Outcomes of radical nephroureterectomy: A series from the Upper Tract Urothelial Carcinoma Collaboration

Margulis, Vitaly; Shariat, Shahrokh F.; Matin, Surena F.; Kamat, Ashish M.; Zigeuner, Richard; Kikuchi, Eiji; Lotan, Yair; Weizer, Alon Z.; Raman, Jay D.; Wood, Christopher G.

doi:10.1002/cncr.24135

Cited by 1,002 publications

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“…[5][6][7] In contrast, retroperitoneal or pelvic lymph node dissection is not uniformly performed for UTUC. 2,3,[8][9][10] Likewise, the management of patients with invasive bladder cancer at risk for recurrence typically involves radical cystectomy and perioperative cisplatin-based combination chemotherapy (CBCC), in either the neoadjuvant or the adjuvant setting. Few patients with UTUC receive neoadjuvant or adjuvant CBCC and there is a paucity of evidence in the literature (either from retrospective series or clinical trials) of a benefit.…”

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confidence: 99%

Chronic kidney disease after nephroureterectomy for upper tract urothelial carcinoma and implications for the administration of perioperative chemotherapy

Lane

Smith

Larson

et al. 2010

Cancer

195

117

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BACKGROUND:The prevalence of chronic kidney disease (CKD) in patients with upper tract urothelial carcinoma (UTUC) is poorly defined, both before and after nephrouretectomy. Although multimodal treatment paradigms for UTUC are under‐developed, this has important implications on patients' ability to receive cisplatin‐based combination chemotherapy (CBCC).METHODS:Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease formula in 336 patients with UTUC, who were treated at the Cleveland Clinic by nephroureterectomy since 1992. An eGFR cutoff of 60 mL/min/1.73 m2 was used to determine the presence of CKD and eligibility for CBCC.RESULTS:Median age was 72 years and median preoperative eGFR was 59 mL/min/1.73m2. Before nephroureterectomy, only 48% of patients were eligible to receive CBCC and this decreased to 22% postoperatively (P < .001). In the 144 patients with pT2‐pT4 and/or pN1‐pN3 disease who are suitable to receive CBCC, these proportions were 40% and 24%, respectively (P = .009). Although 50 patients overall received some form of perioperative chemotherapy, only 3 and 11 patients received neoadjuvant and adjuvant CBCC, respectively.CONCLUSIONS:CKD is prevalent in the UTUC population and a minority of patients has an optimal eGFR to receive neoadjuvant CBCC. Nephrouretectomy may eliminate CBCC as a therapeutic option in 49% of high‐risk patients if it is deferred to the adjuvant setting. Multimodal treatment strategies for UTUC should focus on neoadjuvant chemotherapy, as few patients are eligible for adjuvant CBCC because of the substantial decline in eGFR caused by nephroureterectomy. Cancer 2010. © 2010 American Cancer Society.

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confidence: 99%

Chronic kidney disease after nephroureterectomy for upper tract urothelial carcinoma and implications for the administration of perioperative chemotherapy

Lane

Smith

Larson

et al. 2010

Cancer

195

117

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“…Pathologic stage remains the most important predictor of survival after RnU, roughly doubling the risk of disease recurrence or death at each increment of pathologic T stage (2)(3)(4). In this multicenter retrospective analysis, T4 UTUC was associated with aggressive pathological features such as LVI, tumor necrosis, sessile architecture, concomitant CIS and regional lymph node metastases (2,3).…”

Section: Discussionmentioning

confidence: 99%

“…nodal status was found to be one of the most important predictors of oncologic outcomes for urothelial cancers (4,16,(19)(20)(21)(22). Inadequate LnD during radical surgery for urothelial cancer may underestimate the disease burden and preclude administration of adjunct systemic chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Radical nephroureterectomy (RnU) with excision of an ipsilateral bladder cuff remains the gold standard treatment for patients with invasive UTUC. Pathological stage is the most important predictor of oncologic outcomes in UTUC with dismal survival rates despite radical surgery for patients harboring T4 tumors (2)(3)(4). Therefore, patients with T4 UTUC represent a challenging cohort of patients, with limited data to guide selection of optimal therapy to maximize oncological outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Radical nephroureterectomy for pathologic T4 upper tract urothelial cancer: can oncologic outcomes be improved with multimodality therapy?

et al. 2013

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Purpose: To report the outcomes of patients with pathologic T4 UTUC and investigate the potential impact of peri-operative chemotherapy combined with radical nephroureterectomy (RnU) and regional lymph node dissection (LnD) on oncologic outcomes. Materials and Methods: Patients with pathologic T4 UTUC were identified from the cohort of 1464 patients treated with RnU at 13 academic centers between 1987 and 2007. Oncologic outcomes were stratified according to utilization of perioperative systemic chemotherapy and regional LnD as an adjunct to RnU. Results: The study included 69 patients, 42 males (61%) with median age 73 (range 43-98). Median follow-up was 17 months (range: 6-88). Lymphovascular invasion was found in 47 (68%) and regional lymph node metastases were found in 31 (45%). Peri--operative chemotherapy was utilized in 29 (42%) patients. Patients treated with peri--operative chemotherapy and RnU with LnD demonstrated superior oncologic outcomes compared to those not treated by chemotherapy and/or LnD during RnU (3Y-DFS: 35% vs. 10%; P = 0.02 and 3Y-CSS: 28% vs. 14%; P = 0.08). In multivariate Cox regression analysis, administration of peri-operative chemotherapy and utilization of LnD during RnU was associated with lower probability of recurrence (HR: 0.4, P = 0.01), and cancer specific mortality (HR: 0.5, P = 0.06). Conclusions: Pathological T4 UTUC is associated with poor prognosis. Peri-operative chemotherapy combined with aggressive surgery, including lymph node dissection, may improve oncological outcomes. Our findings support the use of aggressive multimodal treatment in patients with advanced UTUC.

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“…Advanced age, presence of lymphovascular invasion, presence of necrosis, sessile growth pattern of the tumor, and presence of CIS may predict poor prognosis (1). Radical nephroureterectomy with excision of the bladder cuff is the gold standard treatment for UTUCs, regardless of the location of theatumor in the upper urinary tract (7). All patients should be followed up after radical nephroureterectomy for possible development of metachronous bladder tumor.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Role of F-18 Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography in Restaging of Upper Urinary Tract Urothelial Carcinoma

Öztürk¹

2017

jus

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18FDG-PET/CT was performed for re-staging 6-24 months after nephroureterectomy (mean: 18 months). Nearly 1 hour after intravenous injection of 555 MBq of F-18 FDG, the patients underwent whole-body PET scanning from the skull base to the upper thighs after 6 hours of fasting, and nearly 1 hour after all body CT scanning performed in the craniocaudal direction. By using CT data for attenuation correction, FDG-PET images were reconstructed. Results:18 FDG-PET/CT scans proved negative findings in three patients (17.7%) and positive findings in 14 patients (82.3%). Suspicious recurrent or metastatic lesions were confirmed by histopathology or clinical follow-up. Sensitivity of 18 FDG-PET/CT was 93% and the specificity was 75%. Conclusion:18 FDG-PET/CT defines local recurrence and far metastases with high specificity in re-staging of operated UTUC. It is thought that the procedure could play an important role in decisions regarding radiotherapy or chemotherapy and post-operative follow-up after the operation and could affect the whole decision-making process. Keywords: Upper urinary tract urothelial carcinoma, positron-emission tomography, positron-emission tomography/computed tomography, restaging 18 FDG-PET/BT çalışması nefroüreterektomi sonrası 6-24 ay sonra (ortalama 18 ay) yapıldı. Hastalar taramadan önce 6 saat boyunca aç bırakıldı ve kafa tabanından üst uyluk bölgesine kadar olan alanda F-18 FDG 555 MBq intravenöz enjeksiyonundan yaklaşık 1 saat sonra tüm vücut PET taraması yapıldı. Tüm vücut BT taraması kraniokaudal yönünde yapıldı. FDG-PET imajları doğrulama için BT dataları kullanılarak rekonstrükte edildi. ÖzWhat's known on the subject? and What does the study add?There are quite few data in the literature about re-staging of upper urinary tract urothelial carcinoma with positron-emission tomography/ computed tomography (PET/CT). We may see in the study that PET/CT detects local recurrence and distant metastasis with high specificity.

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Outcomes of radical nephroureterectomy: A series from the Upper Tract Urothelial Carcinoma Collaboration

Abstract: , and the Upper TractUrothelial Carcinoma Collaboration BACKGROUND: The literature on upper tract urothelial carcinoma (UTUC) has been limited to small, single center studies. A large series of patients treated with radical nephroureterectomy for UTUC were studied,

Cited by 1,002 publications

References 33 publications

Chronic kidney disease after nephroureterectomy for upper tract urothelial carcinoma and implications for the administration of perioperative chemotherapy

Chronic kidney disease after nephroureterectomy for upper tract urothelial carcinoma and implications for the administration of perioperative chemotherapy

Radical nephroureterectomy for pathologic T4 upper tract urothelial cancer: can oncologic outcomes be improved with multimodality therapy?

Diagnostic Role of F-18 Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography in Restaging of Upper Urinary Tract Urothelial Carcinoma

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