Bladder Recurrence-free Survival Rates Research Articles

The need for a second transurethral resection in high-risk non-muscle-invasive bladder cancer based on the Vesicle Imaging-Reporting and Data System.

The efficacy of Vesical Imaging-Reporting and Data System (VI-RADS) for the second transurethral resection (TUR) has not been adequately validated. This study aimed to evaluate the utility of the VI-RADS for high-risk patients with non-muscle-invasive bladder cancer (NMIBC) who are candidates for a second TUR. We retrospectively analyzed 116 patients who received magnetic resonance imaging (MRI) prior to an initial TUR and underwent a second TUR for a diagnosis of high-risk NMIBC at the initial TUR. MRI images were retrospectively classified according to VI-RADS. Second TUR outcomes and recurrence-free and progression-free survival rates were compared with VI-RADS scores. Ninety-nine (91%) patients were diagnosed with T1 bladder cancer at the initial TUR. At the second TUR, residual cancer was found in 53 (49%) cases, including five (4.6%) cases of muscle invasion. With a median follow-up of 41 months, the 2-year bladder recurrence-free survival rate was 71% and the 2-year progression-free rate was 85%. By two radiologists' consensus, 30 (28%)/49 (45%)/16 (15%)/10 (9.2%)/4 (3.7%) cases were classified as VI-RADS 1/2/3/4/5, respectively. Of five pT2 upstage cases, three were VI-RADS 1, one was VI-RADS 2, and one was VI-RADS 3. There was no significant association between VI-RADS and cancer residual rate and pT2 upstage rate in second TUR outcomes, and recurrence-free and progression-free survival rates. In high-risk NMIBCs, a certain number of residual cancers and pT2 upstage cases exist after the initial TUR, and a second TUR should be performed regardless of VI-RADS scores.

A Propensity Score–Matched Analysis of the Impact of Carcinoma In Situ on the Clinical Outcomes in Patients with Upper Tract Urothelial Carcinomas—A Nationwide Multi-Institutional Cohort Study

Purpose: This study aimed to explore the clinical prognostic features of patients treated with radical nephroureterectomy for upper tract urothelial carcinoma (UTUC) with carcinoma in situ (CIS) compared with those without it. Material and Methods: We retrospectively reviewed the data of 3285 patients with UTUC. Propensity scores were calculated using a logistic regression model to regress disease status on various baseline covariates, including cell type, tumor size, histology, lymphovascular invasion, surgical margin, and pathological stage. Using these scores, we adopted a one-to-two pair matching approach to form matched pairs between the two groups, ensuring patients within each pair had similar propensity score values. Prognostic factors were identified using univariate and multivariate Cox regression models. The Kaplan-Meier method was used to estimate the rates of prognostic outcomes, and survival curves were compared using the stratified log-rank test. Results: Matched cohorts of 810 patients without and 405 with CIS from each group were compared. There was no discernible difference in the 5-year overall survival. The Kaplan-Meier curves for cancer-specific survival were significantly different in the adjusted group only (P = .043). Multivariate Cox regression analyses indicated that disease-free and bladder recurrence-free survival rates were similar between the two groups. The CIS status was not significantly correlated with the disease-free or bladder recurrence-free survival (P = .066 and .179, respectively). Conclusions: Patients with UTUC with CIS did not exhibit significantly worse oncologic outcomes than those without it.

The Comparison of Efficacy between the Connaught and Tice Strains of Bacillus Calmette-guérin in Patients with Non-muscle-invasive Bladder Cancer in Taiwan

Purpose: The purpose of the study is to compare the efficacy of Bacillus Calmette-Guérin (BCG) strains, Connaught (ImmuCyst®), and TICE (OncoTICE®) in patients with nonmuscle invasive bladder cancer (nMIBC). Materials and Methods: Patients with nMIBC who underwent transurethral resection between March 1997 and December 2017 were enrolled. TICE was used due to the Connaught strain shortage since 2012; hence, direct comparison of the two strains could not be performed. An intravesical instillation (IVI) regimen of mitomycin-C, doxorubicin, and cisplatin (MDP) was used as the reference for comparison. The MDP group was separated into two cohorts (MDP-1 and MDP-2) that matched the same time period of Connaught and TICE treatment. Patients who did not complete the IVI course before disease recurrence or progression or were not followed up for at least 24 months were excluded. Results: A total of 730 patients were included in the analysis. There were 67 (9.2%), 38 (5.2%), and 625 (85.6%) patients who received the Connaught, TICE, and MDP treatment, respectively. During a median follow-up duration of 59 months, the recurrence rates of the Connaught, MDP-1, TICE, and MDP-2 groups were 10.5%, 22.8%, 28.9%, and 23.0%, respectively. Both BCG groups had higher tumor grades and more instances of carcinoma in situthan their corresponding MDP cohorts. The Connaught and TICE strains had similar effects in preventing tumor recurrence (Connaught vs. MDP, P= 0.876; TICE vs. MDP, P= 0.556). In the multivariable Cox proportional hazard model that included all patients, the Connaught and TICE groups had a similar risk (hazard ratio = 0.784 and 0.850) of recurrence compared to the MDP protocol. Although progression events were more frequently noticed in the Connaught group, the small number of events limited the analysis. Conclusion: The BCG strains, Connaught and TICE, had similar efficacy in reducing bladder tumor recurrence in nMIBC patients. Both strains resulted in similar bladder recurrence-free survival rates to chemotherapeutic agents.

The Predictive Value of Systemic Immune-Inflammation Index on Bladder Recurrence on Upper Tract Urothelial Carcinoma Outcomes after Radical Nephroureterectomy.

Background: This study aimed to assess the prognostic significance of pre-treatment lymphocyte-related systemic inflammatory biomarkers in upper tract urothelial carcinoma (UTUC) patients. Methods: This study included non-metastatic UTUC patients treated at our hospital between 2001 and 2013. The receiver operating characteristic curve was used to obtain the optimal neutrophile-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). Multivariate logistic regression was performed to investigate the relationship between NLR, PLR, and SII and clinical pathologic characteristics. The Kaplan–Meier method was used to calculate the metastasis-free survival (MFS), cancer-specific survival (CSS), and bladder recurrence-free survival (BRFS), and the log-rank test was used to compare the survival rate. Results: Overall, 376 patients were included in the current study. An elevated SII was associated with symptomatic hydronephrosis, bladder cancer history, advanced pathologic tumor stage, lymph node invasion, adjuvant chemotherapy and concomitant carcinoma in situ (CIS); high NLR was associated with older age, symptomatic hydronephrosis, hemodialysis status, anemia, multifocal tumor, advanced pathologic tumor stage, and adjuvant chemotherapy; and high PLR was associated with older age, anemia, advanced pathologic tumor stage, and adjuvant chemotherapy. The Kaplan–Meier analysis indicated that patients exhibiting higher NLR, PLR, and SII showed significantly poor MFS and CSS rates. Only high SII showed significantly worse BRFS rates. Conclusions: The NLR, PLR, and SII were independent predictive factors for both MFS and CSS in UTUC patients. Among the factors, only elevated SII can predict bladder recurrence. Therefore, the patients might need close bladder monitoring during the follow-up.

Intraoperative prophylactic intravesical chemotherapy to reduce bladder recurrence following radical nephroureterectomy

PurposeSingle, postoperative instillation of prophylactic intravesical chemotherapy (pIVC) is effective in reducing bladder cancer recurrences following radical nephroureterectomy (RNU). Despite high level evidence, pIVC is underutilized. Intraoperative pIVC (I-pIVC) may be easier and safer to implement than postoperative pIVC (P-pIVC). We aimed to evaluate the efficacy of I-pIVC during RNU. Materials and methodsRetrospective analysis of patients undergoing RNU and I-pIVC or postoperative pIVC (P-pVC) with 20 to 40 mg mitomycin-C or 1 to 2 g gemcitabine. Recurrence rates were evaluated using the Kaplan-Meier curves and log rank test. Cox regression was used for univariable and multivariable analysis. ResultsOne hundred and thirty-seven patients were included in the final analysis. 81% (111/137) had I-pIVC and 19% (26/137) had P-pIVC. In the I-pIVC group higher rates of HG, muscle invasive disease and gemcitabine use were observed. Overall, 74% (101/137) and 26% (36/137) had mitomycin-C and gemcitabine instillations, respectively. Within 12 months 14% (19/137) of the patients experienced bladder recurrence. Median time to bladder recurrence was 7 months (range 3–27). Twelve months bladder recurrence-free survival rates were 82% for the I-pIVC group, and 72% for the P-pIVC group ((log rank P = 0.365). ConclusionsI-pIVC during RNU may reduce bladder recurrence rates. Bladder recurrence rates are comparable to those reported using postoperative instillations. Intraoperative instillations may be easier to implement and may increase usage rates.

A Comparison of Different Prophylactic Intravesical Chemotherapy Regimens for Bladder Cancer Recurrence After Nephroureterectomy for Primary Upper Tract Urothelial Carcinomas: A Retrospective 2-center Study

Prophylactic intravesical chemotherapy can decrease bladder cancer recurrence rate after nephroureterectomy for upper tract urothelial carcinoma. We aimed to compare the effect of different prophylactic intravesical chemotherapy regimens in bladder recurrence-free survival. From 2000 to 2016, a total of 270 patients treated with radical nephroureterectomy at both institutions were enrolled. Patients were divided into 3 groups: multiple-instillation group, single-instillation group, and no-instillation group. Univariable and multivariable analyses with Cox regression methods were performed to calculate hazard ratios for bladder recurrence using clinicopathologic data, including our different instillation strategies. Sixty-three (23.3%) of 270 patients had subsequent intravesical recurrence. Significantly fewer patients in both the instillation groups had a recurrence compared to in the no-instillation group (13.1% vs 25.4% vs 41.5%, P = .001). Furthermore, there was a significant difference between both the instillation groups (P = .016). In different subsets of patients with upper tract urothelial carcinoma, intravesical chemotherapy, either multiple or single instillation, was a protective factor of bladder recurrence in pT2-4 (P = .002) and high grade (P < .0001). Importantly, Kaplan-Meier curves of bladder recurrence-free survival rate were increased observably in multiple-instillation group compared to that in single-instillation group (P = .053 in pT2-4 subgroup; P = .048 in high-grade subgroup, respectively). On multivariable analysis, intravesical chemotherapy (P < .001), especially multiple instillations (hazard ratio 0.230; 95% confidence interval 0.110-0.479), was identified an independent predictor of bladder recurrence-free survival. In conclusion, prophylactic intravesical chemotherapy effectively prevents bladder recurrence after nephroureterectomy, especially with multiple instillations, in patients with invasive upper tract urothelial carcinoma or at high-grade status.

Urinary pH Levels are Strongly Associated with Bladder Recurrence After Nephroureterectomy in Upper Tract Urothelial Carcinoma Patients with a Smoking History.

Aromatic amines, well-known bladder carcinogens, derived from cigarette smoke are activated by acidic urine. We herein determined whether urinary pH levels are associated with bladder recurrence in upper tract urothelial carcinoma patients with a positive smoking history. A total of 256 upper tract urothelial carcinoma patients who were surgically treated at our institution between 1990 and 2013 were included. Urinary pH levels were defined as the median of at least two consecutive measurements within 1month of surgery. Ninety-six patients (37.5%) had pH<5.5 and 160 (62.5%) had pH≥5.5, and urinary pH levels were identified as one of the significant predictors for bladder recurrence in univariate but not multivariate Cox regression analysis in overall. In patients with a positive smoking history among those without a history of bladder tumor (N=110), the 5-year bladder recurrence-free survival rate was 52.5% in patients with pH≥5.5, which was significantly higher than that in those with pH<5.5 (25.9%, p=0.032). In the multivariate analysis, urinary pH<5.5 (p=0.022, HR; 1.86) was independently associated with bladder recurrence. No significant difference for bladder recurrence was observed between these two groups in patients with no smoking history among them. Urinary pH<5.5 is associated with an increased risk of bladder recurrence in upper tract urothelial carcinoma patients with a positive smoking history among those without a history of bladder tumor. Modifications to pH for urine alkalization may prevent bladder recurrence.

Influence of late-stage chronic kidney disease on overall survival in patients with upper tract urothelial carcinoma following radical nephroureterectomy

ObjectivesThe prevalence of both chronic kidney disease (CKD) and upper tract urothelial carcinoma (UTUC) in Taiwan is unusually high, and we aimed to investigate the impact of preoperative renal function on UTUC after radical nephroureterectomy. Materials and methodsBetween 2000 and 2013, 248 UTUC patients were enrolled in this retrospective study after excluding patients who had concomitant muscle-invasive bladder cancer, whose tumor metastasized at initial presentation, and who received perioperative chemotherapy or radiotherapy. The significance of CKD on overall survival (OS), cancer-specific survival (CSS), and bladder recurrence-free survival (BRFS) was evaluated by Cox proportional hazard model. ResultsThe median follow-up time was 45.41 months. Overall 5-year OS, CSS, and BRFS rates were 78.27%, 87.81%, and 70.42%, respectively. Aging, late-stage CKD, and nonorgan-confined primary tumor stage were independent predictors for OS after adjustment. Nonorgan-confined primary tumor stage and lymph node involvement were two independent predictors for CSS after adjustment. Concomitant bladder tumor was the only significant predictor for BRFS after adjustment. ConclusionPatients with late-stage CKD had a higher risk of having poor OS. Patients with concomitant bladder tumor had a greater risk of having bladder cancer recurrence despite primary tumor stage. Concomitant bladder tumor, however, had no effect on OS and CSS in this study.

MP2-08 URINARY PH IS HIGHLY ASSOCIATED WITH BLADDER RECURRENCE AFTER NEPHROURETERECTOMY FOR UPPER URINARY TRACT UROTHELIAL CARCINOMA PATIENTS WITH POSITIVE SMOKING HISTORY

You have accessJournal of UrologyBladder Cancer: Upper Tract TCC I1 Apr 2015MP2-08 URINARY PH IS HIGHLY ASSOCIATED WITH BLADDER RECURRENCE AFTER NEPHROURETERECTOMY FOR UPPER URINARY TRACT UROTHELIAL CARCINOMA PATIENTS WITH POSITIVE SMOKING HISTORY Hiroki Ide, Eiji Kikuchi, Nobuyuki Tanaka, Akira Miyajima, and Mototsugu Oya Hiroki IdeHiroki Ide More articles by this author , Eiji KikuchiEiji Kikuchi More articles by this author , Nobuyuki TanakaNobuyuki Tanaka More articles by this author , Akira MiyajimaAkira Miyajima More articles by this author , and Mototsugu OyaMototsugu Oya More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.131AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recently, it has been reported that the past history of smoking is a risk factor of bladder recurrence after surgery in upper urinary tract urothelial carcinoma (UTUC). Furthermore, it has been shown that lower urinary pH is significantly associated with bladder carcinogenesis, especially in smokers because acid urine activates aromatic amines derived from cigarette such as 4-aminobiphenyl and its N-hydroxy metabolite. However, to our knowledge, there has been no report about the association between urinary pH and bladder recurrence after surgery in UTUC patients. In the present study, we evaluated the predictors of bladder recurrence including urinary pH in patients with UTUC after surgery. METHODS A total of 168 UTUC patients without the history of bladder cancer who were surgically treated at our institution between 1990 and 2011 were included in the study. The mean follow-up period was 33 months. Urinary pH was defined as median of 3 consecutive data after surgery. Bladder recurrence-free survival (BRFS) was calculated by the Kaplan-Meir method. We used the Cox proportional hazards regression analysis to assess the independent predictors for BRFS. RESULTS Urinary pH was 5.00 to 5.49, 5.50 to 5.99, 6.00 to 6.49, 6.50 to 6.99 and 7.00 or more in 70, 47, 34, 11, and 6 patients, respectively. During follow-up period, bladder recurrence developed in 73 patients (40.6%) in overall. Furthermore, bladder recurrence rate is 57.1% in patients with pH less than 5.5, compared to 33.7% in those with pH 5.5 or more (p=0.002). Lower urinary pH (<5.5), gender, lymphovascular invasion and grade were all determined to be significant predictors of the BRFS based on a univariate analysis. A multivariate analysis revealed the lower urinary pH (p=0.006, hazard ratio 1.914) to be an independent prognostic factor for the BRFS. The 2-year and 5-year BRFS rates were 67.1 and 36.6 % for patients with pH less than 5.5 compared to 80.1 and 65.3 % for patients with pH 5.5 or more. Furthermore, focusing on patients with smoking history, BRFS in patients with pH less than 5.5 was significantly lower than it in those with pH 5.5 or more. Meanwhile, in patients without smoking history, there was no significant difference between lower and higher urinary pH groups. CONCLUSIONS Results suggest that urinary pH less than 5.5 increases the risk of bladder recurrence in UTUC patients after surgery, especially with smoking history. Modifying pH for urine alkalization might improve bladder recurrence rate after surgery in UTUC patients with smoking history. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e13 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hiroki Ide More articles by this author Eiji Kikuchi More articles by this author Nobuyuki Tanaka More articles by this author Akira Miyajima More articles by this author Mototsugu Oya More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Incidence, characteristics, treatment strategies, and oncologic outcomes of synchronous bilateral upper tract urothelial carcinoma in the Chinese population

ObjectivesTo investigate the incidence and treatment strategies for bilateral upper tract urothelial carcinoma (UTUC) and to compare the characteristic and oncologic outcomes of bilateral UTUC with those of unilateral tumors. Methods and materialsThe study included 892 consecutive patients with UTUC. Bilateral UTUC was defined as synchronous bilateral carcinoma on preoperative imaging before confirmation by pathology or positive urine cytology result plus direct visualization. Radical nephroureterectomy (RNU) or nephron-sparing surgery (NSS) or both were carried out. ResultsA total of 39 patients (4.37%) suffered from bilateral disease. Discordant histological grade of bilateral tumor was found in 39.3% cases. Bilateral tumors were associated with female sex (P<0.001), preoperative renal insufficiency (P<0.001), previous or concomitant bladder tumors (P = 0.013), lower tumor stages (P = 0.020), papillary architecture (P = 0.001), and smaller-sized tumors (P = 0.020). Patients with worse renal function (P<0.001) or large-sized tumors (P = 0.039) tended to be treated with bilateral RNU. Most patients (67.6%) were treated with unilateral RNU plus unilateral NSS, with NSS being performed on tumors that only extended to the ureter (P = 0.003) and had a smaller size (P = 0.005). The median follow-up duration was 56 months. The 5-year cancer-specific survival and bladder recurrence-free survival rates were 81.2% and 64.5%, respectively, similar to those of unilateral tumors. Male sex (hazard ratio = 11.535) and higher tumor stage (hazard ratio = 3.386) were independent worse prognostic factors. ConclusionsThe prevalence of bilateral UTUC is rare. Female patients, patients with renal insufficiency, and those with bladder tumor tended to suffer from bilateral disease and were less likely to present with worse pathological outcomes in the Chinese population. The tumor characteristics and renal function were informative in treatment selection. The oncologic outcomes were similar to those in unilateral UTUC, and male sex and a higher tumor stage were poor prognostic factors for these patients.

Efficiency and outcome of Boari bladder flap plasty surgery for the treatment of middle and lower ureteral carcinoma

To study the effect and outcome of Boari bladder flap plasty surgery for the treatment of kidney-sparing strategy for patients with middle and lower ureteral carcinoma. Database at the department of urology in the Second Xiangya Hospital from 2002-2007 was screened and all cases of primary solitary lower ureteral carcinoma treated with Boari bladder flap plasty surgery or radical nephroureterectomy were collected. We performed a retrospective review of the clinical data including sex, age, smoking history, tumor site, size, stage, grade, bladder recurrence, renal function et al and evaluated survival rate. The Cox proportional hazards regression model was build to analyze the correlation between each variable and survival time. Thirty nine patients in total were enrolled, including 16 cases underwent Boari bladder flap plasty surgery and 23 cases underwent radical nephroureterectomy. The median follow-up time was 53 months (range 10-84 months). During the follow-up time, 18 patients died, including 6 patients treated with Boari bladder flap plasty surgery and 12 patients treated with radical nephroureterectomy. The estimated bladder recurrence-free survival rate and cancer-specific survival rate at 5 years were 63% vs 59% and 73.8% vs 73.5%, respectively (P>0.05). The survival rate at 5 years and the overall survival rate were 61% vs 57 % and 64.8% vs 58.1% respectively in the 2 groups (P>0.05). There was no significant difference in renal function before surgery between the two groups [creatinine clearance 57 (32-104 ) mL/ min vs 55 (30-102) mL/ min, P>0.05]. Patients underwent Boari bladder flap plasty showed better renal function than patients underwent radical nephroureterectomy [creatinine clearance 55 (35-102) mL/ min vs 43 (30-89) mL/min, P<0.05]. In multivariate Cox regression analysis, the tumor size, pT stage, tumor cell grade and the estimated glomerular filtration rate level were independent factors that affected the overall survival rate of the patients (P<0.05). The tumor size, pT stage and tumor cell grade were positively correlated to the survival time, and the estimated glomerular filtration rate was negatively correlated to the survival time. Boari bladder flap plasty surgery could be used to treat lower ureteral carcinoma. Compared with radical nephroureterectomy, Boari bladder flap plasty surgery has equal survival rate and shows superior postoperative renal function.

Intravesical Seeding of Upper Urinary Tract Urothelial Carcinoma Cells During Nephroureterectomy: An Exploratory Analysis from the THPMG Trial

The Pirarubicin Monotherapy Study Group trial was a randomized Phase II study that evaluated the efficacy of intravesical instillation of pirarubicin in the prevention of bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma. This study conducted further analysis of the Pirarubicin Monotherapy Study Group cohort, focusing on intravesical seeding of cancer cells. Using the data from the Pirarubicin Monotherapy Study Group trial, bladder recurrence-free survival rates and factors associated with bladder recurrence in the control group were analyzed. Of 36 patients in the control group, 14 with positive urine cytology had more frequent recurrence when compared with the 22 patients with negative cytology (P = 0.004). Based on the multivariate analysis in the control group, voided urine cytology was an independent predictive factor of bladder recurrence (hazard ratio, 5.54; 95% confidence interval 1.12-27.5; P = 0.036). Of 72 patients in the Pirarubicin Monotherapy Study Group trial, 31 had positive urine cytology. Among the 31 patients, 17 patients who received pirarubicin instillation had fewer recurrences when compared with 14 patients who received control treatment (P = 0.0001). On multivariate analysis, pirarubicin instillation was an independent predictor of better recurrence-free survival rates in the patients with positive urine cytology (hazard ratio, 0.02; 95% confidence interval, 0.00-0.53; P = 0.018). Of 21 patients with bladder recurrence, 17 had recurrent tumor around cystotomy or in the bladder neck compromised by the urethral catheter, supporting the notion that tumor cells seeded in the injured urothelium. Intravesical instillation of pirarubicin immediately after nephroureterectomy significantly reduced the bladder recurrence rate in patients with positive voided urine cytology. The results suggest that intravesical seeding of upper urinary tract urothelial carcinoma occurs during nephroureterectomy.

897 IMPACT OF SMOKING STATUS ON BLADDER RECURRENCE FOLLOWING RADICAL NEPHROURETERECTOMY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyUrothelial Cancer: Upper Tract Tumors (II)1 Apr 2013897 IMPACT OF SMOKING STATUS ON BLADDER RECURRENCE FOLLOWING RADICAL NEPHROURETERECTOMY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA Masayuki Hagiwara, Eiji Kikuchi, Nobuyuki Tanaka, Kazuhiro Matsumoto, Hiroki Ide, Akira Miyajima, Ken Nakagawa, Takeshi Masuda, So Nakamura, and Mototsugu Oya Masayuki HagiwaraMasayuki Hagiwara Tokyo, Japan More articles by this author , Eiji KikuchiEiji Kikuchi Tokyo, Japan More articles by this author , Nobuyuki TanakaNobuyuki Tanaka Tokyo, Japan More articles by this author , Kazuhiro MatsumotoKazuhiro Matsumoto Tokyo, Japan More articles by this author , Hiroki IdeHiroki Ide Tokyo, Japan More articles by this author , Akira MiyajimaAkira Miyajima Tokyo, Japan More articles by this author , Ken NakagawaKen Nakagawa Tokyo, Japan More articles by this author , Takeshi MasudaTakeshi Masuda Saitama, Japan More articles by this author , So NakamuraSo Nakamura Tokyo, Japan More articles by this author , and Mototsugu OyaMototsugu Oya Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.470AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although smoking status has a significant impact on outcome in patients with bladder cancer, its role in the outcome of upper tract urothelial cancer (UTUC) has not yet been fully evaluated. The aims of the present study were to identify independent risk factors of subsequent bladder recurrence in a large series of patients with UTUC and to investigate the possible influence of smoking status on subsequent bladder recurrence after surgery. METHODS We identified a study population of 313 consecutive patients treated with nephroureterectomy for UTUC at our 3 institutions between 1994 and 2010.ü@The associations between the subsequent bladder recurrence and the clinicopathological parameters, including smoking status, were analyzed. RESULTS There were 97 (31.0%) current smokers, 63 (20.1%) ex-smokers, and 153 (48.9%) non-smokers. While we combined ex-smokers and current smokers and classified them as having a positive history of smoking, this group had a significantly higher incidence of high grade tumors compared with non-smokers (P=0.018). During follow-up, bladder recurrence developed in 156 patients (49.8%); 63 current smokers, 34 ex-smokers, 59 non-smokers.ü@The 3-year bladder recurrence-free survival (BRFS) rates were 32.5% in the positive smoking group and 59.9% in non-smokers (P<0.001). Multivariate analysis showed that male gender (P=0.010, HR=1.83) and a positive smoking history (P=0.028, HR=1.50) were independent risk factors for subsequent bladder recurrence. In a subgroup of patients with a positive history of smoking, the 3-year BRFS rate in patient with ≥50 pack-years (14.0%) and those who smoked ≥40 cigarettes per day (6.4%) were significantly lower compared to their counterparts (35.6% and 33.3%, respectively). Multivariate analysis revealed that the number of pack-years ≥50 (P=0.019, HR=1.63) and number of cigarettes per day ≥40 (P=0.011, HR=1.82) were independent risk factors for bladder recurrence in patients with a positive smoking history. CONCLUSIONS A history of smoking and male gender were independent risk factors for subsequent bladder recurrence following nephroureterectomy, and UTUC patients who smoked a large number of cigarettes or long history of smoking had a higher incidence of bladder recurrence. More attention should be paid to the association between smoking status and a worse oncological outcome, such as bladder recurrence, in UTUC patients. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e370-e371 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masayuki Hagiwara Tokyo, Japan More articles by this author Eiji Kikuchi Tokyo, Japan More articles by this author Nobuyuki Tanaka Tokyo, Japan More articles by this author Kazuhiro Matsumoto Tokyo, Japan More articles by this author Hiroki Ide Tokyo, Japan More articles by this author Akira Miyajima Tokyo, Japan More articles by this author Ken Nakagawa Tokyo, Japan More articles by this author Takeshi Masuda Saitama, Japan More articles by this author So Nakamura Tokyo, Japan More articles by this author Mototsugu Oya Tokyo, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Impact of Diagnostic Ureteroscopy on Intravesical Recurrence and Survival in Patients With Urothelial Carcinoma of the Upper Urinary Tract

We determined whether diagnostic ureteroscopy for upper urinary tract cancer affects intravesical recurrence and cancer specific mortality. In a retrospective, multi-institutional study we evaluated 208 patients undergoing nephroureterectomy for upper urinary tract cancer who had no perioperative systemic chemotherapy, history of invasive bladder cancer, distant metastasis or incomplete followup data. Of these 208 patients 55 who composed the study group underwent diagnostic ureteroscopy before nephroureterectomy while 153 serving as controls did not. We analyzed intravesical recurrence and cancer specific survival using the Kaplan-Meier method with the log rank test used to assess significance. There was no significant difference between the 2 groups in patient characteristics or upper urinary tract cancer stage and grade while followup, and the proportion of multiple tumors and lymphovascular invasion positive tumors were significantly greater in controls. The 2-year bladder recurrence-free survival rate was 60.0% in the study group and 58.7% in controls. There was no significant difference in the intravesical recurrence rate between the 2 groups (log rank test p = 0.972). Estimated Kaplan-Meier cancer specific survival was 88.3% and 78.1% at 5 years in the study and control groups, respectively (log rank test p = 0.0687). Diagnostic ureteroscopy did not affect intravesical recurrence or cancer specific survival in patients with upper urinary tract cancer undergoing nephroureterectomy.

Factores predictivos de neoplasia vesical metacrónica tras nefroureterectomía

PurposeTo determine prognostic factors of bladder recurrence in patients with upper urinary tract (UUT) urothelial carcinoma, who underwent nephroureterectomy. Material and methodsPatients (N=51) with UUT transitional cell carcinoma who underwent nephroureterectomy. A Retrospective and prospective observational cohort study was made during the period 1995-2007, at Arquitecto Marcide Hospital, Ferrol Health Area, La Coruna. Differences between groups with and without recurrence were analized by means of chi-squared test in qualitative variables and t-Student and U Mann-Whitney test in quantitative variables. Kaplan-Meier methodology was used in order to predict bladder recurrence free survival (BRFS), developing a multivariate Cox regression model to identify variables related to bladder recurrence. ResultsMean age of patients was 68.51-12.11 (24-86). Histological grade distribution was as follows: 7 g1 (13.72%), 20 g2 (39.21%), 23 g3 (45.10%) and 1 undetermined case(1.97%). With regard to pT category, 19 cases were pt1(37.25%), 12 pt2 (23.53%), 19 pt3 (37.25%) y 1 case undetermined (1.97%). Bladder recurrence was detected in 16 patients during follow-up (31.37%). 70.59% of recurrences were identified during first two years of follow-up. Differences related to follow-up period, presence of obstructive uropathy, microscopic growth pattern and tumour multifocality, were observed between patients without and with bladder recurrence. BRFS rates at 1, 2, 5 and 10 years were 85.10%, 67.90%, 56.60% y 31.80%, respectively. BRFS was significantly modified by tumour location (p=0.019) and tumour multifocality (p=0.002). Multivariate analysis showed that tumour multifocality was an independent factor in the prediction of bladder recurrence (rr=7.35;95%ci=1.57-34.45;p=0.011). ConclusionsThe development of bladder recurrence after nephroureterectomy was observed in 31.37% of patients in our study, detecting most of events during the first two years of follow-up. Tumour multifocality in UUT constitutes the most important risk factor for the development of bladder recurrence.

Oncologic Assessment of Hand-Assisted Retroperitoneoscopic Nephroureterectomy for Urothelial Tumors of the Upper Tract: Comparison with Conventional Open Nephroureterectomy

To evaluate the oncologic results of our operative technique, hand-assisted retroperitoneoscopic nephroureterectomy (HRNU), for the treatment of upper-tract urothelial cancer, various perioperative parameters and oncologic outcomes were compared for HRNU and conventional open nephroureterectomy (CONU). Thirty-six patients with clinical stage T(1,2)N(0)M(0) renal-pelvic and ureteral tumors underwent HRNU. A retroperitoneoscopic nephrectomy was carried out with hand assistance via a lower-abdominal midline incision. The lower ureter was resected by open surgery through the same incision, and the operative specimen was extracted via the same incision. Thirty-seven cases of CONU were reviewed as historical controls. Various perioperative and parameters and oncologic results were compared for the two procedures. The HRNU was completed in all but one case, which was converted to CONU. The mean operating time (395 minutes) was longer than that for CONU (289 minutes), and the mean estimated blood loss with HRNU (497 g) was greater than that with CONU (296 g). The mean time to oral intake (1.4 days) was shorter than that after CONU (2.3 days), and the mean time to walking was shorter (2.1 days v 2.6 days). There were no statistical differences in the cause-specific survival rate, the disease-free survival rate, or the bladder recurrence-free survival rate between HRNU (median follow-up 23 months) and CONU (median follow-up 56 months). The HRNU, a combination of endoscopic and conventional open surgery, seems to be a reasonable surgical procedure, because the lower-abdominal incision can be utilized, not only as a route for hand assistance, but also as a window for open surgery when resecting the distal ureter as well as for extraction of surgical specimens. The procedure is a safe alternative to conventional open surgery for upper urinary-tract tumors from an oncologic viewpoint.

Intermediate Follow-up of Hand-Assisted Retroperitoneoscopic Nephroureterectomy for Management of Upper Urinary Tract Urothelial Carcinoma: Comparison with Open Nephroureterectomy

To evaluate the oncologic outcomes of hand-assisted retroperitoneoscopic nephroureterectomy (HARNU) for upper urinary tract urothelial carcinoma and compare them with the data from conventional open surgery. We collected the data from 25 patients who underwent HARNU at our institution from January 1999 to December 2003 for upper urinary tract urothelial carcinoma. The clinical data were collected retrospectively by reviewing the medical records. The convalescence results and oncologic outcomes were analyzed and compared with the corresponding data from 41 contemporary conventional open nephroureterectomy (ONU) procedures. The median follow-up period in the HARNU group was 32 months (range 21 to 43) and was 62 months (range 8 to 88) in the ONU group. Patient age, sex, body mass index, tumor size, specimen weight, and American Society of Anesthesiologists classification showed no significant differences between the two groups. The HARNU group required a longer operation time (252 versus 212 minutes; P = 0.02). Significantly less blood loss (212 versus 408 mL; P = 0.03) was noted in the HARNU group. The complication rates between the HARNU group and ONU group were similar (12% and 7.3%, respectively, P = 0.67). No open conversion was required in the HARNU group. The average hospital stay, days to oral intake, days to ambulation, and dose of parenteral narcotic analgesics were significantly less in the HARNU group. No significant differences were found in the 3-year bladder recurrence-free survival rate, cancer-specific survival rate, or overall survival rate between the two groups. The results of our study have shown that HARNU, with an open method for the removal of the distal ureter and bladder cuff, is a less-invasive technique and provides comparable oncologic outcomes as ONU for upper urinary tract urothelial carcinoma.