The Impact of Upper Tract Urothelial Carcinoma Diagnostic Modality on Intravesical Recurrence after Radical Nephroureterectomy: A Single Institution Series and Updated Meta-Analysis

Vp, Sharma; Miest, Tanner; Juvet, Tristan; Toussi, Amir; Packiam, Vignesh T.; Chamie, Karim; Matin, Surena F.; Boorjian, Stephen A.; Thompson, R. Houston; Frank, Igor; Tollefson, Matthew K.; Potretzke, Aaron M.

doi:10.1097/ju.0000000000001834

Cited by 50 publications

(88 citation statements)

References 29 publications

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“…The median or mean age of patients in included studies ranged from 63.8 to 73 years, with no statistically significant differences observed between URS (+) and URS (-) groups. The male predominance was reported in twelve [11][12][13][14][15][16]18,[22][23][24][25][26] out of sixteen articles. Six studies [11,13,16,18,19,23] presented populations without history of bladder cancer prior to RNU.…”

Section: Clinicopathological Characteristics Of Included Studiesmentioning

confidence: 97%

“…In accordance with the study inclusion criteria, 12 and 4 articles were excluded for insufficient outcome and inclusion of patients who received tumour ablation during URS, respectively. Finally, sixteen studies were included in this systematic review and meta-analysis [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26].…”

Section: Literature Selectionmentioning

confidence: 99%

“…Among a total of 5489 patients in the selected papers, 2387 (43.4%) and (%) underwent diagnostic URS before RNU [URS (+) group] and 3102 (56.6%) did not [URS (-) group]. Geographically, nine studies were conducted in Asia [13,15,[17][18][19][20][21]25,26], four in North America [12,14,23,24], and three in Europe [11,16,22]. Included articles reported cases from the year 1985 to 2019.…”

Section: Baseline Characteristics Of Included Studiesmentioning

confidence: 99%

“…The median follow-up periods for whole or individual cohorts ranged from 21.4 months to 76.8 months. Among sixteen selected papers, thirteen provided data regarding IVRFS [11,13,[15][16][17][18][19][20][21][23][24][25][26] whilst seven [13,15,17,[20][21][22][23], seven [12,13,14,17,21,23,24] and five [14,17,20,22,23] studies reported CSS, OS and MFS, respectively.…”

Section: Baseline Characteristics Of Included Studiesmentioning

confidence: 99%

“…Six studies [11,13,16,18,19,23] presented populations without history of bladder cancer prior to RNU. The proportion of patients with history of bladder cancer in ten remaining articles [12,14,15,17,20,21,22,24,25,26] ranged from 4.5% -42.7% and 0% -44% in URS (+) and URS (-) groups, respectively. In four [12,17,21,26] out of sixteen articles all patients underwent URS with biopsy, whilst in eight articles [11,15,16,18,20,22,24,25] biopsy rates during URS ranged from 59.5% to 92.6%.…”

Section: Clinicopathological Characteristics Of Included Studiesmentioning

confidence: 99%

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The Impact of Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma: A Comprehensive Systematic Review and Meta-analysis

Nowak

Krajewski

Chorbińska

et al. 2021

Preprint

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Background: The incidence of intravesical recurrence (IVR) following radical nephroureterectomy (RNU) is reported in up to 50% of patients with upper tract urothelial carcinoma (UTUC). It was suggested that preoperative diagnostic ureteroscopy (URS) could increase the IVR rate after RNU, however, the available data are often conflicting. Thus, in this systematic review and meta-analysis we sought to synthesize that available data for the impact of pre-RNU URS for UTUC on IVR and other oncological outcomes; Materials and methods: A systematic literature search of the PubMed, Embase and Cochrane Library databases was performed in June 2020. Cumulative analyses of hazard ratios (HRs) and their corresponding 95% confidence intervals (CI) were conducted. The primary endpoint was intravesical recurrence-free survival (IVRFS), with the secondary endpoints being cancer-specific survival (CSS), overall survival (OS), and metastasis-free survival (MFS); Results: Among a total of 5489 patients included in the sixteen selected papers, 2387 (43.4%) underwent diagnostic URS before RNU and 3102 (56.6%) did not. Pre-RNU diagnostic URS was significantly associated with worse IVRFS after RNU (HR=1.44, 95% CI: 1.29-1.61, p&lt;0.001) than RNU alone. However, subgroup analysis including patients without biopsy during URS revealed no significant impact of diagnostic URS on IVRFS (HR=1.28, 95% CI: 0.90-1.80, p=0.16). The results of other analyses showed no significant differences in CSS (HR=0.94, p=0.63), OS (HR: 0.94, p=0.56), and MFS (HR: 0.91, p=0.37) between patients who underwent URS before RNU and those who did not. Conclusions: The results of this meta-analysis confirm that diagnostic URS prior to RNU is significantly associated with worse IVRFS, albeit with no concurrent impact on the other long-term survival outcomes. Our results indicate that URS has a negative impact on IVRFS only when combined with endoscopic biopsy. Future studies are warranted to assess the role of immediate postoperative intravesical chemotherapy in patients undergoing biopsy during URS for suspected UTUC.

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Section: Clinicopathological Characteristics Of Included Studiesmentioning

confidence: 97%

Section: Literature Selectionmentioning

confidence: 99%

Section: Baseline Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Baseline Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Clinicopathological Characteristics Of Included Studiesmentioning

confidence: 99%

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The Impact of Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma: A Comprehensive Systematic Review and Meta-analysis

Nowak

Krajewski

Chorbińska

et al. 2021

Preprint

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A computed tomography urography‐based machine learning model for predicting preoperative pathological grade of upper urinary tract urothelial carcinoma

Zheng,

Shi,

et al. 2024

Cancer Medicine

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ObjectivesDevelopment and validation of a computed tomography urography (CTU)‐based machine learning (ML) model for prediction of preoperative pathology grade of upper urinary tract urothelial carcinoma (UTUC).MethodsA total of 140 patients with UTUC who underwent CTU examination from January 2017 to August 2023 were retrospectively enrolled. Tumor lesions on the unenhanced, medullary, and excretory periods of CTU were used to extract Features, respectively. Feature selection was screened by the Pearson and Spearman correlation analysis, least absolute shrinkage and selection operator algorithm, random forest (RF), support vector machine (SVM), and eXtreme Gradient Boosting (XGBoost). The logistic regression (LR) was used to screen for independent influencing factors of clinical baseline characteristics. Machine learning models based on different feature datasets were constructed and validated using algorithms such as LR, RF, SVM, and XGBoost. By computing the selected features, a radiomics score was generated, and a diverse feature dataset was constructed. Based on the training set, 16 ML models were created, and their performance was evaluated using the validation set for metrics including sensitivity, specificity, accuracy, area under the receiver operating characteristic curve (AUC), and others.ResultsThe training set consisted of 98 patients (mean age: 64.5 ± 10.5 years; 30 males), whereas the validation set consisted of 42 patients (mean age: 65.3 ± 9.78 years; 17 males). Hydronephrosis was the best independent influence factor (p < 0.05). The RF model had the best performance in predicting high‐grade UTUC, with AUC of 0.914 (95% Confidence Interval [95%CI] 0.852–0.977) and 0.903 (95%CI 0.809–0.997) in the training set and validation set, and accuracy of 0.878 and 0.857, respectively.ConclusionsAn ML model based on the RF algorithm exhibits excellent predictive performance, offering a non‐invasive approach for predicting preoperative high‐grade UTUC.

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Treatment advances improve survival in upper tract urothelial carcinoma

Shepherd,

Kovacic,

Dhar

2024

Trends Urol & Men's Health

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The Impact of Upper Tract Urothelial Carcinoma Diagnostic Modality on Intravesical Recurrence after Radical Nephroureterectomy: A Single Institution Series and Updated Meta-Analysis

Cited by 50 publications

References 29 publications

The Impact of Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma: A Comprehensive Systematic Review and Meta-analysis

The Impact of Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma: A Comprehensive Systematic Review and Meta-analysis

A computed tomography urography‐based machine learning model for predicting preoperative pathological grade of upper urinary tract urothelial carcinoma

Treatment advances improve survival in upper tract urothelial carcinoma

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