Recurrence Of Upper Tract Urothelial Carcinoma Research Articles

Radiomics-Based Computed Tomography Urogram Approach for the Prediction of Survival and Recurrence in Upper Urinary Tract Urothelial Carcinoma.

Upper tract urothelial carcinoma (UTUC) is a rare and aggressive malignancy with a poor prognosis. The accurate prediction of survival and recurrence in UTUC is crucial for effective risk stratification and guiding therapeutic decisions. Models combining radiomics and clinicopathological data features derived from computed tomographic urograms (CTUs) can be a way to predict survival and recurrence in UTUC. Thus, preoperative CTUs and clinical data were analyzed from 106 UTUC patients who underwent radical nephroureterectomy. Radiomics features were extracted from segmented tumors, and the Least Absolute Shrinkage and Selection Operator (LASSO) method was used to select the most relevant features. Multivariable Cox models combining radiomics features and clinical factors were developed to predict the survival and recurrence. Harrell's concordance index (C-index) was applied to evaluate the performance and survival distribution analyses were assessed by a Kaplan-Meier analysis. The significant outcome predictors were identified by multivariable Cox models. The combined model achieved a superior predictive accuracy (C-index: 0.73) and higher recurrence prediction (C-index: 0.84). The Kaplan-Meier analysis showed significant differences in the survival (p < 0.0001) and recurrence (p < 0.002) probabilities for the combined datasets. The CTU-based radiomics models effectively predicted survival and recurrence in the UTUC patients, and enhanced the prognostic performance by combining radiomics features with clinical factors.

Oncologic surveillance intensity after endoscopic treatment of upper tract urothelial carcinoma.

The optimal oncologic surveillance in patients with upper tract urothelial carcinoma (UTUC) elected for conservative treatment is still a matter of debate. Patients elected for endoscopic treatment of UTUC were followed up according to EAU guidelines recommendations after treatment. Bladder cancer recurrence-free survival (BCa-RFS), UTUC recurrence-free survival (UTUC-RFS), radical nephroureterectomy-free survival (RNU-FS), and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. The crude risks of BCa and UTUC recurrences over time were estimated with the Locally Weighted Scatterplot Smoothing method. Overall, 54 and 55 patients had low- and high-risk diseases, respectively. Median follow-up was 46.9 (IQR: 28.7-68.7) and 36.9 (IQR: 19.8-60.1) months in low and high-risk patients, respectively. In low-risk patients, BCa recurrence risk was more than 20% at 24 months follow-up. At 60 months, time point after which cystoscopy and imaging should be interrupted, the risk of BCa recurrence and UTUC recurrence were 14% and 7%, respectively. In high-risk patients, the risk of BCa and UTUC recurrence at 36 months was approximately 40% and 10%, respectively. Conversely, at 60 months, the risk of bladder recurrence and UTUC recurrence was 28% and 8%, respectively. For low-risk patients, cystoscopy should be performed semi-annually until 24 months, while upper tract assessment should be obtained up to 60 months, as per current EAU guidelines recommendations. For high-risk patients, upper tract assessment should be intensified to semi-annually up to 36 months, then obtained yearly. Conversely, cystoscopy should be ideally performed semi-annually until 60 months and yearly thereafter.

Cumulative incidence and risk factors for recurrence of upper tract urothelial carcinoma in patients undergoing radical cystectomy

AbstractObjectivesThis study aimed to evaluate the cumulative incidence of upper tract urothelial carcinoma (UTUC) recurrence and identify its risk factors in patients who underwent radical cystectomy (RC).Patients and methodsWe performed RC on 385 patients between September 2002 and February 2020. After excluding 20 patients—13 with simultaneous nephroureterectomy, 6 with distal ureteral stump positivity and 1 with urachal cancer—365 patients were included in the analysis. To predict UTUC recurrence, we examined the cancer extension pattern in cystectomy specimens and categorized them into three types: cancer located only in the bladder (bladder‐only type), cancer extending to the urethra or distal ureter (one‐extension type) and cancer extending to both the urethra and distal ureter (both‐extension type). We determined hazard ratios for UTUC recurrence for each covariate, including this cancer extension pattern.ResultsOf the 365 patients, 60% had the bladder‐only type, 30% had the one‐extension type and 10% had the both‐extension type. During a median follow‐up period of 72 months for survivors, UTUC recurred in 25 of the 365 patients, with cumulative incidences of 3.7% at 5 years and 8.3% at 10 years. The median interval from cystectomy to recurrence was 65 months (interquartile range: 36–92 months). In the multivariate analysis, the extension pattern was a significant predictor of UTUC recurrence. The hazard ratios for UTUC recurrence were 3.12 (95% confidence interval [CI] = 1.15–8.43, p = 0.025) for the one‐extension type and 5.96 (95% CI = 1.98–17.91, p = 0.001) for the both‐extension type compared with the bladder‐only type.ConclusionsThe cancer extension pattern in cystectomy specimens is predictive of UTUC recurrence. A more extensive cancer extension in cystectomy specimens elevates the risk of subsequent UTUC recurrence. Intensive long‐term monitoring is essential, particularly for patients with the both‐extension type.

Longer is Better for Endoscopic Follow-up of Upper Tract Urothelial Carcinoma After Ureteroscopic Treatment: An Evaluation Spanning 10 Years of Data

BackgroundTumour recurrences are frequent among patients with upper tract urothelial carcinoma (UTUC) treated with ureteroscopy (URS). Therefore, guidelines recommend a strict follow-up regimen, but there is little evidence on how to do this. ObjectiveTo analyse outcomes during our follow-up regimen and the impact on treatment in terms of ipsilateral UTUC recurrence, treatment conversion, and tumour upgrading, and to evaluate potential prognostic factors, including second-look URS outcomes. A secondary objective was to evaluate survival outcomes. Design, setting, and participantsThe single-centre cohort included all adult patients with nonmetastatic UTUC treated with URS from January 2010 to December 2020. Follow-up involved endoscopy at 3-mo intervals in the first year, then at 6-mo intervals up to year 3, and yearly thereafter. Outcome measurements and statistical analysisDescriptive analyses were performed for the follow-up outcomes. The Andersen-Gill model for recurrent event analysis was used to analyse tumour recurrences, and multivariable Cox regression to analyse for predictors for treatment conversion in low-grade tumours. Results and limitationsWe analysed 71 patients with median follow-up of 49.5 mo. The overall 2-yr recurrence-free survival (RFS) rate was 22%. In low-grade disease, the 1-yr RFS rate was 50% and the 2-yr RFS rate was 29%. Treatment was converted to radical nephroureterectomy for 23 patients, at a median time to conversion of 9.9 mo. Upgrading was seen in 13 patients, at a median time to upgrading of 21.9 mo. No factors were prognostic for either tumour recurrence or treatment conversion. The 5-yr OS, CSS, and MFS rates were 82%, 86%, and 84%, respectively. ConclusionsOur data show that it is rational to extend endoscopic follow-up for UTUC treated with URS, as clinically relevant events (treatment conversion and tumour upgrading) occur beyond the current 6-mo guideline recommendation. Second-look URS outcomes were not prognostic for tumour recurrence or treatment conversion during follow-up. Patient summaryOur study results show that for patients with cancer of the upper urinary tract treated with kidney-sparing surgery through a small telescope called a ureteroscope (URS), most of the clinically relevant events (treatment conversion and tumour upgrading) occur outside the current recommended follow-up of 6 months. Therefore, URS follow-up should be extended for these patients.

Intravesical Therapy for Upper Urinary Tract Urothelial Carcinoma: A Comprehensive Review.

Upper tract urothelial carcinoma (UTUC) poses unique challenges in diagnosis and treatment. This comprehensive review focuses on prophylactic intravesical therapy for UTUC, summarizing key aspects of intravesical therapy in various clinical scenarios, including concurrent with or following radical nephroureterectomy, kidney-sparing surgery, ureteroscopy-guided biopsy. The incidence of intravesical recurrence in UTUC after surgical treatment is significant, necessitating effective preventive measures. Intravesical therapy plays a vital role in reducing the risk of bladder recurrence following UTUC surgery. Tailoring timing, drug selection, dosage, and frequency is vital in optimizing treatment outcomes and reducing intravesical recurrence risk in UTUC. This review provides a comprehensive summary of the history, clinical trials, guideline recommendations, and clinical applications of intravesical therapy for UTUC. It also discusses the future directions based on current clinical needs and ongoing trials. Future directions entail optimizing dosage, treatment duration, and drug selection, as well as exploring novel agents and combination therapies. Intravesical therapy holds tremendous potential in improving outcomes for UTUC patients and reducing the risk of bladder recurrence. Although advancements have been made in UTUC treatment research, further refinements are necessary to enhance efficacy and safety.

The importance of second-look ureteroscopy implementation in the conservative management of upper tract urothelial carcinoma.

The purpose of the study was to evaluate the effect of second-look ureteroscopy (SU) in the endoscopic operative work-up of patients with upper tract urothelial carcinoma (UTUC). Patients with UTUC who underwent SU between 2016 and 2021 were included. Cancer detection rate (CDR) at SU was defined as endoscopic visualization of tumor. The effect of SU on recurrence-free survival (RFS), radical nephroureterectomy-free survival (RNU-FS), bladder cancer-free survival (BC-FS), and cancer-specific survival (CSS) was estimated using the Kaplan-Meier method. Multivariate logistic regression analysis (MLR) assessed predictors of negative SU. Finally, we evaluated the effect of SU timing on oncological outcomes, classifying SUs as "early" (≤ 8weeks) and "late" (> 8weeks). Overall, 85 patients underwent SU. The CDR at SU was 44.7%. After a median follow-up was 35 (IQR: 15-56) months, patients with positive SU had a higher rate of UTUC recurrence (47.4% vs 19.1%, p = 0.01) and were more frequently radically treated (34.2% vs 8.5%, p = 0.007). Patients with high-grade disease (hazard ratio [HR]: 3.14, 95% CI 1.18-8.31; p = 0.02) had a higher risk of UTUC recurrence, while high-grade tumor (HR: 3.87, 95%CI 1.08-13.77; p = 0.04) and positive SU (HR: 4.56, 95%CI 1.05-22.81; p = 0.04) were both predictors of RNU. Low-grade tumors [odds ratio (OR): 5.26, 95%CI 1.81-17.07, p = 0.003] and tumor dimension < 20mm (OR: 5.69, 95%CI 1.48-28.31, p = 0.01) were predictors of negative SU. Finally, no significant difference emerged regarding UTUC recurrence, RNU, BC-FS, and CSM between early vs. late SUs (all p > 0.05). SU may help in identifying patients with UTUC experiencing an early recurrence after conservative treatment. Patients with low-grade and small tumors are those in which SU could be safely postponed after 8weeks.

A case of duodenal perforation and pancreatic bleeding after flexible ureteroscopy for right renal pelvis UTUC

Upper tract urothelial carcinoma (UTUC) can be managed by flexible ureteroscopy (f-URS) and tumor laser ablation if kidney-sparing surgery is possible. This procedure can be affected by minor to serious complications, including life-threatening sepsis, ureteral strictures, and ureteral and renal pelvis injuries. The case of a 53-year-old man with history of high grade right renal pelvis and bladder tumor who undergone multiple endoscopic treatments and has already refused radical surgery is reported. F-URS and laser ablation with Thulium: YAG laser for UTUC recurrence of the right renal pelvis was performed, but the procedure was stopped due to significant bleeding which impaired vision. Postoperatively, the patient developed hematemesis and hemodynamic instability due to duodenal lesion and active bleeding documented at CT scan. An emergency exploratory laparotomy was performed to drain hemoperitoneum, repair duodenal lesion and concurrent radical right nephroureterectomy was carried out. A second surgery was necessary for repairing duodenal fistula. After 1 week the patient presented again with recurrent hematemesis and hemorrhagic shock. He underwent angiography and selective embolization of the duodenal branch of superior mesenteric artery and as well as branches of gastroduodenal artery successfully and the patient recovered with no other complications. This is the first case of duodenal perforation and pancreatic bleeding due to flexible ureteroscopy and laser ablation of right renal pelvis urothelial carcinoma.

Endophytic upper tract urothelial carcinoma in a solitary kidney treated by cryotherapy: an unorthodox case for successful management

BackgroundNephroureterectomy remains the gold standard treatment for upper tract urothelial carcinoma (UTUC). Considering the high risk of developing renal function impairment after surgery, the rationale for nephron sparing approaches in treatment of UTUC has been raised. In this case, renal cryoablation was able to achieve successful oncologic control while preserving renal function during 5 years of follow up without intraoperative or post operative complications.Case presentationA 79 year old male presents after three months of macroscopic hematuria. Imaging revealed a 3.6 × 3.1 × 2.7 cm endophytic mass in the interpolar region of the left kidney and an atrophic right kidney. After weighing the lesion’s location with the patient’s of complex medical history, he was counselled to undergo a minimally invasive percutaneous cryoablation as treatment for his solitary renal mass. A diagnostic dilemma was encountered as imaging suggested a diagnosis of renal cell carcinoma. However, the pre-ablation biopsy established an alternative diagnosis, revealing UTUC. Percutaneous cryoablation became an unorthodox treatment modality for the endophytic component of his UTUC followed by retrograde ureteroscopic laser fulguration. The patient was followed in 3 months, 6 months, then annually with cross sectional imaging by MRI, cystoscopy, urine cytology and renal function testing. After five years of follow-up, the patient did not encountered recurrence of UTUC or deterioration in renal function, thereby maintaining a stable eGFR.ConclusionAlthough evidence for nephron-sparing modalities for UTUC is mounting in recent literature, limited data still exists on cryotherapy as a line of treatment for urothelial carcinoma. We report successful management of a low-grade UTUC using cryoablation with the crucial aid of an initial renal biopsy and long-term follow-up. Our results provide insight into the role of cryoablation as a nephron-sparing approach for UTUC.

MP69-08 FOLLOW-UP INTENSITY SCHEME FOR UPPER TRACT UROTHELIAL CARCINOMA AFTER NEPHRON-SPARING SURGERY

You have accessJournal of UrologyCME1 Apr 2023MP69-08 FOLLOW-UP INTENSITY SCHEME FOR UPPER TRACT UROTHELIAL CARCINOMA AFTER NEPHRON-SPARING SURGERY Giuseppe Basile, Andrea Gallioli, Paolo Verri, Julia Aumatell, Sofia Fontanet, Alessandro Uleri, Francesco Sanguedolce, Oscar Rodriguez-Faba, Angelo Territo, Alberto Martini, Joan Palou, and Alberto Breda Giuseppe BasileGiuseppe Basile More articles by this author , Andrea GallioliAndrea Gallioli More articles by this author , Paolo VerriPaolo Verri More articles by this author , Julia AumatellJulia Aumatell More articles by this author , Sofia FontanetSofia Fontanet More articles by this author , Alessandro UleriAlessandro Uleri More articles by this author , Francesco SanguedolceFrancesco Sanguedolce More articles by this author , Oscar Rodriguez-FabaOscar Rodriguez-Faba More articles by this author , Angelo TerritoAngelo Territo More articles by this author , Alberto MartiniAlberto Martini More articles by this author , Joan PalouJoan Palou More articles by this author , and Alberto BredaAlberto Breda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The EAU guidelines on upper tract urothelial carcinoma (UTUC) have been implemented to provide separate recommendations on oncologic surveillance for low- and high-risk UTUC after nephron-sparing surgery (NSS). This study aimed to evaluate whether the surveillance scheme is accurate for patients with UTUC after NSS. METHODS: We relied on a prospectively maintained database of patients who underwent NSS for UTUC between 2015-2021. Patients were followed up in compliance with the EAU guidelines. The crude risk of recurrence was evaluated against time from URS, with the Locally Weighted Scatterplot Smoothing. The risk of recurrence at the time points when imaging should be de-intensified according to the EAU guidelines was estimated. RESULTS: Overall, 63 (39.4%) and 97 (60.6%) patients resulted in low- and high-risk groups as defined by the Guidelines, respectively. In the low vs high-risk group, 19% and 28.9% of patients had bladder recurrence during the follow-up. Conversely, 14.3% and 16.5% of patients had UTUC recurrence in the two cohorts. Figure 1 displays the risk of bladder and UTUC recurrence over time for the low- (1A) and high-risk group (1B), respectively. Vertical lines correspond to the time points when imaging should be obtained. For low-risk patients, bladder cancer recurrence is higher than 20% up to 24-months. At 60-month, timepoint after which imaging should be interrupted, the risk of bladder cancer recurrence was 14%, while the risk of UTUC recurrence was 7%. Conversely, for high-risk patients, the risk of bladder and UTUC recurrence at 36-months was approximately 40% and 10%, respectively. Conversely, at 60-month, the risk of bladder recurrence and UTUC recurrence was 28% and 8%, respectively. CONCLUSIONS: Our findings suggest that the surveillance scheme for patients with UTUC treated with NSS can be further improved. For low-risk patients, cystoscopy should be performed semi-annually until 24-months after RNU, while imaging should be obtained up to 60 months, as per current guidelines. For high-risk patients, imaging should be intensified to semi-annually up to 36-month after surgery, then obtained yearly thereafter; cystoscopy should be ideally performed semi-annually until 60-month, then yearly thereafter. Source of Funding: No © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e966 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giuseppe Basile More articles by this author Andrea Gallioli More articles by this author Paolo Verri More articles by this author Julia Aumatell More articles by this author Sofia Fontanet More articles by this author Alessandro Uleri More articles by this author Francesco Sanguedolce More articles by this author Oscar Rodriguez-Faba More articles by this author Angelo Territo More articles by this author Alberto Martini More articles by this author Joan Palou More articles by this author Alberto Breda More articles by this author Expand All Advertisement PDF downloadLoading ...

CD155 immunohistochemical expression in upper tract urothelial carcinoma predicts poor prognosis.

A novel immune checkpoint, CD155/T-cell immunoreceptor with Ig and ITIM domains, has been recognized as a new therapeutic target in addition to conventional immune checkpoints, such as anti-programmed cell death protein 1/programmed cell death ligand 1 (PD-L1), for urothelial carcinoma (UC). Fibroblast growth factor receptor (FGFR) is considered another new therapeutic target for UC. As FGFR3-mutant UC may be associated with decreased T-cell infiltration, FGFR3 inhibition may facilitate lymphocyte invasion into the tumor microenvironment. Although a combined effect of immune checkpoint inhibitors and FGFR inhibition is expected, the combined expression profiles of CD155, PD-L1 and FGFR3 have not been evaluated in upper tract UC (UTUC). The present study aimed to investigate the association between CD155 expression and clinicopathological factors in 208 patients with UTUC undergoing radical nephroureterectomy. Furthermore, the expression profiles of CD155, PD-L1 and FGFR3 were compared. Immunohistochemical analysis was performed using tissue microarray specimens and survival analyses were performed using the Kaplan-Meier method and the Cox proportional hazards model. High immunohistochemical expression of CD155 was observed in 177 patients (85.1%) and it was associated with advanced pathological stage and lymphovascular invasion. The survival rate was lower among patients with tumors exhibiting high CD155 expression than among those with tumors with low CD155 expression. In addition, multivariate survival analysis revealed that high CD155 expression was an independent prognostic factor for recurrence (hazard ratio=7.32, 95% CI=1.01-53.35, P=0.049). FGFR3 and immune checkpoint signaling molecules, such as CD155 and PD-L1, had a weak negative correlation. The present results indicated that the expression of CD155 is a useful marker for predicting the recurrence of UTUC. In addition, the immunohistochemical expression profiles of CD155, PD-L1 and FGFR3 may further the understanding of the role of FGFR-targeted therapies in immunotherapy for UTUC.

MP40-13 ARE METACHRONOUS BLADDER TUMORS PREDICTIVE OF UPPER TRACT UROTHELIAL CARCINOMA RECURRENCE IN PATIENTS TREATED WITH RADICAL OR ENDOSCOPIC SURGERY

You have accessJournal of UrologyCME1 May 2022MP40-13 ARE METACHRONOUS BLADDER TUMORS PREDICTIVE OF UPPER TRACT UROTHELIAL CARCINOMA RECURRENCE IN PATIENTS TREATED WITH RADICAL OR ENDOSCOPIC SURGERY Christian Ericson, Anthony Compton, Bryce Baird, and Raymond Pak Christian EricsonChristian Ericson More articles by this author , Anthony ComptonAnthony Compton More articles by this author , Bryce BairdBryce Baird More articles by this author , and Raymond PakRaymond Pak More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002600.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Upper tract urothelial carcinoma (UTUC) comprises 5% of urothelial cancers. Treatment with nephroureterectomy or endoscopically with ureteroscopy with dual laser ablation using holmium and neodymium fibers are current management strategies. Regular surveillance for recurrence is performed post operatively with cross sectional imaging or by ureteroscopy. Metachronous bladder tumors are often identified during surveillance and there is paucity of literature defining their role in predicting upper tract recurrence of UTUC. METHODS: Data was collected from a total of 127 patients who were treated for upper tract urothelial carcinoma (UTUC) with either nephroureterectomy or endoscopic management from 2016 to 2020. Patients underwent surveillance for a maximum of 48 months and the rates of upper tract recurrence (ipsilateral or contralateral) were recorded. Patients were separated into groups based on the presence or absence of metachronous bladder tumors (MBT). The rates of upper tract recurrence overall as well as solely in the contralateral kidney were compared in the two groups. A Pearson’s chi-squared test was utilized to determine statistical significance of the two groups. A p-value of 0.05 was set for statistical significance. RESULTS: Overall, upper tract recurrence occurred in 23 of 127 (18.1%) patients. 35 of 127 (34%) patients developed MBT. Prescence of MBT vs absence of MBT was predictive of overall UTUC recurrence with incidence of 12 of 35 (34%) vs 11 of 92 (12%) (p=0.0035). Presence of MBT vs absence of MBT was also predictive of solely contralateral UTUC recurrence with incidence of 3 of 26 (11.5%) vs 0 of 81 (0%) (p=0.0019). CONCLUSIONS: Identification of metachronous bladder tumors during surveillance for UTUC is predictive of upper tract recurrence. This is applicable to patients who have bilateral renal units being treated with endoscopic management as well as in patients with a solitary kidney after nephroureterectomy. Physicians should be aware of the increased rate of recurrence in these patients when performing surveillance. Source of Funding: Mayo Clinic Florida © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e679 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Ericson More articles by this author Anthony Compton More articles by this author Bryce Baird More articles by this author Raymond Pak More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP50-20 SURGICAL MANAGEMENT AND OUTCOMES OF NATIVE UPPER URINARY TRACT UROTHELIAL CARCINOMA AFTER KIDNEY TRANSPLANTATION

You have accessJournal of UrologyCME1 May 2022MP50-20 SURGICAL MANAGEMENT AND OUTCOMES OF NATIVE UPPER URINARY TRACT UROTHELIAL CARCINOMA AFTER KIDNEY TRANSPLANTATION Shi-Jie Tsai, Eric Yi-Hsiu Huang, Tzu-Hao Huang, Tzu-Chun Wei, Chih-Chieh Lin, Tzu-Ping Lin, Hsiao-Jen Chung, William J.S. Huang, and Yen-Hwa Chang Shi-Jie TsaiShi-Jie Tsai More articles by this author , Eric Yi-Hsiu HuangEric Yi-Hsiu Huang More articles by this author , Tzu-Hao HuangTzu-Hao Huang More articles by this author , Tzu-Chun WeiTzu-Chun Wei More articles by this author , Chih-Chieh LinChih-Chieh Lin More articles by this author , Tzu-Ping LinTzu-Ping Lin More articles by this author , Hsiao-Jen ChungHsiao-Jen Chung More articles by this author , William J.S. HuangWilliam J.S. Huang More articles by this author , and Yen-Hwa ChangYen-Hwa Chang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002625.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Kidney transplant (KT) recipients were associated with increased incidence of malignancy due to use of immunosuppressant. Urothelial carcinoma (UC) was one of the leading de novo malignancies following KT. For UC arising from native upper urinary tract after KT, radical nephroureterectomy (RNU) was the gold standard of treatment. We aim to analyze the surgical and oncological outcomes of KT recipients with native upper urinary tract UC underwent RNU. METHODS: We retrospectively reviewed KT patients underwent RNU due to upper tract urothelial carcinoma (UTUC) at our institute from 2005 to 2016. Demographic data and oncologic outcomes were collected from medical records. RESULTS: A total of 26 patients were included in this study. The average age at RNU was 59.4±12.2 years (range 22-73), and the time interval from KT to RNU was 10.7±5.6 years (range 1.5-20). Five patients (19%) received unilateral RNU. Twenty-one patients (81%) received simultaneous bilateral radical nephroureterectomy (SBRNU). The methods of surgical approach were open in 13 (50%) cases, laparoscopy in 10 (38%) cases, and robotic-assisted in 3 (12%) cases. The perioperative complication rate was 30%, and 11% was ≥ grade III Clavien-Dindo classification. Function loss of the graft kidney was not observed in all cases.The histopathology results showed 11 (42%) cases were locally advanced stage (pT3/4 or node positive). Twenty-two (85%) patients had multifocal tumors, and 13 (50%) patients had concomitant carcinoma in situ (CIS) lesions. Among 21 patients received SBRNU, synchronous UC in bilateral upper urinary tracts were identified in 11 (52%) patients, while only three of them (27%) had pre-operative image or pathology suspicion of bilateral lesions. Two out of five patients received unilateral RNU eventually experienced contralateral recurrence with mean interval of 5.5 years. The mean follow-up period of our cohort was 46 months (range 2-138). Local recurrence and/or metastasis were observed in 9 (35%) patients. Intravesical recurrences were noted in 14 (54%) patients, with a median time of 8.5 months from surgery to recurrence. The cancer-specific and overall survival rate was 67% and 62%, respectively. CONCLUSIONS: Native UTUC after KT is a unique patient cohort that is commonly associated with multifocal tumors, concomitant CIS lesions, and locally advanced stage, thus warranted timely surgical intervention and further therapy. SBRNU should be performed if possible due to high prevalence of synchronous bilateral UTUC and high contralateral recurrence rate. Source of Funding: Nil © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e874 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shi-Jie Tsai More articles by this author Eric Yi-Hsiu Huang More articles by this author Tzu-Hao Huang More articles by this author Tzu-Chun Wei More articles by this author Chih-Chieh Lin More articles by this author Tzu-Ping Lin More articles by this author Hsiao-Jen Chung More articles by this author William J.S. Huang More articles by this author Yen-Hwa Chang More articles by this author Expand All Advertisement PDF DownloadLoading ...

The Prognostic Impact of Tumor Location in pT3N0M0 Upper Urinary Tract Urothelial Carcinoma: A Retrospective Cohort Study.

BackgroundWe aimed to evaluate the impact of tumor location on cancer outcomes in patients with pT3N0M0 upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU) with bladder cuff excision.Materials and MethodsWe retrospectively reviewed 302 patients with pT3N0M0 UTUC who underwent RNU with bladder cuff excision at our institution between 2005 and 2019, including 191 renal pelvis tumors and 111 ureteral tumors. Clinicopathologic characteristics were compared between renal pelvis and ureter urothelial carcinomas. Multivariate Cox proportional hazard regression was used to assess the association between outcomes and clinical factors. Outcomes of interest included intravesical recurrence-free survival (IVRFS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and cancer-specific survival (CSS), which were measured using the Kaplan–Meier curve with a log-rank test.ResultsA total of 302 patients underwent RNU with bladder cuff excision. During the median follow-up of 42.7 months, 70 (23.2%), 95 (31.5%), and 99 (32.8%) patients experienced intravesical recurrence, local recurrence, and distant metastasis, respectively. Seventy (23.2%) patients died from UTUC. Multivariate Cox regression analysis showed that tumor location was an independent predictor of local recurrence (HR = 2.05, p = 0.001), with borderline independent significance in intravesical recurrence (HR = 1.54, p = 0.074) and distant metastasis (HR = 1.45, p = 0.08). Kaplan–Meier analysis showed that ureter tumors had a worse 5-year local recurrence (log-rank p < 0.001) and borderline worse 5-year intravesical recurrence (log-rank p = 0.055) and 5-year distant metastasis (log-rank p = 0.073).ConclusionUreter tumors seem to be associated with worse oncological outcomes, especially with local recurrence in UTUC. Further large and long-term studies are warranted for investigating biological differences based on tumor location.

Urinary pH is an independent predictor of upper tract recurrence in non-muscle-invasive bladder cancer patients with a smoking history

Limited information is currently available on predictors of upper tract urothelial carcinoma (UTUC) recurrence in non-muscle-invasive bladder cancer (NMIBC) patients according to smoking history, although smoking probably contributes to urothelial carcinogenesis. Therefore, the present study aimed to identify independent predictors of UTUC recurrence in all patients and those with a smoking history. Our study population comprised 1190 NMIBC patients who underwent transurethral resection of bladder tumor. UTUC developed in 43 patients during the follow-up. A history of bacillus Calmette-Guérin (BCG) therapy was independently associated with a lower incidence of UTUC (HR = 0.43; P = 0.011). In a subgroup of NMIBC patients with a smoking history, concomitant carcinoma in situ (CIS) and a lower urinary pH (< 6) were independently associated with a higher incidence of UTUC recurrence (HR = 3.34, P = 0.006 and HR = 3.73, P = 0.008, respectively). Among patients with a longer smoking duration (≥ 20 years) or larger smoking intensity (≥ 20 cigarettes per day), those with lower urinary pH (< 6) had a significantly higher UTUC recurrence rate than their counterparts. These results suggest that BCG instillation may prevent UTUC recurrence in NMIBC patients, while a lower urinary pH and concomitant CIS increase the risk of UTUC recurrence in those with a smoking history.

MP48-14 UTUC SURVEILLANCE FOLLOWING BCG-TREATED NMIBC: TIMING AND RISK FACTORS ASSOCIATED WITH RECURRENCE

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP48)1 Sep 2021MP48-14 UTUC SURVEILLANCE FOLLOWING BCG-TREATED NMIBC: TIMING AND RISK FACTORS ASSOCIATED WITH RECURRENCE Kelly Bree, Patrick Hensley, Nathan Brooks, Supriya Nagaraju, Neema Navai, Colin Dinney, Surena Matin, and Ashish Kamat Kelly BreeKelly Bree More articles by this author , Patrick HensleyPatrick Hensley More articles by this author , Nathan BrooksNathan Brooks More articles by this author , Supriya NagarajuSupriya Nagaraju More articles by this author , Neema NavaiNeema Navai More articles by this author , Colin DinneyColin Dinney More articles by this author , Surena MatinSurena Matin More articles by this author , and Ashish KamatAshish Kamat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002074.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Following a diagnosis of non-muscle invasive bladder cancer (NMIBC), patients are at risk for developing upper tract urothelial carcinoma (UTUC). Guidelines vary on the frequency of upper tract imaging during surveillance from yearly (EAU) to every 1-2 years (AUA/SUO) but this is based on admittedly ‘weak evidence’ or ‘expert opinion’ due to a paucity of data. Herein, we sought to characterize the timing of UTUC following NMIBC diagnosis, as well as to identify risk factors for UTUC which could inform future screening recommendations. METHODS: An IRB approved review of patients with NMIBC who received adequate induction BCG, as defined by the US FDA, at our institution from 2000-2018 was performed. Patients were stratified by development of metachronous UTUC (any time after NMIBC diagnosis). Patients with UTUC prior to or synchronous with NMIBC diagnosis were excluded. RESULTS: Of 537 patients with NMIBC who received induction BCG, 22 (4.1%) developed metachronous UTUC. Factors associated with the development of UTUC included pure Tis (22.7% vs. 5.0%, p=0.002) and multifocal disease (86.4% vs. 50.1%, p=0.0009). Notably, bladder tumor grade and size were not associated with UTUC recurrence (p=0.569 and p=1.00, respectively). UTUC onset occurred within 5 years in the majority of patients (86.4%, 19/22), however, one patient did develop UTUC more than 10 years after initial NMIBC diagnosis. Rates of radical cystectomy (45.5% vs. 14.0%, p=<0.001) and urothelial cancer-specific mortality (27.3% vs. 4.1%, p<0.001) were higher in patients with metachronous UTUC. CONCLUSIONS: UTUC occurs within the first five years following NMIBC diagnosis in the overwhelming majority of patients, however, late recurrences (>10 years) were noted. The presence of Tis and multifocal NMIBC are associated with increased risk of UTUC and screening efforts may be focused on this subgroup of patients. Source of Funding: This research was supported by the Wayne B. Duddlesten Professorship in Cancer Research and the Raymond and Maria Floyd Bladder Cancer Research Foundation Grant © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e870-e870 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kelly Bree More articles by this author Patrick Hensley More articles by this author Nathan Brooks More articles by this author Supriya Nagaraju More articles by this author Neema Navai More articles by this author Colin Dinney More articles by this author Surena Matin More articles by this author Ashish Kamat More articles by this author Expand All Advertisement Loading ...

MP48-09 UPPER TRACT UROTHELIAL CARCINOMA FOLLOWING RADICAL CYSTECTOMY: A RISK-ADAPTED SCORING MODEL FOR STRATIFYING SURVEILLANCE INTENSITY

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP48)1 Sep 2021MP48-09 UPPER TRACT UROTHELIAL CARCINOMA FOLLOWING RADICAL CYSTECTOMY: A RISK-ADAPTED SCORING MODEL FOR STRATIFYING SURVEILLANCE INTENSITY Tanner Miest, Abhinav Khanna, Vidit Sharma, Patrick Hensley, Rebecca Campbell, Prabin Thapa, Andrew Zganjar, Matthew Tollefson, Houston Thompson, Igor Frank, Jeffrey Karnes, Aaron Potretzke, Surena Matin, Prithvi Murthy, Georges-Pascal Haber, Byron Lee, and Stephen Boorjian Tanner MiestTanner Miest More articles by this author , Abhinav KhannaAbhinav Khanna More articles by this author , Vidit SharmaVidit Sharma More articles by this author , Patrick HensleyPatrick Hensley More articles by this author , Rebecca CampbellRebecca Campbell More articles by this author , Prabin ThapaPrabin Thapa More articles by this author , Andrew ZganjarAndrew Zganjar More articles by this author , Matthew TollefsonMatthew Tollefson More articles by this author , Houston ThompsonHouston Thompson More articles by this author , Igor FrankIgor Frank More articles by this author , Jeffrey KarnesJeffrey Karnes More articles by this author , Aaron PotretzkeAaron Potretzke More articles by this author , Surena MatinSurena Matin More articles by this author , Prithvi MurthyPrithvi Murthy More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber More articles by this author , Byron LeeByron Lee More articles by this author , and Stephen BoorjianStephen Boorjian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002074.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Metachronous upper tract urothelial carcinoma (UTUC) is diagnosed in approximately 5% of patients following radical cystectomy (RC) for urothelial carcinoma of the bladder. Balancing the potential oncologic benefit of early diagnosis with the costs and anxiety from surveillance, we sought to develop and validate an UTUC recurrence risk score to optimize UT surveillance after RC. METHODS: A multi-institutional retrospective review was performed of patients undergoing RC for urothelial carcinoma. Clinicopathologic variables were evaluated using multivariable cox proportional hazard models to develop and validate a subsequent UTUC diagnosis risk score using two independent institutional registries as training and validation cohorts. RESULTS: Between 1980 and 2019, 3170 patients in the training cohort and 959 patients in the validation cohort underwent RC for bladder urothelial carcinoma. At a median follow-up after RC of 4.6 years (IQR 2.1-8.7), 167/4129 (4.0%) patients were diagnosed with UTUC. Four factors were significantly associated with metachronous UTUC on multivariable Cox regression in the training cohort: any positive margin (hazard ratio [HR] 2.35, 95% confidence interval [CI] 1.62-3.41, p<0.01), history of BCG (HR 2.24, 95% CI 1.60-3.14, p<0.01), CIS at RC (HR 2.07, 95% CI 1.42-3.03, p<0.01), and pre-RC hydronephrosis (HR 1.49, 95% CI 1.021-2.17, p=0.04). These factors had similar discriminative capacity in the training and validation cohorts (C-stat 0.70 and 0.72, respectively). An UTUC risk score was developed by ascribing 2 points to positive margins, history of BCG, and CIS, and 1 point to hydronephrosis. The model-derived risk score stratified patients into low (0 points), intermediate (1-3 points), and high risk (4+ points) for subsequent UTUC diagnosis, with 5-year UTUC free survivals of 99%, 96%, 89% for low, intermediate and high risk groups in the training cohort, and 98%, 96%, and 92% in the validation cohort, respectively (Figure 1). CONCLUSIONS: We developed and validated a post-RC UTUC risk score using two independent institutional cohorts. Further study is warranted to optimize guideline recommended UTUC surveillance protocols after RC in concordance with our risk score. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e866-e867 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tanner Miest More articles by this author Abhinav Khanna More articles by this author Vidit Sharma More articles by this author Patrick Hensley More articles by this author Rebecca Campbell More articles by this author Prabin Thapa More articles by this author Andrew Zganjar More articles by this author Matthew Tollefson More articles by this author Houston Thompson More articles by this author Igor Frank More articles by this author Jeffrey Karnes More articles by this author Aaron Potretzke More articles by this author Surena Matin More articles by this author Prithvi Murthy More articles by this author Georges-Pascal Haber More articles by this author Byron Lee More articles by this author Stephen Boorjian More articles by this author Expand All Advertisement Loading ...

PD43-11 THE USE OF URETERAL ACCESS SHEATH DOES NOT MODIFY THE PATTERN OF DISEASE RECURRENCE DURING CONSERVATIVE MANAGEMENT OF UPPER TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma I (PD43)1 Sep 2021PD43-11 THE USE OF URETERAL ACCESS SHEATH DOES NOT MODIFY THE PATTERN OF DISEASE RECURRENCE DURING CONSERVATIVE MANAGEMENT OF UPPER TRACT UROTHELIAL CARCINOMA Eugenio* Ventimiglia, Luca Villa, Costantino Abbate, Pietro Dioni, Olivier Traxer, Alberto Briganti, Francesco Montorsi, and Andrea Salonia Eugenio* VentimigliaEugenio* Ventimiglia More articles by this author , Luca VillaLuca Villa More articles by this author , Costantino AbbateCostantino Abbate More articles by this author , Pietro DioniPietro Dioni More articles by this author , Olivier TraxerOlivier Traxer More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002057.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The use of ureteral access sheath (UAS) during ureteroscopy for conservative management of upper tract urothelial carcinoma (UTUC) has been advocated as beneficial in order to prevent cancer recurrence both in the bladder and the upper urinary tract. However, there is no clear evidence at this regard. We aimed at assessing whether the use of UAS in this setting is able to prevent UTUC recurrence during follow-up ureteroscopy. METHODS: Data from 102 consecutive ureteroscopies performed for UTUC at a single academic center between 2015 and 2020 were included in this analysis. Two experienced endo-urologists performed all the procedures. Ureteroscopies were performed using a digital flexible ureterorenoscope (Flex XC, Karl-Storz). Tumor Ho:YAG laser ablation was performed in every case whenever feasible (VersaPulse PowerSuite 100W, Lumenis) using 1 J and 10 Hz. The use of 10/12 UAS (ReTrace, Porges-Coloplast) was attempted whenever there was no evidence of disease in the ureter according to surgeon’s preference. Multivariable logistic regression models tested the association between the use of UAS and cancer recurrence at follow-up ureteroscopy both in the upper tract and the bladder, accounting for possible differences in terms of age, tumor size and grade. RESULTS: Ureteral access sheath was used in 21 (21%) cases. There were not significant differences in terms of patients and tumor characteristics between cases performed with and without UAS (all p>0.05). During follow-up ureteroscopies, evidence for upper tract and bladder recurrence were found in 52/77 (68%) and 18/77 (23%) cases, respectively. The use of UAS was not associated with a decreased probability of cancer recurrence in the upper tract (OR=1.22; 95%CIs=0.44-3.43; p>0.05) and in the bladder (OR=2.76; 95%CIs=0.87-1.56; p>0.05) after accounting for tumor size, grade, and patient age. CONCLUSIONS: The use of UAS does not seem to prevent the UTUC recurrence during endoscopic follow-up. Both upper urinary tract and bladder recurrence pattern are not modified by the use of UAS. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e735-e735 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eugenio* Ventimiglia More articles by this author Luca Villa More articles by this author Costantino Abbate More articles by this author Pietro Dioni More articles by this author Olivier Traxer More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement Loading ...

FOXO3A Expression in Upper Tract Urothelial Carcinoma.

BackgroundEpidemiological studies have reported various results regarding whether FOXO3A is related to various carcinomas. However, the prognostic significance of FOXO3A in upper tract urothelial carcinoma (UTUC) remains unclear. The purpose of this study was to validate the correlation between FOXO3A expression and oncological outcomes in UTUC.MethodsThe expression levels of FOXO3A in 107 UTUC patients were examined by immunohistochemistry (IHC). We examined the prognostic role of FOXO3A by using the Cox proportional hazard model.ResultsThe results indicated that FOXO3A expression was notably decreased in UTUC tissue compared with control tissue. Decreased expression of FOXO3A was also related to advanced pathologic stage (P = 0.026), lymph node metastasis (P = 0.040), lymphovascular invasion (P < 0.001), and adjuvant therapy (P = 0.048). In addition, UTUC patients with low FOXO3A expression had a significantly shorter survival time, including both overall survival (OS) [hazard ratio (HR) 2.382, P = 0.004] and recurrence-free survival (RFS) (HR 2.385, P = 0.004), than those with high expression. Multivariate analyses showed that FOXO3A was a significant predictor for OS (HR 2.145, P = 0.014) and RFS (HR 2.227, P = 0.010) in UTUC patients.ConclusionOur results indicate that FOXO3A may be involved in the recurrence of UTUC and that it has certain clinical value in the therapeutic targeting and prognostic evaluation of UTUC.

Prognostic Impact of Preoperative Renal Insufficiency on Metastasis-Free Survival after Radical Cystectomy.

Several studies founded that preoperative renal insufficiency is associated with a higher risk of upper tract urothelial carcinoma recurrence and mortality than normal renal function patients. However, previous studies were all retrospective; no study focused on urothelial carcinoma in the bladder and metastasis-free survival (MFS). Herein, we examined the prognostic impact of preoperative renal insufficiency on the oncologic outcomes of patients with urothelial carcinoma in the bladder after radical cystectomy. We used data from 262 patients prospectively collected from a radical cystectomy cohort between March 2016 and February 2021. The patients were divided into those with a preoperative glomerular filtration rate (GFR) of <60 mL/min/1.73 m2 (renal insufficiency; n=66) and those with a GFR ≥60 mL/min/1.73 m2 (control; n=196). We investigated MFS, cancer-specific survival (CSS), and overall survival (OS). Kaplan-Meier curves and Cox proportional hazard regression were used to estimate the prognostic impact of renal insufficiency. The mean MFS was significantly shorter in the renal insufficiency group than in the control group (36.58±3.09 months vs. 47.37±1.87 months); however, OS and CSS were not significantly different. T stage ≥3 (hazard ratio [HR]: 2.79), lymph node positivity (HR: 2.261), and renal insufficiency (HR: 2.04) were significant independent predictors of MFS. Preoperative renal insufficiency was an independent prognostic factor for worse MFS. Well-designed randomized clinical trials and translational studies are needed to clarify the mechanism of relationship between preoperative renal insufficiency and MFS.

1133 - Intravesical BCG instillation is strongly associated with a decreased risk of upper tract urothelial carcinoma recurrence as well as intravesical recurrence in elderly male patients with non-muscle invasive bladder cancer

1133 - Intravesical BCG instillation is strongly associated with a decreased risk of upper tract urothelial carcinoma recurrence as well as intravesical recurrence in elderly male patients with non-muscle invasive bladder cancer