was 56 months. Bladder recurrence occurred in 39 out of 104 patients (37.5%), and the median time to recurrence was 5.8 months (interquartile range 3.6 to 11.0 months). Tumor location in the distal ureter (p-value=0.038) and history of diagnostic ureteroscopy (p-value=0.004) were significantly associated with bladder recurrence in the univariate model. However, only the history of diagnostic ureteroscopy remained significant in the multivariate analysis (p-value=0.023).Conclusion: Bladder recurrence, following RNU, occurs in one-third of patients. Potential predictive factors may include history of diagnostic ureteroscopy, and the tumor location being in the distal ureter.

Clinicopathological features and oncological outcomes of urothelial carcinoma involving the ureterovesical junction

2021 ◽  
Author(s):  
Takahiro Oshina ◽  
Satoru Taguchi ◽  
Jimpei Miyakawa ◽  
Yoshiyuki Akiyama ◽  
Yusuke Sato ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Transurethral Resection ◽  
Bladder Tumor ◽  
Treatment Strategies ◽  
Upper Tract Urothelial Carcinoma ◽  
Radical Nephroureterectomy ◽  
Ureterovesical Junction ◽  
Upper Tract

Abstract Background The ureterovesical junction is the boundary between the urinary bladder and upper urinary tract. Because treatment strategies for bladder cancer and upper tract urothelial carcinoma are entirely different, urothelial carcinoma involving the ureterovesical junction requires special attention. Nevertheless, studies focusing on the disease are lacking. Methods We reviewed consecutive patients with urothelial carcinoma treated via either transurethral resection of bladder tumor (n = 2791) or radical nephroureterectomy (n = 292) between 2000 and 2020 and identified those with bladder cancer involving the ureteral orifice (n = 64) and those with upper tract urothelial carcinoma involving the intramural ureter (≤2 cm) (n = 41). After excluding overlapping cases (n = 24), 80 patients with urothelial carcinoma involving the ureterovesical junction were analyzed. Results The initial symptoms or reasons for diagnosing urothelial carcinoma involving the ureterovesical junction were hematuria (n = 30), hydronephrosis (n = 21), follow-up examinations for prior urothelial carcinoma (n = 13), screening examinations (n = 7), frequent urination (n = 6) and unknown causes (n = 3). During a median follow-up period of 42 months, 18 patients died of urothelial carcinoma. The definitive surgical treatments for urothelial carcinoma involving the ureterovesical junction were transurethral resection of bladder tumor alone (n = 26), radical nephroureterectomy (n = 41) and radical cystectomy (n = 13), with different treatments having different cancer-specific survivals. Multivariate analyses identified T stage (≥T2) as an independent predictor of shorter cancer-specific survival. Conclusions Given the positional property of urothelial carcinoma involving the ureterovesical junction, the profiles of patients with the disease were highly heterogeneous. Further optimization of treatment strategies for urothelial carcinoma involving the ureterovesical junction is urgently warranted for better clinical outcomes.

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 &lt; 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 &lt; 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
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