Prevention of Bladder Tumours after Nephroureterectomy for Primary Upper Urinary Tract Urothelial Carcinoma: A Prospective, Multicentre, Randomised Clinical Trial of a Single Postoperative Intravesical Dose of Mitomycin C (the ODMIT-C Trial)

O’Brien, Tim; Ray, Eleanor; Singh, Rajinder; Coker, Bola; Beard, R.C.

doi:10.1016/j.eururo.2011.05.064

Cited by 293 publications

(227 citation statements)

References 16 publications

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“…A salient feature of our proposed protocol is the lack of chest imaging in low risk disease and more judicious use of abdominal imaging in low and intermediate risk patients. Our results also reiterate the importance of the initial surveillance cystoscopy at the 3-month postoperative time-point, given the evident risk of early bladder recurrence, especially in the absence of post-operative intravesical chemotherapy, which was not used in any of our patients 20 .…”

Section: Cuaj -Original Research Locke Et Al Risk-adapted Post-rnu Sumentioning

confidence: 85%

Surveillance guidelines based on recurrence patterns for upper tract urothelial carcinoma

Locke

Hamidizadeh

Kassouf

et al. 2018

CUAJ

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Introduction: Upper tract urothelial carcinoma (UTUC) accounts for 5% of all urothelial tumours. Due to its rarity, evidence regarding postoperative surveillance is lacking. The objective of this study was to develop a post-radical nephroureterectomy (RNU) surveillance protocol based on recurrence patterns in a large multi-institutional cohort of patients. Methods: Retrospective clinical and pathological data were collected from 1029 patients undergoing RNU over a 15-year period (1994-2009) at 10 Canadian academic institutions. A multivariable model was used to identify prognostic clinicopathological factors, which were then used to define risk categories. Risk-based surveillance guidelines were proposed based on actual recurrence patterns. Results: Overall, 555 (49.9%) patients developed recurrence, including 289 (25.9%) in the urothelium and 266 (23.9%) with loco-regional and distant recurrences. Based on multivariable analysis, three risk groups were identified: 1) low-risk patients with pTa-T1, pN0 disease and no adverse histological features (high tumour grade, lymphovascular invasion [LVI], tumour multifocality); 2) intermediate-risk patients with pTa-T1, pN0 disease with one or more of the adverse histological features; and 3) high-risk patients with a ≥pT2 tumour and/or nodal involvement. Low-, intermediate-, and high-risk patients were free of urothelial recurrence at three years in 72%, 66%, and 63%, respectively, and free of regional/distant recurrence in 93%, 87%, and 62%, respectively. The risks of loco-regional and distant recurrences (p<0.0001) and time to death (p<0.0001) were significantly different between the low-, intermediate-, and highrisk patients.

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Section: Cuaj -Original Research Locke Et Al Risk-adapted Post-rnu Sumentioning

confidence: 85%

Surveillance guidelines based on recurrence patterns for upper tract urothelial carcinoma

Locke

Hamidizadeh

Kassouf

et al. 2018

CUAJ

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“…[35][36][37] It is unknown how the use of postoperative intravesical chemotherapy will affect these results.…”

Section: Discussionmentioning

confidence: 99%

The impact of method of distal ureter management during radical nephroureterectomy on tumour recurrence

Kapoor

Dason

Allard

et al. 2014

CUAJ

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Introduction: Radical nephroureterectomy for upper tract urothelial carcinoma (UTUC) must include some form of distal ureter management to avoid high rates of tumour recurrence. It is uncertain which distal ureter management technique has the best oncologic outcomes. To determine which distal ureter management technique resulted in the lowest tumour recurrence rate, we analyzed a multiinstitutional Canadian radical nephroureterectomy database. Methods: We retrospectively analyzed patients who underwent radical nephroureterectomy with distal ureter management for UTUC between January 1990 and June 2010 at 10 Canadian tertiary hospitals. Distal ureter management approaches were divided into 3 categories: (1) extravesical tenting for ureteric excision without cystotomy (EXTRAVESICAL); (2) open cystotomy with intravesical bladder cuff excision (INTRAVESICAL); and (3) extravesical excision with endoscopic management of ureteric orifice (ENDOSCOPIC). Data available for each patient included demographic details, distal ureter management approach, pathology and operative details, as well as the presence and location of local or distant recurrence. Clinical outcomes included overall recurrence-free survival and intravesical recurrence-free survival. Survival analysis was performed with the Kaplan-Meier method. Multivariable Cox regression analysis was also performed. Results: A total of 820 patients underwent radical nephroureterectomy with a specified distal ureter management approach at 10 Canadian academic institutions. The mean patient age was 69.6 years and the median follow-up was 24.6 months. Of the 820 patients, 406 (49.5%) underwent INTRAVESICAL, 316 (38.5%) underwent EXTRAVESICAL, and 98 (11.9%) underwent ENDOSOPIC distal ureter management. Groups differed significantly in their proportion of females, proportion of laparoscopic cases, presence of carcinoma in situ and pathological tumour stage (p < 0.05). Recurrence-free survival at 5 years was 46.3%, 35.6%, and 30.1% for INTRAVESICAL, EXTRAVESICAL and ENDOSCOPIC, respectively (p < 0.05). Multivariable Cox regression analysis confirmed that INTRAVESICAL resulted in a lower hazard of recurrence compared to EXTRAVESICAL and ENDOSCOPIC. When looking only at intravesical recurrence-free survival (iRFS), a similar trend held up with INTRAVESICAL having the highest iRFS, followed by ENDOSCOPIC and then EXTRAVESICAL management (p < 0.05). At last follow-up, 406 (49.5%) patients were alive and free of disease. Conclusion: Open intravesical excision of the distal ureter (INTRAVESICAL) during radical nephroureterectomy was associated with improved overall and intravesical recurrence-free survival compared with extravesical and endoscopic approaches. These findings suggest that INTRAVESICAL should be considered the gold standard oncologic approach to distal ureter management during radical nephroureterectomy. Limitations of this study include its retrospective design, heterogeneous cohort, and limited follow-up.

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“…31 Other prognostic variables following nephroureterectomy include lymphovascular invasion, concomitant carcinoma in situ (CIS), positive surgical margins, ureteral tumour location (as opposed to renal pelvis), previous or concomitant bladder tumours, tumour multifocality, and lack of postoperative intravesical mitomycin C instillation. 4,6,7,[10][11][12][14][15][16][17][18][19][21][22][23][24]26,[28][29][30][31][32][33][34][35][36][65][66][67][68][69] The rates of recurrence stratified by these variables are seldom reported.…”

Section: Prognostic Variablesmentioning

confidence: 99%

Canadian guidelines for postoperative surveillance of upper urinary tract urothelial carcinoma

Kapoor¹,

Allard²,

Black³

et al. 2013

CUAJ

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Prevention of Bladder Tumours after Nephroureterectomy for Primary Upper Urinary Tract Urothelial Carcinoma: A Prospective, Multicentre, Randomised Clinical Trial of a Single Postoperative Intravesical Dose of Mitomycin C (the ODMIT-C Trial)

Cited by 293 publications

References 16 publications

Surveillance guidelines based on recurrence patterns for upper tract urothelial carcinoma

Surveillance guidelines based on recurrence patterns for upper tract urothelial carcinoma

The impact of method of distal ureter management during radical nephroureterectomy on tumour recurrence

Canadian guidelines for postoperative surveillance of upper urinary tract urothelial carcinoma

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