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 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.

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 Propensity-Matched Survival Analysis of Upper Urinary Tract Urothelial Carcinomas between End-Stage Renal Disease with and without Kidney Transplantation

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Hao Lun Luo ◽  
Po Hui Chiang ◽  
Yuan Tso Cheng ◽  
Yen Ta Chen
Keyword(s):  
Kidney Transplantation ◽  
Urinary Tract ◽  
Propensity Score ◽  
Urothelial Carcinoma ◽  
End Stage Renal Disease ◽  
Upper Urinary Tract ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Urinary Tract Urothelial Carcinoma

Urothelial carcinoma is the most common cancer following kidney transplantation (KT) in Taiwan. Unusual presentation of upper urinary tract urothelial carcinoma (UTUC) is noted in Taiwan and China. As the post-KT-UTUC oncological course is not fully understood, the aim of this study is to identify postulated significant differences for the clinical cancer course of UTUC among end-stage renal disease (ESRD) patients with and without KT. From 2005 January to 2016 March, 194 ESRD patients underwent radical nephroureterectomy due to UTUC in our hospital. The parameters were obtained from the chart record and pathology report. SPSS version 21 software was used for all statistical analyses. Unequal matching created study groups wherein a 0.2 caliper width was performed for adjusting these confounding pathological factors. Propensity score-matching cohort was performed for each population first, and then for all the study patients. We observed that the average age of UTUC in ESRD patients after KT was younger than in those without KT. The pathological factors such as stage, bladder cancer history, papillary structure, lymphovascular invasion, and variant histology were equal in these two groups. However, younger onset (p<0.001), more multifocal tumors, and carcinomas in situ were observed in post-KT UTUC (p<0.001 and 0.006, respectively). After adjustment of pathological factors by propensity score-matched analysis, the 5-year systemic UTUC recurrence was significantly more in ESRD after KT compared with ESRD without KT (p=0.03). No obvious difference in 5-year cancer related death could be observed between these two groups (p=0.314). Post-kidney transplantation upper urinary tract urothelial carcinoma in Taiwan is relatively common, has younger onset, and is associated with aggressive pathological features. The oncologic outcome of UTUC after KT is poor in our observation, even after propensity scored-matched analysis. It indicates the immunosuppression status is still associated with more malignant UTUC behavior.

p53 Expression as a Prognostic Factor in Upper Urinary Tract Urothelial Carcinoma: A Systematic Review and Meta-Analysis

2014 ◽  
Vol 94 (1) ◽  
pp. 50-57 ◽  
Author(s):  
Joo Yong Lee ◽  
Kang Su Cho ◽  
Richilda Red Diaz ◽  
Young Deuk Choi ◽  
Hong Yong Choi
Keyword(s):  
Urinary Tract ◽  
Urothelial Carcinoma ◽  
Meta Analysis ◽  
Female Gender ◽  
Upper Urinary Tract ◽  
Case Control ◽  
Histologic Grade ◽  
P53 Expression ◽  
Pathologic Stage ◽  
Urinary Tract Urothelial Carcinoma

Objective: To conduct a meta-analysis examining p53 expression as a potential risk factor in upper urinary tract urothelial carcinoma (UUT-UC) and to systematically review the available data. Methods: A comprehensive literature review was performed from January 1991 to August 2012, using search engines such as PubMed, EMBASE, Cochrane Library and KoreaMed. All retrieved references were manually reviewed, and two authors independently extracted the data. The quality of case-control and cohort studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) checklists. Heterogeneity among studies was examined using the Q statistics and Higgins' I2 statistic. Results: Of 302 abstracts of original research studies, nine case-control trials fit our criteria for inclusion in the analysis. Of the nine articles included, four scored ‘low' and five scored ‘modest' in the quality assessment performed according to the SIGN checklists. Analysis of the correlation between different factors and p53 expression in UUT-UC showed that pathologic stage (≥pT3 or <pT3) differed significantly between the p53 and non-p53 groups (OR = 2.720, p < 0.001). Statistically significant correlations were also detected between p53 expression and histologic grade (OR = 4.507, p < 0.001) and female gender (OR = 2.724, p < 0.001). Conclusion: The results of our meta-analysis suggest that p53 expression in UUT-UC was correlated with advanced pathologic stage, high histologic grade and female gender.

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 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.

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