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.acuroe.2011.09.001

Cited by 93 publications

(157 citation statements)

References 115 publications

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“…2 Upper urinary tract urothelial cell carcinomas that invade the muscle wall usually have a very poor prognosis, even if radical nephroureterectomy is performed appropriately. 1 The 5-year specific survival is o50% for pT2/ pT3 and o10% for pT4. 3,4 According to the most recent classifications, the primarily recognized prognostic factors are tumor stage and grade.…”

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confidence: 99%

“…1 Radical nephroureterectomy with excision of an ipsilateral bladder cuff is the standard therapy for patients with a normal contralateral kidney. 2 Upper urinary tract urothelial cell carcinomas that invade the muscle wall usually have a very poor prognosis, even if radical nephroureterectomy is performed appropriately.…”

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confidence: 99%

“…3,4 According to the most recent classifications, the primarily recognized prognostic factors are tumor stage and grade. 1 Gender, age and the initial location of the tumor within the upper urinary tract are no longer accepted as prognostic factors. 1 Lymphovascular invasion, [5][6][7] tumor necrosis, 8,9 tumor architecture 10 and concomitant carcinoma in situ 11,12 are associated with higher risks of recurrent disease and cancer-specific mortality.…”

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confidence: 99%

“…1 Gender, age and the initial location of the tumor within the upper urinary tract are no longer accepted as prognostic factors. 1 Lymphovascular invasion, [5][6][7] tumor necrosis, 8,9 tumor architecture 10 and concomitant carcinoma in situ 11,12 are associated with higher risks of recurrent disease and cancer-specific mortality. Molecular markers such as microsatellite instabilities, 13 E-cadherin, hypoxia-inducible factor-1a and a telomerase RNA component 14 have been shown to be useful for prognosis, although none of the markers has been externally validated.…”

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confidence: 99%

“…Molecular markers such as microsatellite instabilities, 13 E-cadherin, hypoxia-inducible factor-1a and a telomerase RNA component 14 have been shown to be useful for prognosis, although none of the markers has been externally validated. 1 Cancer stem-like cells/tumor-initiating cells are a small population of cancer cells that have the properties of tumor-initiating ability, self-renewal and differentiation. Cancer stem-like cells/tumor-initiating cells are more resistant to chemotherapy and radio-therapy than non-cancer stem-like cell/tumor-initiating cell populations via various mechanisms, 15 suggesting that the existence of these cells is a prognostic factor in cancer patients.…”

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confidence: 99%

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Prognostic impact of the expression of ALDH1 and SOX2 in urothelial cancer of the upper urinary tract

et al. 2013

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Aldehyde dehydrogenase 1 (ALDH1) and sex determining region-Y-related high mobility group box 2 (SOX2) have been identified as putative cancer stem-like cell/tumor-initiating cell markers in various cancer tissues. The aim of this study was to elucidate the prognostic impact of these putative cancer stem-like cell/tumorinitiating cell markers in upper urinary tract urothelial cell carcinoma. Immunohistochemical staining for ALDH1 and SOX2 was carried out on archival specimens from 125 patients with upper urinary tract urothelial cell carcinoma who underwent radical nephroureterectomy. The prognostic value of ALDH1 and SOX2 expression and other clinicopathological features was evaluated. On univariate analysis, tumor grade, pathological T stage, pathological N stage, lymphovascular invasion, ALDH1 expression and SOX2 expression were associated with a poor prognosis. On multivariate analysis, the independent factors of prognosis were tumor grade (P ¼ 0.014), pathological N stage (P ¼ 0.005) and ALDH1 expression (P ¼ 0.002). In subgroup analysis, those subgroups with no positive, one positive or two positive results in immunohistochemistry for ALDH1 and SOX2 expression had estimated 5-year cancer-specific survival rates of 80%, 49% and 22%, respectively (Po0.001). Neither ALDH1 nor SOX2 expression correlated with intravesical recurrence after radical nephroureterectomy. These findings suggest that cancer stem-like cells/tumor-initiating cells are linked to more aggressive behavior of upper urinary tract urothelial cell carcinoma, supporting the current cancer stem cell hypothesis. Thus, therapeutic targeting of cancer stem-like cells/tumor-initiating cells in upper urinary tract urothelial cell carcinoma is a future possibility.

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confidence: 99%

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Prognostic impact of the expression of ALDH1 and SOX2 in urothelial cancer of the upper urinary tract

et al. 2013

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Robotic‐assisted versus laparoscopic nephroureterectomy; a systematic review and meta‐analysis

et al. 2023

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Background: Upper tract urothelial carcinoma (UTUC) is the malignant transformation of urothelial cells, from the renal calyces to the ureteral orifices. While the benefits of minimally invasive nephroureterectomy over their open counterpart have been established, the optimal technique remains a debate. We aimed to assess current evidence in the literature and compare outcomes between robotic-assisted (RANU) and laparoscopic nephroureterectomy (LNU).Methods: A systematic review of the literature was performed for studies comparing RANU and LNU for bladder cancer. Outcome measurements were recurrence rates (local and distal), positive margins, positive lymph node yield and perioperative outcomes. Meta-analysis was performed using Review Manager 5.Results: Our results demonstrate a significantly higher mortality rate in patients undergoing laparoscopic nephroureterectomy when compared with the roboticassisted approach for the treatment of UTUC (1.8% vs. 1.1%, p = 0.008); however, these results were inconsistent on sensitivity analysis and should therefore be interpreted with caution. No significant difference was observed for other outcomes. Conclusion:The ideal approach to minimally invasive radical nephroureterectomy remains undetermined. Future research, ideally prospective randomised studies, should focus on long-term outcomes, in particular recurrence, recurrence-free survival, overall survival and the correlation between surgical technique and survival.

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Outcomes after adjuvant chemotherapy in the treatment of high‐risk urothelial carcinoma of the upper urinary tract (UUT‐UC)

Vassilakopoulou

Rouge

Colin

et al. 2011

Cancer

107

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BACKGROUND: Urothelial carcinoma of the upper urinary tract (UUT-UC) was a rare, aggressive urologic cancer with a propensity for multifocality, local recurrence, and metastasis. High-risk patients had poor outcomes. Because of the rarity of these tumors, randomized clinical trials and data regarding adjuvant chemotherapy in locally advanced tumors are currently unavailable. Our objective was to assess the effect of adjuvant chemotherapy and the impact of potential prognostic factors on survival in high-risk, postsurgical UUT-UC patients. METHODS: Using a multi-institutional, international retrospective database, identified were 627 patients with high risk UUT-UCs (pT3N0, pT4N0 and/or Nþ and/or Mþ) who underwent surgical removal. Only patients who received adjuvant chemotherapy were included. RESULTS: Overall, 140 patients (22.6%) with a median age of 67 years were included. The median follow-up was 22.5 months. The 5-year, overall survival for the entire cohort was 43%, the 5-year recurrencefree survival was 54%, and metastasis-free survival was 53% at 5 years. Positive surgical margins were an independent prognostic factor for recurrence (P ¼ .06), cancer-specific mortality (P ¼ .05), and overall mortality (P ¼ .02) of any cause. Adjuvant chemotherapy was not linked with overall or cancer-specific survival in patients with high risk disease (adjuvant chemotherapy [n ¼ 140] vs no treatment [n ¼ 487]) (P >.5). CONCLUSIONS: Adjuvant postoperative chemotherapy did not offer any significant benefit to overall survival in our population. Additional data were necessary, and studies enrolling patients at high risk in clinical trials investigating neoadjuvant chemotherapy in conjunction with chemotherapy should have been highly encouraged. Cancer 2011;117:5500-8.

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European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update

Cited by 93 publications

References 115 publications

Prognostic impact of the expression of ALDH1 and SOX2 in urothelial cancer of the upper urinary tract

Prognostic impact of the expression of ALDH1 and SOX2 in urothelial cancer of the upper urinary tract

Robotic‐assisted versus laparoscopic nephroureterectomy; a systematic review and meta‐analysis

Outcomes after adjuvant chemotherapy in the treatment of high‐risk urothelial carcinoma of the upper urinary tract (UUT‐UC)

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