Novel Classification for Upper Tract Urothelial Carcinoma to Better Risk-stratify Patients Eligible for Kidney-sparing Strategies: An International Collaborative Study

Marcq, Gautier; Foerster, Beat; Abufaraj, Mohammad; Matin, Surena F.; Azizi, Mounsif; Gupta, Mohit; Li, Wei Ming; Seisen, Thomas; Clinton, Timothy; Xylinas, Évanguelos; Mir, Maria Carmen; Schweitzer, D.G.; Mari, Andrea; Kimura, Shoji; Bandini, Marco; Mathiéu, Romain; Ku, Ja Hyeon; Guruli, Georgi; Grabbert, Markus; Czech, Anna; Muilwijk, Tim; Pycha, Armin; D’Andrea, David; Petros, Firas; Spiess, Philippe E.; Bivalacqua, Trinity J.; Wu, Wen Jeng; Rouprêt, Morgan; Krabbe, Laura Maria; Hendricksen, Kees; Egawa, Shin; Briganti, Alberto; Moschini, Marco; Graffeille, V.; Autorino, Riccardo; John, Patricia; Heidenreich, Axel; Chłosta, Piotr; Joniau, Steven; Soria, Francesco; Pierorazio, Phillip M.; Kassouf, Wassim

doi:10.1016/j.euf.2021.03.018

Cited by 21 publications

(13 citation statements)

References 28 publications

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“…However, this survival correlation was not observed in our analysis. 18–21 Previous studies noted that hydronephrosis was correlated with advanced pathological tumor stage and lymphovascular invasion but not with CSS, 22,23 and our data support these findings. Regarding tumor grade, two- or three-tiered tumor grading was shown to be an independent predictor for survival.…”

Section: Discussionsupporting

confidence: 87%

Concomitant carcinoma in situ is an independent prognostic predictor for patients with localized lymph node–negative upper-tract urothelial carcinoma undergoing nephroureterectomy

Cheng

Chung

Tsai

2021

Journal of Clinical Urology

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Purpose: This study aimed to determine the predictive value of concomitant carcinoma in situ (CIS) for cancer-specific survival (CSS) in patients with upper-tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy. Methods: This was a retrospective analysis of the clinicopathological features in a cohort of 126 patients with localized lymph node–negative UTUC who underwent radical nephroureterectomy with bladder-cuff excision in a tertiary medical center between January 1, 2007, and June 30, 2018. Cox proportional hazards models were used to identify risk factors for CSS in UTUC. Additionally, Kaplan–Meier analyses were performed in subgroups according to pathological tumor stage. Results: The median age and follow-up duration were 70 years and 3.5 years, respectively. Concomitant CIS, which was present in 21% of the patient specimens, was not associated with most clinical or pathological features, except for lymphovascular invasion and multifocality. Concomitant CIS (adjusted hazard ratio (HR)=4.64, 95% confidence interval (CI) 1.78–12.06, p=0.002) and pathological tumor stage (adjusted HR=4.07, 95% CI 1.99–8.31, p<0.001) were significantly associated with CSS in the multivariate Cox regression model. In the subgroup analysis, concomitant CIS in patients with locally advanced (pT3/pT4) UTUC was associated with significantly worse CSS compared to those without CIS (HR=3.83, 95% CI 1.20–12.21). Conclusion: The pathological presence of concomitant CIS was independently associated with poor CSS in patients with localized lymph node–negative UTUC undergoing radical nephroureterectomy. These findings provide crucial information relevant for postoperative patient counseling, use of adjuvant therapy, follow-up intensity, and clinical trial enrollment. Level of evidence Level II.

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Section: Discussionsupporting

confidence: 87%

Concomitant carcinoma in situ is an independent prognostic predictor for patients with localized lymph node–negative upper-tract urothelial carcinoma undergoing nephroureterectomy

Cheng

Chung

Tsai

2021

Journal of Clinical Urology

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“…Nonetheless, high-risk UTUC is a heterogenous group of tumors and it can be hypothesized that we report here a selected cohort of DU for high risk. New risk stratification models are being developed [ 12 , 13 , 14 ], in line with this observation, helping in the future to better refine treatment indications in high-risk tumors.…”

Section: Discussionmentioning

confidence: 99%

Oncological Outcomes of Distal Ureterectomy for High-Risk Urothelial Carcinoma: A Multicenter Study by The French Bladder Cancer Committee

Masson-Lecomte

Vaillant

Roumiguié

et al. 2022

Cancers

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Upper urinary tract urothelial carcinoma (UTUC) is an uncommon disease and its gold-standard treatment is radical nephroureterectomy (RNU). Distal ureterectomy (DU) might be an alternative for tumors of the distal ureter but its indications remain unclear. Here, we aimed to evaluate the oncological outcomes of DU for UTUC of the pelvic ureter. We performed a multicenter retrospective analysis of patients with UTUC who underwent DU. The primary endpoint was 5-year cancer-specific survival (CSS), followed by overall survival (OS), intravesical recurrence-free (IVR) and homolateral urinary tract recurrence-free (HUR) survivals as secondary endpoints. Univariate and multivariate Cox regressions were performed to assess factors associated with outcomes. 155 patients were included, 91% of which were high-risk. 5-year CSS was 84.4%, OS was 71.9%, IVR-free survival was 43.6% and HUR-free survival was 74.4%. Multifocality, high grade and tumor size were the most significant predictors of survival endpoints. Of note, neither hydronephrosis nor pre-operative diagnostic ureteroscopy/JJ stent were associated with any of the endpoints. Perioperative morbidity was minimal. In conclusion, DU stands as a possible alternative to RNU for UTUC of the pelvic ureter. Close monitoring is mandatory due to the high risk of recurrence in the remaining urinary tract.

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“…Besides, Xu et al (33) demonstrated that CONUT score was an independent predictor for CSS, RFS and OS. Moreover, Marcq et al (34) performed an international collaborative study to evaluate the predictive value of a new classification of UTUC for kidney-sparing surgery. They found that the higher age, biopsy, high-grade cytology, sessile tumor, hydronephrosis and non-organ-confined disease on preoperative imaging were independently associated with muscle invasion at RNU (34).…”

Section: Discussionmentioning

confidence: 99%

The Impact of Diabetes on the Prognosis of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy: A Systematic Review and Meta-Analysis

Gao

Zhou

et al. 2021

Front. Oncol.

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BackgroundStudies have reported that diabetes is related to the prognosis of upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU), but this conclusion is still controversial. Here, we performed a meta-analysis to comprehensively explore the association between diabetes and UTUC prognosis.MethodsIn November 2020, we searched PubMed, Web of science and the Cochrane Library to find relevant studies that evaluated the effect of diabetes on the prognosis of UTUC. The Newcastle Ottawa Scale was used to assess the quality of the literature. Review Manager 5.3 was used to pool cancer-specific survival (CSS), overall survival (OS), recurrence-free survival (RFS) and intravesical recurrence (IVR).ResultsA total of 10 studies with 11,303 patients were included in this meta-analysis. Our pooled results showed that diabetes did not affect the survival outcome of UTUC, including CSS (HR: 1.33, 95% CI: 0.89-1.98; P = 0.16), OS (HR: 1.18, 95% CI: 0.77-1.80; P = 0.45) and RFS (HR: 1.37, 95% CI: 0.91-2.05; P = 0.13). However, diabetes increased the risk of IVR of UTUC patients (HR: 1.26, 95% CI: 1.11-1.43; P = 0.0004).ConclusionAlthough diabetes has no significant impact on the survival outcomes of UTUC after RNU, it increases the risk of IVR. Therefore, special attention should be paid to monitoring the IVR for UTUC patients with diabetes and the necessity of appropriate intravesical adjuvant treatment when needed.

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Novel Classification for Upper Tract Urothelial Carcinoma to Better Risk-stratify Patients Eligible for Kidney-sparing Strategies: An International Collaborative Study

Cited by 21 publications

References 28 publications

Concomitant carcinoma in situ is an independent prognostic predictor for patients with localized lymph node–negative upper-tract urothelial carcinoma undergoing nephroureterectomy

Concomitant carcinoma in situ is an independent prognostic predictor for patients with localized lymph node–negative upper-tract urothelial carcinoma undergoing nephroureterectomy

Oncological Outcomes of Distal Ureterectomy for High-Risk Urothelial Carcinoma: A Multicenter Study by The French Bladder Cancer Committee

The Impact of Diabetes on the Prognosis of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy: A Systematic Review and Meta-Analysis

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