Ureteroscopy and tailored treatment of upper tract urothelial cancer: recent advances and unmet needs

Loizzo, Davide; Pandolfo, Savio Domenico; Giudice, Francesco Del; Cerrato, Clara; Chung, Benjamin I.; Wu, Zhenjie; Imbimbo, Ciro; Ditonno, Pasquale; Derweesh, Ithaar; Autorino, Riccardo

doi:10.1111/bju.15746

Cited by 10 publications

(5 citation statements)

References 7 publications

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“…Whether to perform ureteroscopy before RNU is still controversial. Although there is a clear relationship between ureteroscopy and the increased risk of intravesical recurrence (IVR), it does not affect the survival results [ 30 ]. Hemal et al [ 31 ] performed RLNU-BCE on 21 patients.…”

Section: Discussionmentioning

confidence: 99%

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Perioperative and oncologic outcomes of transperitoneal versus retroperitoneal laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and pooled analysis of comparative outcomes

Zhu

Wang

et al. 2023

World J Surg Onc

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Background The debate on whether to choose a transperitoneal (TP) or retroperitoneal (RP) approach for treating upper urinary tract urothelial carcinoma (UTUC) with laparoscopic surgery has been drawing attention. This study aimed to systematically review and meta-analyze the existing evidence regarding oncologic and perioperative outcomes of transperitoneal laparoscopic radical nephroureterectomy (TLNU) and retroperitoneal laparoscopic radical nephroureterectomy (RLNU) in managing UTUC. Methods A comprehensive literature search was conducted using PubMed, Scopus, Embase, and Google Scholar for identifying randomized controlled trials (RCTs) and observational studies that evaluated the outcomes of TLNU and RLNU for UTUC. Continuous variables were represented by weighted mean difference (WMD) and standard mean difference (SMD), while binary variables were represented by odds ratio (OR), with 95% confidence intervals (CIs). The quality was assessed using the Newcastle–Ottawa scale. A sensitivity analysis was performed to evaluate the robustness of the estimates. Result Six observational studies were incorporated into this meta-analysis. The overall TLNU was associated with significantly shorter operating time (WMD − 19.85; 95% CI − 38.03 to − 1.68; P = 0.03); longer recovery time of intestinal function (SMD 0.46; 95% CI 0.08 to 0.84; P = 0.02). However, the terms of estimated blood loss (WMD − 5.72; 95% CI − 19.6 to − 8.15; P = 0.42); length of stay (WMD − 0.35; 95% CI − 1.61 to 0.91; P = 0.59), visual analog pain scale (WMD − 0.38; 95% CI − 0.99 to 0.84; P = 0.22); drainage duration (WMD − 0.22; 95% CI − 0.61 to 0.17; P = 0.26); overall complication rates (OR 1.24; 95% CI 0.58 to 2.63; P = 0.58); local recurrence rate (OR 0.6; 95% CI 0.3 to 1.21; P = 0.16); distant metastasis (OR 0.94; 95% CI 0.04 to 20.77; P = 0.97); 1-year overall survival (OS) (OR 0.45; 95% CI 0.1 to 2.01; P = 0.3) showed no difference between TLNU and RLUN. Conclusion TLNU provides similar surgical outcomes and oncologic results compared to RLUN; however, TLNU has a shorter procedure time and prolonged intestinal function recovery time. Due to the heterogeneity among the studies, randomized clinical trials with follow-ups in the long term are required to obtain more definite results. Trial registration www.crd.york.ac.uk/prospero/, identifier CRD42023388554.

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Section: Discussionmentioning

confidence: 99%

“…the robotic platform might allow easier achievement of a watertight bladder closure. This appears to be more conducive to the perioperative perfusion of mitomycin [ 30 ]. In addition, UTUC ranks as the third most prevalent malignancy observed in individuals with Lynch syndrome (LS).…”

Section: Discussionmentioning

confidence: 99%

Perioperative and oncologic outcomes of transperitoneal versus retroperitoneal laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and pooled analysis of comparative outcomes

Zhu

Wang

et al. 2023

World J Surg Onc

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“…Although IHC has limitations, the IHC panel of CK20, p53, and CD44 has potential utility. Because ureteroscopic biopsy of the upper urinary tract is difficult, the diagnostic rate is more important [ 33 ]. The usefulness of other IHC markers has been explored, as urothelial carcinoma can be triggered by genetic conditions, such as Lynch syndrome [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Roles of Immunohistochemical Markers CK20, CD44, AMACR, and p53 in Urothelial Carcinoma In Situ

Yoo,

Min,

Pyo

et al. 2023

Medicina

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Background and Objectives: This study aimed to evaluate the diagnostic roles of various immunohistochemical (IHC) markers in urothelial carcinoma in situ (uCIS) through a meta-analysis and review of diagnostic test accuracy. Materials and Methods: The IHC markers CK20, CD44, AMACR, and p53 were evaluated in the present study. We analyzed the expression rates of the IHC markers and compared their diagnostic accuracies. Results: The estimated expression rates were 0.803 (95% confidence interval [CI]: 0.726–0.862), 0.142 (95% CI: 0.033–0.449), 0.824 (95% CI: 0.720–0.895), and 0.600 (95% CI: 0.510–0.683) for CK20, CD44, AMACR, and p53, respectively. In the comparison between uCIS and reactive/normal urothelium, the expression of CK20, AMACR, and p53 in uCIS was significantly higher than in reactive/normal urothelium. CD44 showed significantly lower expression in uCIS than in the reactive/normal urothelium. Among the markers, AMACR had the highest sensitivity, specificity, and diagnostic odds ratio. The AUC on SROC was the highest for CK20. Conclusions: In conclusion, IHC markers, such as CK20, CD44, AMACR, and p53, can be useful in differentiating uCIS from reactive/normal urothelium.

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“…Its reliability in predicting the tumour stage is low, with a high rate of underestimation (45% of Ta lesions are actually infiltrating tumours) [34]. Also, there is a rising concern that ureterorenoscopy increases the risk of intravesical recurrence [35], and a risk-stratified approach has been proposed to avoid this in high-risk cases [36]. Urinary cytology, based on cells obtained from the natural desquamation of the urothelial lining of the urinary tract, can be performed.…”

Section: Diagnosismentioning

confidence: 99%

Clinical and Biological Differences between Upper Tract Carcinoma and Bladder Urothelial Cancer, Including Implications for Clinical Practice

Lefort,

Rhanine,

Larroquette

et al. 2023

Cancers

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Upper tract urothelial carcinoma (UTUC) is a rare disease included, along with the much more frequent urothelial bladder cancer (BUC), in the family of urothelial carcinomas (UCs). However, while UTUCs and BUCs share several features, their epidemiological, clinical, pathological, and biological differences must be considered to establish an optimal therapeutic strategy. This review examines the clinical differences between UTUC and BUC, as well as the main results obtained by molecular screening of the two diseases. The findings of clinical trials, performed in peri-operative and metastatic settings and assessing systemic treatments in UC, are summarised. A comparison of the data obtained for UTUC and BUC suggests improved therapeutic approaches, both in regards to routine practice and future drug development.

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Ureteroscopy and tailored treatment of upper tract urothelial cancer: recent advances and unmet needs

Abstract: Dr. Davide Loizzo unexpectedly passed away in a tragic car accident. Davide was a young brilliant Urology trainee, a future rising star in academia. He will forever be remembered and missed by his family, friends, and colleagues. This contribution will be part of his legacy.

Cited by 10 publications

References 7 publications

Perioperative and oncologic outcomes of transperitoneal versus retroperitoneal laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and pooled analysis of comparative outcomes

Perioperative and oncologic outcomes of transperitoneal versus retroperitoneal laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and pooled analysis of comparative outcomes

Diagnostic Roles of Immunohistochemical Markers CK20, CD44, AMACR, and p53 in Urothelial Carcinoma In Situ

Clinical and Biological Differences between Upper Tract Carcinoma and Bladder Urothelial Cancer, Including Implications for Clinical Practice

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