Outcome of Surgical Treatment of Patients with Upper versus Lower Urinary Tract Urothelial Carcinoma: Stage-by-Stage Comparison

Moussa, Sabri; Yafi, Faysal A.; El-Hakim, Assaad; Fahmy, Nader; Aprikian, Armen; Tanguay, Simon; Anidjar, Maurice; Kassouf, Wassim

doi:10.1159/000273466

Cited by 25 publications

(17 citation statements)

References 39 publications

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“…The highest risk of UUTR has been reported in patients with a positive surgical margin involving the anastomosis of the ureter and the urinary diversion. Since patients with UUTR after RC tend to have a worse outcome than those with initial tumour of the upper urinary tract achieving negative ureteral surgical margins is viewed as paramount [1,2,3], although it was shown that invasive urothelial cancer of the upper urinary tract appears to have similar tumour biology and outcome compared to BC of the lower urinary tract [8]. …”

Section: Discussionmentioning

confidence: 99%

Frozen Section Analysis of Ureteral Margins in Patients Undergoing Radical Cystectomy for Bladder Cancer: Differential Impact of Carcinoma in situ in the Bladder on Reliability and Impact on Tumour Recurrence in the Upper Urinary Tract

Loeser¹,

Katzenberger²,

Vergho³

et al. 2013

Urol Int

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Background: Patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) are at risk for upper urinary tract recurrence (UUTR), especially in case of carcinoma in situ (CIS). Data on the impact of CIS in the urinary bladder on ureteral tumour involvement or UUTR are conflicting. We presently evaluate the accuracy of intraoperative frozen section analysis (FSA) of the ureteral margin, the incidence of ureteral tumour involvement and their impact on UUTR in patients undergoing RC for UCB with versus without CIS of the bladder. Material and Methods: Between 2003 and 2007, 243 patients underwent RC in our department. 176 of these for UCB, either without CIS (n = 117, group I) or solitary/concomitant CIS (n = 59, group II). FSA was performed. Patients were followed up for UUTR. Results: Overall, 403 ureteral margins - including re-resections - were analysed (group I, n = 232; group II, n = 171). One patient (0.85%) in group I and 21 patients (35.6%) in group II had tumour involvement of the ureter (p < 0.0001) at the time of RC. The false-negative rate of FSA compared to final histopathology was 0.4% (1/232) for group I and 2.9% (5/171) for group II, respectively. Mean duration of follow-up was 26 months (1-72). In group II, 2 patients (1.1%) had UUTR in the follow-up; both had initially positive and subsequently false-negative FSA. Conclusions: Tumour involvement of the ureter is found significantly more often in solitary or concomitant CIS of the bladder. Intraoperative ureteral FSA is accurate and should be recommended in these patients. Ureteral tumour involvement predisposes to UUTR especially with initial positive margins mandating careful follow-up.

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Section: Discussionmentioning

confidence: 99%

Frozen Section Analysis of Ureteral Margins in Patients Undergoing Radical Cystectomy for Bladder Cancer: Differential Impact of Carcinoma in situ in the Bladder on Reliability and Impact on Tumour Recurrence in the Upper Urinary Tract

Loeser¹,

Katzenberger²,

Vergho³

et al. 2013

Urol Int

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“…An additional advantage of administering chemotherapy in the preoperative setting is that the patient has better renal function before RNU, thus allowing administration of cisplatin-based therapy. In patients with bladder cancer, neoadjuvant chemotherapy has also been shown to improve survival [22], and it has been postulated that this benefit may be extrapolated to patients with UTUC [19,23]. Investigators have also shown a survival benefit for more extensive lymphadenectomy in patients with UTUC with locally advanced disease [24].…”

Section: Introductionmentioning

confidence: 99%

Combining imaging and ureteroscopy variables in a preoperative multivariable model for prediction of muscle‐invasive and non‐organ confined disease in patients with upper tract urothelial carcinoma

et al. 2011

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Objective To create a preoperative multivariable model to identify patients at risk of muscle-invasive (pT2+) upper tract urothelial carcinoma (UTUC) and/or non-organ confined (pT3+ or N+) UTUC (NOC-UTUC) who potentially could benefit from radical nephroureterectomy (RNU), neoadjuvant chemotherapy and/or an extended lymph node dissection. Patients and Methods We retrospectively analysed data from 324 consecutive patients treated with RNU between 1995 and 2008 at a tertiary cancer centre. Patients with muscle-invasive bladder cancer were excluded, resulting in 274 patients for analysis. Logistic regression models were used to predict pT2+ and NOC-UTUC. Pre-specified predictors included local invasion (i.e. parenchymal, renal sinus fat, or periureteric) on imaging, hydronephrosis on imaging, high-grade tumours on ureteroscopy, and tumour location on ureteroscopy. Predictive accuracy was measured by the area under the curve (AUC). Results The median follow-up for patients without disease recurrence or death was 4.2 years. Overall, 49% of the patients had pT2+, and 30% had NOC-UTUC at the time of RNU. In the multivariable analysis, only local invasion on imaging and ureteroscopy high grade were significantly associated with pathological stage. AUC to predict pT2+ and NOC-UTUC were 0.71 and 0.70, respectively. Conclusions We designed a preoperative prediction model for pT2+ and NOC-UTUC, based on readily available imaging and ureteroscopic grade. Further research is needed to determine whether use of this prediction model to select patients for conservative management vs RNU, neoadjuvant chemotherapy, and/or extended lymphadenectomy will improve patient outcomes.

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“…Rink et al found stage-specific different oncologic outcomes between UTUC and UCB following radical surgery, 9 whereas others reported comparable oncologic outcomes. 16 Nevertheless, studies showed that OS from the time of upper tract recurrence after RC was poor, and median OS was 0.8 to 4.6 years with most patients dying of metastatic disease. 2, 3, 17 Favaretto et al previously reported the 5-year CSS of 78% in patients with primary UTUC at our institution, excluding patients with previous or concurrent RC.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes in Patients with Panurothelial Carcinoma Treated with Radical Nephroureterectomy Following Cystectomy for Metachronous Recurrence

Assel

Benfante

et al. 2017

Journal of Urology

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Purpose We report pathologic, functional, and oncologic outcomes in patients treated with radical nephroureterectomy following radical cystectomy. Materials and Methods We identified patients who underwent radical cystectomy then radical nephroureterectomy for metachronous urothelial recurrence at our institution between January 1995 and December 2014. Univariable Cox regression was used to assess the association between overall survival and age, grade, stage, lymph node metastasis, and radiographic findings. Results Of the 3173 radical cystectomy patients, 64 underwent subsequent radical nephroureterectomy for metachronous urothelial recurrence. Median age at radical cystectomy was 66 years (IQR 61–74). Of the 64 who underwent radical nephroureterectomy, the median time from radical cystectomy to radical nephroureterectomy was 2.7 years (IQR: 1.4–4.6). Among 37 patients that underwent ureteroscopy prior to radical nephroureterectomy, 29 (78%) had positive biopsy. Radical nephroureterectomy pathology revealed 39% locally advanced disease (pT3/pT4) and 11% positive node status compared with 17% locally advanced disease, and 6% positive node status from radical cystectomy pathology. Post- radical nephroureterectomy eGFR was <60 mL/min/1.73m2 and <30 mL/min/1.73m2 for 96% and 40% of patients, respectively. Median overall survival from radical nephroureterectomy was 3.1 years (95% CI: 2.4–4.3). Only lymph node involvement on radical nephroureterectomy was significantly associated with worse overall mortality (HR=2.73, 95% CI 1.04, 7.15, p=0.041). Conclusions Prognosis is poor for patients with panurothelial carcinoma treated with nephroureterectomy following cystectomy, with locally advanced disease in a large proportion of patients. Renal function after these procedures diminished and almost all patients were ineligible for cisplatin-based chemotherapy.

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Outcome of Surgical Treatment of Patients with Upper versus Lower Urinary Tract Urothelial Carcinoma: Stage-by-Stage Comparison

Cited by 25 publications

References 39 publications

Frozen Section Analysis of Ureteral Margins in Patients Undergoing Radical Cystectomy for Bladder Cancer: Differential Impact of Carcinoma in situ in the Bladder on Reliability and Impact on Tumour Recurrence in the Upper Urinary Tract

Frozen Section Analysis of Ureteral Margins in Patients Undergoing Radical Cystectomy for Bladder Cancer: Differential Impact of Carcinoma in situ in the Bladder on Reliability and Impact on Tumour Recurrence in the Upper Urinary Tract

Combining imaging and ureteroscopy variables in a preoperative multivariable model for prediction of muscle‐invasive and non‐organ confined disease in patients with upper tract urothelial carcinoma

Clinical Outcomes in Patients with Panurothelial Carcinoma Treated with Radical Nephroureterectomy Following Cystectomy for Metachronous Recurrence

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