Significant Predictive Factors for Prognosis of Primary Upper Urinary Tract Cancer after Radical Nephroureterectomy in Taiwanese Patients

Li, Ching-Chia; Chang, Tsung‐Kun; Wu, Wen‐Jeng; Ke, Hung‐Lung; Huang, Shu-Pin; Tsai, Pei‐Chien; Chang, Shun‐Jen; Shen, Jung-Tsung; Chou, Yii‐Her; Huang, Chun‐Hsiung

doi:10.1016/j.eururo.2008.01.054

Cited by 179 publications

(139 citation statements)

References 28 publications

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“…Hisakata et al [5] reported an increased risk of such recurrence after treatment of pathological T2 or higher primary UUT-UC, while some investigators [8,13] identified lower pathological stages as a significant and independent factor for subsequent bladder cancer recurrence. However, key previous studies [6,7,9,10,11,12,14,15,16,17] as well as our data failed to address these statements.…”

Section: Discussioncontrasting

confidence: 55%

“…Table 3summarizes the main identified clinicopathological risk factors for metachronous bladder cancer recurrence after surgical treatment of UUT-UC in previously published articles since 2000 [5,6,7,8,9,10,11,12,13,14,15,16,17]. These studies and our own results show a mean subsequent bladder cancer recurrence rate after surgical management for UUT-UC of 32.7% (range, 21.7–49.5%), and a mean rate of recurrence at 2 years of 82.1% (range, 77–98%) [5,6,8,9,10,11,12,17].…”

Section: Discussionmentioning

confidence: 99%

“…The current mainstay for treating UUC-UC is complete resection of the tumor via nephroureterectomy, with bladder cuff excision to effectively prevent local recurrence in the ipsilateral urothelium [4]. However, 22–50% of patients undergoing surgical treatment for UUT-UC develop subsequent urinary bladder recurrence [5,6,7,8,9,10,11,12,13,14,15,16,17]. Several possible predictive factors for this high incidence of intravesical recurrence (IVR) have been reported including tumor multiplicity [5,6,8,13,17], stage [5,8,13], grade [10,15], size [8], and ureteric location [10], as well as gender [14,15] and surgical modality [8].…”

Section: Introductionmentioning

confidence: 99%

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Intravesical Recurrence after Surgical Management of Urothelial Carcinoma of the Upper Urinary Tract

Hirano¹,

Okada²,

Nagane³

et al. 2012

Urol Int

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Objectives: To elucidate clinicopathological risk factors for intravesical recurrence (IVR) in patients undergoing nephroureterectomy for upper urinary tract urothelial carcinoma (UUT-UC). Methods: We identified a study population of 151 consecutive patients without previous or concurrent bladder cancer who underwent nephroureterectomy for UUT-UC. IVR was assessed in relation to tumor location, size, and multifocality, operation modality and time, stage, grade, lymphovascular invasion, regional lymph node metastasis, preoperative urinary cytology, and perioperative chemotherapy. The median follow-up time was 24 months. Results: Of 151 patients, 51 (34%) developed IVR after nephroureterectomy, and 50 (98%) of the patients presented with IVR within 2 years. Tumor multifocality and site (located in ureter) were determined as risk factors for IVR by univariate analysis. In a multivariate analysis, only tumor multifocality (relative risk: 4.024, p = 0.001) was an independent predictor of IVR. Ten-year cancer-specific survival rates for the patients with and without IVR were 68 and 52%, respectively (p = 0.06). Conclusions: Tumor multifocality is a significant risk factor in developing IVR after surgery for UUT-UC. These results indicate that despite most IVR occurring within 2 years of treatment, it is necessary to follow such patients more closely using cystoscopy. However, IVR is unlikely to indicate a poorer prognosis.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intravesical Recurrence after Surgical Management of Urothelial Carcinoma of the Upper Urinary Tract

Hirano¹,

Okada²,

Nagane³

et al. 2012

Urol Int

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“…The risk factors for intravesical recurrence after nephroureterectomy have not been fully elucidated. In the related literature, the prognostic variables for bladder cancer after managing upper tract urothelial cancer focused largely on the clinical and pathological characteristics of upper urinary tract cancer, without consistent results [6,7,8,9,10,11]. A history of bladder cancer prior to UUTC management and upper tract tumor multifocality are the frequently reported clinical risk factors [7].…”

Section: Discussionmentioning

confidence: 99%

Impact of Earlier Ureteral Ligation on Intravesical Recurrence during Hand-Assisted Retroperitoneoscopic Nephroureterectomy

Ou¹,

Yang²

2013

Urol Int

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Objective: To determine the impact of earlier ureteral ligation (EUL) during hand-assisted retroperitoneoscopic nephroureterectomy (HARN) for primary renal pelvis urothelial cancer. Methods: We retrospectively reviewed 240 patients with upper urinary tract urothelial cancer who underwent HARN. Only patients with primary renal pelvis urothelial cancer and complete follow-up with a minimum of 1 year after HARN were enrolled into our study. We defined EUL as ligating the ureter prior to pneumoretroperitoneum and mobilizing the kidney during the surgery. Of these 61 patients, 31 (who composed the study group) underwent EUL, while 30 serving as controls were without ureteral ligation during the surgery. We analyzed intravesical recurrence utilizing log rank testing to assess the significance between the two groups. Results: Clinical parameters were similar between the two groups. The median follow-up after HARN was 39.7 months (range 12-96). There was no significant difference in the rate of intravesical recurrence and cancer-specific survival. However, patients without ligation of the ureter had shorter time to first bladder tumor recurrence (11.7 ± 9.1 months vs. 26.4 ± 19.1 months, p = 0.03). Conclusion: EUL during HARN for primary renal urothelial cancer did not affect intravesical recurrence rate or cancer-specific survival.

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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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Significant Predictive Factors for Prognosis of Primary Upper Urinary Tract Cancer after Radical Nephroureterectomy in Taiwanese Patients

Cited by 179 publications

References 28 publications

Intravesical Recurrence after Surgical Management of Urothelial Carcinoma of the Upper Urinary Tract

Intravesical Recurrence after Surgical Management of Urothelial Carcinoma of the Upper Urinary Tract

Impact of Earlier Ureteral Ligation on Intravesical Recurrence during Hand-Assisted Retroperitoneoscopic Nephroureterectomy

Canadian guidelines for postoperative surveillance of upper urinary tract urothelial carcinoma

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