Impact of variant histology on disease aggressiveness and outcome after nephroureterectomy in Japanese patients with upper tract urothelial carcinoma

Sakano, Shigeru; Matsuyama, Hideyasu; Kamiryo, Yoriaki; Hayashida, Shigeaki; Yamamoto, Norio; Kaneda, Yoshitaka; Nasu, Tetsuo; Baba, Yasunori; Shimabukuro, Tomoyuki; Suga, Atsushi; Yamamoto, Miyuki; Arakawa, Akihiko; Takai, Kimio; Yoshihiro, Satoru; Oba, Kazuo

doi:10.1007/s10147-014-0721-3

Cited by 39 publications

(39 citation statements)

References 17 publications

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“…Similar results were reported in another multi-institutional study conducted by Sakano et al [8]. However, in a subgroup analysis, Sakano et al [8] found that CVH was an independent predictor of DFS in patients with non-organ-confined disease (pT3/4) on multivariate analysis (P ¼ 0.0095). Thus, the effect of CVH on the prognosis of patients with UTUC following RNU needs to be further investigated.…”

Section: Introductionsupporting

confidence: 79%

Effect of concomitant variant histology on the prognosis of patients with upper urinary tract urothelial carcinoma after radical nephroureterectomy

Yan

Song

Wang

et al. 2015

Urologic Oncology: Seminars and Original Investigations

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Section: Introductionsupporting

confidence: 79%

Effect of concomitant variant histology on the prognosis of patients with upper urinary tract urothelial carcinoma after radical nephroureterectomy

Yan

Song

Wang

et al. 2015

Urologic Oncology: Seminars and Original Investigations

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“…We recently reported that patients with upper tract UC (UTUC) with divergent differentiation had more biologically aggressive features than did patients with pure UTUC after radical nephroureterectomy (21). UTUC is a potentially lethal disease and is histologically similar to urothelial bladder cancer.…”

Section: Discussionmentioning

confidence: 99%

Impact of divergent differentiation in urothelial carcinoma on oncological outcome in patients with T1 high-grade bladder cancer

Fujii

Hoshii

Hirata

et al. 2017

Japanese Journal of Clinical Oncology

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Objective: T1 high-grade bladder cancer has a poor prognosis compared with other non-muscleinvasive bladder cancers. We investigated the clinical outcomes among patients with T1 highgrade bladder cancer to identify factors related to cancer recurrence and disease progression. Methods: We retrospectively reviewed the data of 148 patients who were diagnosed with T1 highgrade bladder cancer by transurethral resection from January 2001 to February 2015 at our institution. Clinicopathological factors were analyzed using univariate and multivariate analyses. Results: The median age and follow-up duration were 72 years and 45.4 months, respectively. Sixty-two patients (41.9%) had recurrence, 28 (18.9%) experienced progression and 13 (8.8%) died of bladder cancer. In the multivariate analysis, divergent differentiation was an independent factor related to recurrence (P = 0.0096, hazard ratio = 2.5), whereas a non-papillary tumor shape, divergent differentiation and presence of a residual tumor at the time of the second transurethral resection were independent factors related to progression (P = 0.0349, hazard ratio = 3.8; P = 0.0074, hazard ratio = 6.8 and P = 0.0449, hazard ratio = 4.1, respectively). There were no independent factors related to cancer-specific mortality. Divergent differentiation was the only independent factor associated with both recurrence and progression. In addition, patients with divergent differentiation had significantly worse recurrence-free survival and progression-free survival rates than did patients without divergent differentiation (log-rank P = 0.0009 and P = 0.0019, respectively). Conclusions: In this study, the presence of divergent differentiation was related to worse oncological outcomes in patients with T1 high-grade bladder cancer. Patients with divergent differentiation may require stringent follow-up and early cystectomy after recurrence to improve oncological outcomes.

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“…In the present study, selective ureteral cytology was independently associated with the presence of concomitant carcinoma in situ, while voided urine cytology was not (data not shown). According to previous reports, high tumor grade is an independent variable for predicting cancer-specific survival in UTUC, but carcinoma in situ is not (2,6). These might be the reasons why selective ureteral cytology had no additional efficacy for predicting advanced pathology.…”

Section: Resultsmentioning

confidence: 99%

“…Because we only had data from a short follow-up period in some patients, we could not evaluate whether these variables were prognostic factors for the study patients. However, in our previous study using a different cohort, ≥pT3, G3 and LVI were independent predictors for poor disease-specific survival (6).…”

Section: Resultsmentioning

confidence: 99%

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Positive voided urine cytology predicts worse pathological findings of nephroureterectomy specimens in patients with upper tract urothelial carcinoma: does selective ureteral cytology have an additional efficacy?

Sakano

Inamoto

Inoue

et al. 2015

Jpn. J. Clin. Oncol.

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Objective: After radical nephroureterectomy, substantial numbers of patients with upper tract urothelial carcinoma are ineligible for adjuvant chemotherapy owing to diminished renal function. Accurate pre-operative prediction of worse pathological findings in radical nephroureterectomy specimens can guide appropriate patient selection for neoadjuvant chemotherapy. Herein, we evaluated pre-operative voided urine cytology and the additional efficacy of selective ureteral cytology for predicting pathological features in upper tract urothelial carcinoma patients. Methods: This retrospective cohort study comprised 722 patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy. Patients with concomitant bladder cancer and those who received neoadjuvant therapy were excluded. Finally, 437 patients with urinary cytology data were enrolled in the study. We assessed the positive voided urine and selective ureteral cytology for predicting higher pathological T stage (≥pT3), higher tumor grade (3) and positive lymphovascular invasion. Results: Previous bladder cancer, tumor location, clinical T stage and voided urine cytology (P = 0.029) were independently associated with ≥pT3, whereas selective ureteral cytology was not. Gender, clinical N category and voided urine cytology (P = 0.017) were independently associated with tumor Grade 3, whereas selective ureteral cytology was not. Hydronephrosis, clinical T stage, clinical N category and voided urine cytology (P = 0.0021) were independently associated with lymphovascular invasion, whereas selective ureteral cytology was not. Conclusions: Pre-operative positive voided urine cytology was an independent predictor for worse pathological findings in radical nephroureterectomy specimens, while selective ureteral cytology had no additional efficacy. However, further studies with larger numbers of patients and complete data sets are needed to select patients for more aggressive treatments including neoadjuvant chemotherapy.

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Impact of variant histology on disease aggressiveness and outcome after nephroureterectomy in Japanese patients with upper tract urothelial carcinoma

Cited by 39 publications

References 17 publications

Effect of concomitant variant histology on the prognosis of patients with upper urinary tract urothelial carcinoma after radical nephroureterectomy

Effect of concomitant variant histology on the prognosis of patients with upper urinary tract urothelial carcinoma after radical nephroureterectomy

Impact of divergent differentiation in urothelial carcinoma on oncological outcome in patients with T1 high-grade bladder cancer

Positive voided urine cytology predicts worse pathological findings of nephroureterectomy specimens in patients with upper tract urothelial carcinoma: does selective ureteral cytology have an additional efficacy?

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