European Guidelines for the Diagnosis and Management of Upper Urinary Tract Urothelial Cell Carcinomas: 2011 Update

Rouprêt, Morgan; Zigeuner, Richard; Palou, Juan; Boehle, Andreas; Kaasinen, Eero; Sylvester, Richard; Babjuk, Marko; Oosterlinck, Willem

doi:10.1016/j.eururo.2010.12.042

Cited by 349 publications

(182 citation statements)

References 116 publications

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“…[6][7][8][9] Recently, Margulis et al identified age, high tumour grade, high pathological T stage, LN metastasis, sessile architecture, an infiltrative growth pattern, and lymphovascular invasion (LVI) as independent prognostic indicators of disease recurrence and cancer-specific survival (CSS). 8 Tumour stage, grade, and LVI are independent predictors of clinical outcome in patients with UTUC; 10,11 however, knowledge of assessable prognostic factors in UTUC is still limited.…”

Section: Introductionmentioning

confidence: 99%

“…[15][16][17][18] Metastasis of UTUC to regional LNs occurs frequently and is a significant predictor of oncologic outcomes. LN dissection (LND) is highly recommended in muscle-invasive UTUC; 10,19 however, LND for UTUC is not universally performed. A recent study presented at the American Urological Association (AUA) annual meeting suggested that LVI is associated with LN involvement in patients with UTUC and may be used as a surrogate marker in patients who do not undergo LND at the time of surgery.…”

Section: Introductionmentioning

confidence: 99%

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Can lymphovascular invasion replace the prognostic value of lymph node involvement in patients with upper tract urothelial carcinoma after radical nephroureterectomy?

Yoo

Lee

et al. 2016

CUAJ

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Introduction: This study aimed to evaluate whether lymphovascular invasion (LVI) can replace lymph node (LN) involvement as a prognostic marker in patients who do not undergo lymph node dissection (LND) during surgery in patients with upper tract urothelial carcinoma (UTUC). Methods: A total of 505 patients who underwent radical nephroureterectomy (RNU) were recruited from four academic centres and divided into four groups: node negative (N0, Group 1); node positive (N+, Group 2); no LND without LVI (NxLVI-, Group 3); and no LND with LVI (NxLVI+, Group 4). Results: Patients in Group 2 had larger tumours, a higher incidence of left-sided involvement, more aggressive T stage and grade, and a higher positive surgical margin rate than patients in other groups. Pathological features (T stage and grade) were poorer in Group 4 than in Groups 1 and 3. Compared to other groups, Group 2 had the worst prognostic outcomes regarding locoregional/distant metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). LVI and LN status in Group 4 was not associated with MFS in multivariate analysis. Among Nx diseases, LVI was not an independent predictor of MFS or CCS. The small number of cases in Groups 2 and 4 is a major limitation of this study. Conclusions: Clinical outcomes according to LVI did not correlate with those outcomes predicted by LN involvement in patients with UTUC. Therefore, LVI may not be used as a substitute for nodal status in patients who do not undergo LND at the time of surgery.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Can lymphovascular invasion replace the prognostic value of lymph node involvement in patients with upper tract urothelial carcinoma after radical nephroureterectomy?

Yoo

Lee

et al. 2016

CUAJ

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“…2 It accounts for 5% to 10% of urothelial carcinomas. [3][4][5] Radical nephroureterectomy with bladder cuff excision is the gold standard for the treatment of non-metastatic UTUC.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5] Radical nephroureterectomy with bladder cuff excision is the gold standard for the treatment of non-metastatic UTUC. 2,6 In one multi-institutional series, radical nephro-…”

Section: Introductionmentioning

confidence: 99%

The impact of method of distal ureter management during radical nephroureterectomy on tumour recurrence

Kapoor

Dason

Allard

et al. 2014

CUAJ

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Introduction: Radical nephroureterectomy for upper tract urothelial carcinoma (UTUC) must include some form of distal ureter management to avoid high rates of tumour recurrence. It is uncertain which distal ureter management technique has the best oncologic outcomes. To determine which distal ureter management technique resulted in the lowest tumour recurrence rate, we analyzed a multiinstitutional Canadian radical nephroureterectomy database. Methods: We retrospectively analyzed patients who underwent radical nephroureterectomy with distal ureter management for UTUC between January 1990 and June 2010 at 10 Canadian tertiary hospitals. Distal ureter management approaches were divided into 3 categories: (1) extravesical tenting for ureteric excision without cystotomy (EXTRAVESICAL); (2) open cystotomy with intravesical bladder cuff excision (INTRAVESICAL); and (3) extravesical excision with endoscopic management of ureteric orifice (ENDOSCOPIC). Data available for each patient included demographic details, distal ureter management approach, pathology and operative details, as well as the presence and location of local or distant recurrence. Clinical outcomes included overall recurrence-free survival and intravesical recurrence-free survival. Survival analysis was performed with the Kaplan-Meier method. Multivariable Cox regression analysis was also performed. Results: A total of 820 patients underwent radical nephroureterectomy with a specified distal ureter management approach at 10 Canadian academic institutions. The mean patient age was 69.6 years and the median follow-up was 24.6 months. Of the 820 patients, 406 (49.5%) underwent INTRAVESICAL, 316 (38.5%) underwent EXTRAVESICAL, and 98 (11.9%) underwent ENDOSOPIC distal ureter management. Groups differed significantly in their proportion of females, proportion of laparoscopic cases, presence of carcinoma in situ and pathological tumour stage (p < 0.05). Recurrence-free survival at 5 years was 46.3%, 35.6%, and 30.1% for INTRAVESICAL, EXTRAVESICAL and ENDOSCOPIC, respectively (p < 0.05). Multivariable Cox regression analysis confirmed that INTRAVESICAL resulted in a lower hazard of recurrence compared to EXTRAVESICAL and ENDOSCOPIC. When looking only at intravesical recurrence-free survival (iRFS), a similar trend held up with INTRAVESICAL having the highest iRFS, followed by ENDOSCOPIC and then EXTRAVESICAL management (p < 0.05). At last follow-up, 406 (49.5%) patients were alive and free of disease. Conclusion: Open intravesical excision of the distal ureter (INTRAVESICAL) during radical nephroureterectomy was associated with improved overall and intravesical recurrence-free survival compared with extravesical and endoscopic approaches. These findings suggest that INTRAVESICAL should be considered the gold standard oncologic approach to distal ureter management during radical nephroureterectomy. Limitations of this study include its retrospective design, heterogeneous cohort, and limited follow-up.

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“…The European Association of Urology guidelines for the management of upper tract urothelial carcinoma recommend a minimum follow-up period of 5 years. 18 During this time, cystoscopy and urine cytology testing is performed at 3 months and annually thereafter. We consider this to also be an appropriate follow-up protocol for LELC of the renal pelvis given its similarity to urothelial carcinoma.…”

mentioning

confidence: 99%

Lymphoepithelioma-like carcinoma of the renal pelvis: Pathological and therapeutic implications

Modi

Beckley

Bhattarai

et al. 2013

CUAJ

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A 75-year-old woman presented with a presumed urothelial carcinoma of the right renal pelvis. A radical nephroureterectomy was carried out and histological analysis of the specimen revealed lymphoepithelioma-like carcinoma. This is the seventh reported case of this normally nasopharyngeal tumour found in the renal pelvis. These tumours have a distinct histological appearance comprising sheets of undifferentiated syncytial cells on a background of lymphoid stroma. We review the pathological features of lymphoepithelioma-like carcinoma and make arguments for managing these tumours in a similar way to urothelial carcinoma.

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European Guidelines for the Diagnosis and Management of Upper Urinary Tract Urothelial Cell Carcinomas: 2011 Update

Cited by 349 publications

References 116 publications

Can lymphovascular invasion replace the prognostic value of lymph node involvement in patients with upper tract urothelial carcinoma after radical nephroureterectomy?

Can lymphovascular invasion replace the prognostic value of lymph node involvement in patients with upper tract urothelial carcinoma after radical nephroureterectomy?

The impact of method of distal ureter management during radical nephroureterectomy on tumour recurrence

Lymphoepithelioma-like carcinoma of the renal pelvis: Pathological and therapeutic implications

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