scholarly journals The effect of tumor location on overall survival for pT2-4 bladder and upper tract urothelial carcinoma following radical surgery

2020 ◽  
Vol 15 (5) ◽  
Author(s):  
Andrew W. Tam ◽  
Christine Liaw ◽  
Eric Li ◽  
Andrew B. Katims ◽  
Rollin K. Say ◽  
...  
Keyword(s):  
Overall Survival ◽  
Urothelial Carcinoma ◽  
Renal Pelvis ◽  
Cox Regression ◽  
Tumor Location ◽  
Upper Tract Urothelial Carcinoma ◽  
Upper Tract ◽  
Risk Of Mortality ◽  
Bladder Urothelial Carcinoma ◽  
Definitive Surgery

Introduction: Historically, staging and treatment for upper tract urothelial carcinoma were extrapolated from bladder urothelial carcinoma literature. However, embryological, genetic, and anatomical differences exist between them. We sought to explore the relationship between location of urothelial cancer and overall survival (OS). Methods: Data was culled from the National Cancer Database from 2004–2015. Patients with pT2-pT4 treated with definitive surgery were included; those with metastatic disease or who received neoadjuvant or adjuvant treatment were excluded. Patients were stratified by tumor location and pathological stage. The primary outcome was OS. Secondary outcomes were predictors of mortality in each pT stage stratum. Results: A total of 11 330 patients with bladder, 954 patients with ureteral, and 1943 patients with renal pelvis urothelial carcinoma were analyzed. Mean followup was 43.3, 39.4, and 41.4 months for bladder, ureteral, and renal pelvis, respectively. On univariable analysis, ureteral pT2 was associated with worse OS compared to both bladder (61.3 vs. 80.4 months, p=0.007) and renal pelvis (61.3 vs. 80.5 months, p=0.014). Renal pelvis pT3 was associated with improved OS compared to both bladder (42.5 vs. 28.6 months, p=0.003) and ureteral (42.5 vs. 25.7 months, p<0.001). Renal pelvis pT4 had decreased survival compared to bladder (11.4 vs. 17.7 months, p<0.001). On multivariable Cox regression, only renal pelvis pT3 was associated with a 20% decreased risk of mortality compared to bladder pT3 (hazard ratio 0.80, 95% confidence interval 0.72–0.88, p<0.001). Conclusions: Renal pelvis pT3 is associated with lower mortality. Mutational and embryological differences may play a role in this disparity.

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.

Disease-free survival as a surrogate for overall survival in upper tract urothelial carcinoma

2012 ◽  
Vol 31 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Harun Fajkovic ◽  
Eugene K. Cha ◽  
Evanguelos Xylinas ◽  
Michael Rink ◽  
Armin Pycha ◽  
...  
Keyword(s):  
Overall Survival ◽  
Urothelial Carcinoma ◽  
Disease Free Survival ◽  
Upper Tract Urothelial Carcinoma ◽  
Free Survival ◽  
Upper Tract ◽  
Disease Free

Impact of Tumor Location on Prognosis for Patients with Upper Tract Urothelial Carcinoma Managed by Radical Nephroureterectomy

2010 ◽  
Vol 57 (6) ◽  
pp. 1072-1079 ◽  
Author(s):  
Jay D. Raman ◽  
Casey K. Ng ◽  
Douglas S. Scherr ◽  
Vitaly Margulis ◽  
Yair Lotan ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Tumor Location ◽  
Upper Tract Urothelial Carcinoma ◽  
Radical Nephroureterectomy ◽  
Upper Tract

scholarly journals Survival Benefits Based on the Number of Lymph Nodes Removed during Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: Systematic Review and Meta-Analysis

2020 ◽  
Vol 9 (6) ◽  
pp. 1933 ◽  
Author(s):  
Min Soo Choo ◽  
Sangjun Yoo ◽  
Hyeong Dong Yuk ◽  
Chang Wook Jeong ◽  
Min Chul Cho ◽  
...  
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Lymph Node ◽  
Urothelial Carcinoma ◽  
Meta Analysis ◽  
Upper Tract Urothelial Carcinoma ◽  
Radical Nephroureterectomy ◽  
Case Control Studies ◽  
Level Of Evidence ◽  
Upper Tract

The role of lymph node dissection (LND) is still controversial for upper tract urothelial carcinoma (UTUC), and there are no guidelines regarding its use. This study was conducted to find a higher level of evidence for the survival benefits based on the number of LNs removed during radical nephroureterectomy (RNUx) through a systematic review and meta-analysis. We included studies comparing patients who underwent LND during RNUx for UTUC. We searched the major electronic databases (Pubmed, Embase®, and Scopus®) and conducted manual searches of the electronically available abstracts of the major international urology cancer meetings [American Society of Clinical Oncology (ASCO), American Urological Association (AUA), and Eropean Association of Urology (EAU)] prior to April 2019 using grouped terms of nephroureterectomy (nephroureterectom*) and lymph node excision (lymphadenectomy; lymph + node*; lymph* + metasta*) with variations in the terms. Study selection, data collection, and risk of bias assessment were performed by two independent authors (A and B). Six retrospective case-control studies included a total of 33,944 patients who underwent RNUx for UTUC, 5071 of whom underwent LND and were finally included in the meta-analysis. The pooled hazard ratio (HR) in these studies revealed that an increased number of LNs removed during RNUx was associated with improved cancer-specific survival (CSS) in patients with UTUC (HR = 0.95, 95% CI: 0.91–0.99; p = 0.07). In addition, increased numbers of LNs removed were associated with improved overall survival (OS) in pN0 patients. However, in pN+ patients, the number of LNs removed showed no survival benefit on CSS, overall survival (OS), or progression-free survival (PFS). Higher numbers of LNs removed during RNUx were associated with improved survival outcomes in patients with UTUC. This study confirmed that LND also has oncological benefits in UTUC patients. Although still a controversial topic, meticulous LND must be considered, and efforts should be made to eliminate as many LNs as possible when administering RNUx for UTUC, especially in patients without clear evidence of LN metastasis.

The expression and clinical significance of PD-L1 in patients with upper tract urothelial carcinoma.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 444-444
Author(s):  
Xinan Sheng ◽  
Zhisong He ◽  
Yan Kong ◽  
Zhihong Chi ◽  
Lu Si ◽  
...  
Keyword(s):  
Cell Membrane ◽  
Tumor Cell ◽  
Urothelial Carcinoma ◽  
Tumor Staging ◽  
Prognostic Significance ◽  
Upper Tract Urothelial Carcinoma ◽  
Tumor Cell Membrane ◽  
Upper Tract ◽  
Bladder Urothelial Carcinoma ◽  
N Classification

444 Background: Primary upper tract urothelial carcinoma (UTUC) is rare. In China UTUCs are more common than in Western populations and account for 20–30% of all TCCs.An antibody that targets programmed death ligand-1 (PD-L1) pathway has been shown to be active towards various types of cancer including bladder urothelial carcinoma. In this study, we investigated the PD-L1 expression and prognostic significance in UTUC. Methods: Formalin-fixed paraffin-embedded tumor samples from 78 patients with upper tract urothelial carcinoma from Peking University Cancer Hospital and Peking Universiy First Hospital were retrieved. PD-L1 expression was evaluated by immunohistochemistry using rabbit monoclonal anti-PD-L1 antibody. PD-L1 positivity on tumor cell membrane was defined as ≥ 1% of tumor cell membrane staining.The clinical data of patients were retrospective collected. The multivariate analysis was used to assess the association of PD-L1 expressionwith tumor staging, pathological N classification, whether firstly diagnosed with metastasis, disease free survival(DFS) and overall survival (OS) in patients. Results: The positive rates of PD-L1 expression were 42.3% (33/78) for upper tract urothelial carcinoma. Sex,location, pathological tumor staging, pathological N classification, whether firstly diagnosed with metastasis did not correlate with PD-L1 expression. In patients with upper tract UC, PD-L1 expression was not associated with DFS and OS on univariate analyses. Conclusions: To our knowledge, this is first study about PD-L1 expression in UTUC patients. In this study, We found the PD-L1 expression in UTUC was higher than in the bladder urothelial carcinoma. It means anti-PD-L1 treatment may be better for advanced UTUC. There was no correlation between PD-L1 expression and outcome.

IMPACT OF TUMOR LOCATION ON PROGNOSIS FOR UPPER- TRACT UROTHELIAL CARCINOMA: OUTCOMES FROM OVER 1300 PATIENTS

2008 ◽  
Vol 179 (4S) ◽  
pp. 289-289 ◽  
Author(s):  
Jay D Raman ◽  
Casey K Ng ◽  
Vitaly Margulis ◽  
Douglas S Scherr ◽  
Yair Lotan ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Tumor Location ◽  
Upper Tract Urothelial Carcinoma ◽  
Upper Tract

scholarly journals Expression Analysis and Mutational Status of Histone Methyltransferase KMT2D at Different Upper Tract Urothelial Carcinoma Locations

2021 ◽  
Vol 11 (11) ◽  
pp. 1147
Author(s):  
Ekaterina Laukhtina ◽  
Ursula Lemberger ◽  
Andreas Bruchbacher ◽  
Dafina Ilijazi ◽  
Stephan Korn ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Protein Expression ◽  
Urothelial Carcinoma ◽  
Clinical Decision Making ◽  
Histone Methyltransferase ◽  
Tumor Location ◽  
Upper Tract Urothelial Carcinoma ◽  
Survival Outcomes ◽  
Upper Tract ◽  
Mutational Status

The gene coding for histone methyltransferase KMT2D is found among the top mutated genes in upper tract urothelial carcinoma (UTUC); however, there is a lack of data regarding its association with clinicopathologic features as well as survival outcomes. Therefore, we aimed to investigate KMT2D expression, mutation patterns, and their utility as prognostic biomarkers in patients with UTUC. A single-center study was conducted on tumor specimens from 51 patients treated with radical nephroureterectomy (RNU). Analysis of KMT2D protein expression was performed using immunohistochemistry (IHC). Customized next-generation sequencing (NGS) was used to assess alterations in KMT2D exons. Cox regression was used to assess the relationship of KMT2D protein expression and mutational status with survival outcomes. KMT2D expression was increased in patients with a previous history of bladder cancer (25% vs. 0%, p = 0.02). The NGS analysis of KMT2D exons in 27 UTUC tumors revealed a significant association between pathogenic KMT2D variants and tumor location (p = 0.02). Pathogenic KMT2D variants were predominantly found in patients with non-pelvic or multifocal tumors (60% vs. 14%), while the majority of patients with a pelvic tumor location (81% vs. 20%) did not harbor pathogenic KMT2D alterations. Both IHC and NGS analyses of KMT2D failed to detect a statistically significant association between KMT2D protein or KMT2D gene alteration status and clinical variables such as stage/grade of the disease or survival outcomes (all p > 0.05). KMT2D alterations and protein expression were associated with UTUC features such as multifocality, ureteral location, and previous bladder cancer. While KMT2D protein expression and KMT2D mutational status do not seem to have prognostic value in UTUC, they appear to add information to improve clinical decision-making regarding the type of therapy.

Sign in / Sign up

Export Citation Format

Share Document