Risk Of Intravesical Recurrence Research Articles

Oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma: a literature review.

Radical nephroureterectomy (RNU) represents the gold standard treatment for non-metastatic upper tract urothelial cancer. We sought to provide a comprehensive review of reported oncologic outcomes of the RNU procedure and of factors that might impact these outcomes. A non-systematic review of the literature was conducted by performing an electronic literature search using PubMed with "radical nephroureterectomy" and "oncologic outcomes" as free text search terms. Both original articles and systematic reviews were considered. Search was limited to articles in English that were published in the last 20 years. Open and laparoscopic RNU offer comparable oncologic outcomes. In more recent years, the discussion has de facto shifted towards the "oncological safety" of robotic RNU, which also seems to offer comparable oncologic outcomes. Several studies have looked at the impact of different treatment-, patient- and tumor-related factors. Among treatment-related factors, attention has been given to diagnostic ureteroscopy and the risk of intravesical recurrence. Surgical wait time and perioperative blood transfusion have also been studied. Perioperative chemotherapy, specifically adjuvant therapy, was shown to improve survival. Among patient-related factors, baseline chronic kidney disease, diabetes mellitus, body mass index, and systemic inflammation have gained recent attention. Some tumor related factors, such as stage, grade, location, and multifocality may negatively impact survival outcomes. Lymphovascular invasion and histologic variants are clinically significant pathological findings. RNU is a procedure with measured long-term oncologic outcomes. Minimally invasive techniques have gained an established role as they seem to offer comparable oncologic "safety", although special attention is needed in relation to the method of bladder cuff excision. Robotic RNU is gaining popularity, and while evidence remains limited, the current literature supports the oncologic safety of this procedure. Several factors, which can be categorized as treatment-related, patient-related, and tumor-related, might impact the oncologic outcomes of UTUC patients undergoing RNU. These factors can provide crucial information to stratify patients based on their relative risk of disease recurrence and mortality which may guide clinical decision-making.

Ten-year survival outcomes after radical nephroureterectomy with a risk-stratified approach using prior diagnostic ureteroscopy: a single-institution observational retrospective cohort study.

To evaluate the long-term oncological outcomes of patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU) and the impact of diagnostic ureteroscopy (URS) on survival outcomes. A retrospective analysis of all consecutive patients undergoing RNU for suspected UTUC at a UK tertiary referral centre from a prospectively maintained database was conducted. The primary outcome measures were 5- and 10-year cancer-specific survival (CSS). The secondary outcomes were: overall survival (OS), recurrence-free survival (RFS), impact of prior diagnostic URS on OS, CSS and intravesical RFS (intravesical-RFS), and predictors of intravesical recurrence. Statistical analysis was performed in R using the 'survminer' and 'survival' packages. The Kaplan-Meier method was used to calculate survival functions and these were expressed in graphical form. Uni-/multivariate survival analyses were performed using the Cox proportional hazard regression model. Statistical significance in this study was set at P < 0.05. A total of 422 patients underwent RNU with confirmed UTUC. The median (interquartile range) follow-up of patients with confirmed UTUC was 9.2 (5.6-12.7) years. The 5- and 10-year CSS rates were 70.5% (95% confidence interval [CI] 65.9-74.9) and 67.1% (95% CI 62.4-71.6), respectively. OS (HR 1.04 [95% CI 0.78-1.38]; P = 0.46) and CSS (HR 0.96 [95% CI 0.68-1.34]; P = 0.81) were similar in the diagnostic URS and the direct RNU cohorts. intravesical RFS was superior for the direct RNU cohort (HR 1.94 [95% CI 1.19-3.17]; P = 0.008). In multivariate analysis, prior URS, T2 stage, proximal ureter tumour and bladder cancer history were predictors of metachronous bladder recurrence. This single-centre retrospective cohort study reports the long-term oncological outcomes of RNU with a median follow-up of 9.2 years, serving as a reference standard in counselling patients undergoing RNU. Stage and grade of the RNU specimen were the only two studied factors that appeared to adversely impact long-term CSS and OS. Our results suggest that the risk of intravesical recurrence is increased nearly twofold in patients who have undergone diagnostic URS prior to RNU. Prior URS, however, does not appear to adversely impact long-term CSS and OS. The authors suggest that a risk-stratified approach be adopted, wherein diagnostic URS is offered only in equivocal cases.

Diagnostic Ureteroscopy in CT Urography-Diagnosed Upper Tract Urothelial Carcinoma: Delay in Definitive Treatment and Increased Intravesical Recurrence.

PurposeTo investigate the effect of diagnostic ureteroscopy (URS) on the delay to surgical treatment of upper tract urothelial carcinoma (UTUC) detected by imaging and the risk of intravesical recurrence.Materials and methodsWe undertook a retrospective case-note analysis of all patients who underwent radical nephroureterectomy (NUU) from November 2012 to July 2019. We identified those who underwent diagnostic ureteroscopy prior to NUU as Group 1 and those who did not undergo diagnostic URS as Group 2. Perioperative and pathological parameters were compared between both groups. Kaplan-Meier and Log-Rank analyses were used to compare delay to NUU and the intravesical recurrence (IVR) free survival. Cox regression models were employed to analyze the risk factors of intravesical recurrence.ResultsOut of 69 patients with a mean age of 71.3 years and a mean follow-up of 48.5 months, 49 (71%) underwent URS while 20 (29%) did not. The mean time between the computerized tomography urography (CTU) and surgery was 86 days with URS and 59 days in the control groups(p=0.007). Intravesical recurrence in year one postoperatively was 28.2 % in the URS group vs 5.9% in the control group (p=0.04). The Kaplan-Meier curve showed improved, yet insignificant, IVR-free survival for the control group (Log-Rank p-value=0.21). In multivariate Cox regression analysis, concomitant bladder carcinoma was an independent risk factor for IVR (HR, 15.01; 95%CI, 3.311 - 68.07; p=0.0004). Intravesical mitomycin-c was a protective factor (HR 0.154; 95%CI 0.025 - 0.922; p=0.040).ConclusionIn our retrospective single-unit study, diagnostic ureteroscopy for CTU-detected upper tract urothelial carcinoma delayed definitive surgical treatment. Furthermore, it was associated with a significantly increased risk of early intravesical recurrence. URS can provide useful information and reassurance prior to major surgery but must be used with caution in light of these findings.

Does the diagnostic modality for upper tract urothelial carcinoma prior to radical nephroureterectomy influence the risk of subsequent intravesical recurrence?

405 Background: The diagnosis of upper tract urothelial carcinoma (UTUC) is frequently obtained via diagnostic ureteroscopy (URS) with biopsy. In a recent meta-analysis of five retrospective series comparing UTUC RNU patients with and without prior diagnostic URS, prior URS was associated with intravesical recurrence of urothelial carcinoma. However, there remains an incomplete understanding of the risks of URS on intravesical recurrence after RNU, and existing studies have not examined the risks of URS without endoscopic biopsy or percutaneous biopsy alone. Here, we query our institutional RNU registry to determine if UTUC diagnostic modality influences post-RNU intravesical recurrence risk. Methods: Years 1995 to 2019 of our institutions RNU registry were queried. Patients with UTUC were divided into four groups: 1) URS with endoscopic biopsy; 2) URS without endoscopic biopsy (visual confirmation alone); 3) percutaneous biopsy without any URS; 4) no URS and no percutaneous biopsy. Exclusion criteria included pure non-urothelial histology, RNU for benign indications, and prior/concomitant cystectomy. The primary outcome was intravesical recurrence of urothelial carcinoma compared across the four groups using Kaplan-Meier log-rank analyses and Cox-proportional hazard modeling (hazard ratio = HR). Results: In a cohort of 878 patients (mean post-RNU follow-up 43 months), 461 (53%) had URS with biopsy, 130 (15%) had URS without biopsy, 229 (26%) had no URS or percutaneous biopsy, and 58 (7%) had percutaneous biopsy alone. The 3-year intravesical recurrence rate was 27%, 22%, 18%, 12% for groups 1-4, respectively. Covariates associated with intravesical recurrence on univariable analysis included age (HR 1.03, p &lt; 0.01), female gender (HR 0.76, p = 0.06), history of bladder cancer (HR 1.39, p = 0.01), current smoker (HR 1.49, p = 0.04), and multifocality (HR 1.34, p = 0.03). After adjusting for these covariates, multivariable analysis found that group 1 (URS with biopsy) was associated with increased intravesical recurrence (HR 1.41, p = 0.03) relative to group 3 (no URS or percutaneous biopsy). Compared to group 1, the hazard ratio for intravesical recurrence was not significantly different for group 2 (HR 1.18, p = 0.45) or group 4 (HR 1.11, p = 0.79). Conclusions: Patients undergoing ureteroscopic biopsy to diagnose UTUC prior to RNU had a higher risk of intravesical recurrence after RNU compared to patients who did not undergo any URS or percutaneous biopsy. This agrees with prior literature and suggests that aggressive ureteroscopic manipulation of UTUC tumors via biopsy may promote shedding of urothelial carcinoma cells capable of seeding the bladder. Our study does support the initiation of a randomized trial to determine if intravesical chemotherapy after ureteroscopic biopsy can reduce intravesical urothelial carcinoma recurrences.

Preoperative positive voided urine cytology predicts poor clinical outcomes in patients with upper tract urothelial carcinoma undergoing nephroureterectomy

BackgroundPerformance of urinary cytology is recommended as the part of a standard diagnostic workup and base surveillance regimens in upper tract urothelial carcinoma (UTUC). However, the effect of positive voided urine cytology (VUC) on UTUC prognosis, compared with negative VUC, has not been fully demonstrated. This study aimed to evaluate the impact of preoperative VUC on predicting intravesical recurrence, disease recurrence, and mortality in patients with UTUC who underwent nephroureterectomy (RNU).MethodsClinicopathological information was collected from 315 UTUC patients treated with RNU. The association between VUC and oncological outcomes was analyzed using the Kaplan–Meier method with log-rank test and Cox proportional hazards regression models. Multiple logistic regression analysis was performed to identify the influence of VUC on tumor grade.ResultsPreoperative positive VUC, presenting in 101 patients (32%), was significantly associated with tumor multifocality (P = 0.017) and higher tumor grade (P = 0.010). On multivariable Cox regression analyses, preoperative positive VUC was an independent prognostic factor of intravesical recurrence-free survival (RFS) (hazard ratio [HR] = 2.21, 95% confidence interval [CI] 1.06–4.64; P = 0.035), RFS (HR = 1.80, 95% CI 1.08–2.99; P = 0.023), and cancer-specific survival (CSS) (HR = 1.87, 95% CI 1.10–3.18; P = 0.020), but not overall survival (HR = 1.32, 95% CI 0.80–2.18; P = 0.28). Logistic regression analysis revealed that VUC was related to high tumor grade in UTUC (odds ratio = 2.23, 95%CI 1.15–4.52).ConclusionPreoperative positive VUC significantly increases the risk of intravesical recurrence in UTUC patients undergoing RNU. In addition, positive VUC is an adverse predictor of RFS and CSS, which might be due to the association between positive VUC and high tumor grade.

MP08-10 THE INTRODUCTION OF A SURGICAL CHECKLIST FOR THE TRANSURETHRAL RESECTION OF THE BLADDER IMPROVES RECURRENCE-FREE SURVIVAL IN NON-MUSCLE INVASIVE BLADDER CANCER PATIENTS

You have accessJournal of UrologyBladder Cancer: Non-invasive I1 Apr 2018MP08-10 THE INTRODUCTION OF A SURGICAL CHECKLIST FOR THE TRANSURETHRAL RESECTION OF THE BLADDER IMPROVES RECURRENCE-FREE SURVIVAL IN NON-MUSCLE INVASIVE BLADDER CANCER PATIENTS Francesco Soria, David D'Andrea, Mirko Preto, Kilian M. Gust, Alberto Briganti, Shahrokh F. Shariat, and Paolo Gontero Francesco SoriaFrancesco Soria More articles by this author , David D'AndreaDavid D'Andrea More articles by this author , Mirko PretoMirko Preto More articles by this author , Kilian M. GustKilian M. Gust More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat More articles by this author , and Paolo GonteroPaolo Gontero More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.315AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES More than half of patients with non-muscle invasive bladder cancer (NMIBC) will experience an intravesical recurrence, requiring additional treatment and its resulting morbidity, decreasing quality of life and increasing healthcare costs. The quality of surgical resection is essential in the management of bladder cancer (BC) patients and may have a significant impact on the risk of intravesical recurrence. To standardize the procedure and to improve surgical outcomes, the introduction of a surgical checklist (SC) has been proposed. Moreover, the SC improves operative reporting, which can be considered a proxy of surgical quality. However, studies reporting the impact of a SC on oncological outcomes are lacking. The aim of our study was to evaluate the impact of the introduction of a SC on recurrence-free survival (RFS) of NMIBC patients undergoing TURBT. METHODS An eight-item SC was progressively implemented into clinical practice at two tertiary referral centers. We reviewed the reports of TURBTs performed before and during the SC’s implementation. Patients undergoing TURBTs between January 2012 and January 2017 were enrolled in this retrospective study. The number of reported items was collected from surgical reports. A multivariable logistic regression was performed to assess the impact of operative report on the presence of detrusor muscle in pathologic specimen. A multivariable Cox regression model was built to assess the impact of operative reports on RFS rate. RESULTS Overall, 547 patients were included in the study and 266 of them (49%) underwent TURBT after the SCs’ implementation. Median follow-up for patients alive at last follow-up was 20 months (IQR 10-31). Median age at TURBT was 72 years (IQR 63-78) and 459 (84%) patients were male. Most of the patients had NMIBC (91%) and high-grade disease (58%). Detrusor muscle in TURBT specimen was detected in 60% of the cases. The implementation of the SC increased the number of reported items from 5 to 6 (median values). On logistic multivariable regression analysis, the number of reported items was not significantly associated with the presence of detrusor muscle in the surgical specimen (HR 1.01, 95% CI 0.75-1.35, p=0.9). On multivariable Cox regression analysis, the number of reported items was independently associated with a significative improvement of RFS (OR 0.78, 95% CI 0.61-0.99, p=0.04). CONCLUSIONS TURBT is essential in the management of BC patients. We demonstrated that the implementation of a SC into clinical practice increases the quality of operative report thereby potentially improving individualized risk-stratification and care resulting in lower disease recurrence-rate. Therefore, the introduction of a SC should be recommended in order to enhance oncological outcomes by improving surgical standardization and operative reporting. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e99 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Francesco Soria More articles by this author David D'Andrea More articles by this author Mirko Preto More articles by this author Kilian M. Gust More articles by this author Alberto Briganti More articles by this author Shahrokh F. Shariat More articles by this author Paolo Gontero More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP78-01 IMPACT OF URETEROSCOPY BEFORE RADICAL NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMAS ON ONCOLOGIC OUTCOMES: A META-ANALYSIS

Objectives To investigate whether ureteroscopy (URS) before radical nephroureterectomy (RNU) for upper tract urothelial carcinomas (UTUCs) has an impact on oncological outcomes. Patients and Methods We performed a systematic literature search of PubMed, Web of Science, and EMBASE for citations published prior to September 2017 that described URS performed on patients with UTUC and conducted a standard meta-analysis on survival outcomes. Results Our meta-analysis included eight eligible studies containing 3975 patients. The results were as follows: cancer-specific survival (CSS; hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.59-0.99; P = 0.04), overall survival (OS; HR 0.76, 95% CI 0.48-1.21; P = 0.24), recurrence-free survival (RFS; HR 0.89, 95% CI 0.69-1.14; P = 0.37), metastasis-free survival (MFS; HR 1.06, 95% CI 0.82-1.36; P = 0.66), and intravesical recurrence-free survival (IRFS; HR 1.51, 95% CI 1.29-1.77; P l 0.001). When excluding previous bladder tumour history, the result for IRFS was a HR of 1.81 (95% CI 1.53-2.13; P l 0.001). Conclusions This meta-analysis indicated that URS before RNU did not have a negative impact on CSS, OS, RFS, or MFS in patients with UTUC. However, patients were at higher risk of intravesical recurrence after RNU when they had undergone URS before RNU. Further studies are needed to assess the effects of post-URS intravesical chemotherapy on intravesical recurrence.

Risk of Intravesical Recurrence After Ureteroscopic Biopsy for Upper Tract Urothelial Carcinoma: Does the Location Matter?

To investigate whether ureteroscopic biopsy (URS-Bx) for upper tract urothelial carcinoma (UTUC) before radical nephroureterectomy affects intravesical recurrence (IVR). Of the 515 patients receiving radical nephroureterectomy for UTUC between 1998 and 2012, 387 patients were included for the analysis. URS-Bx was performed in 69 patients (17.8%). Patients were stratified according to tumor location, and the impact of URS-Bx on IVR was evaluated after adjusting for other clinicopathologic variables. IVR occurred in 163 patients (42.1%). The postoperative 5-year IVR-free survival was not significantly different according to URS-Bx in the overall patient group (54.0% vs 39.3%, p = 0.056). In patients with renal pelvic tumor, IVR-free probability was lower in patients with URS-Bx than in patients without URS-Bx (39.6% vs 62.2%, p = 0.012), although IVR-free survival in patients with ureteral tumor was equivalent (36.7% vs 45.8%, p = 0.946). In multivariate analysis, previous bladder tumors (hazard ratio [HR], 1.65; p = 0.016) were a significant risk factor for IVR in all patients and ureteral tumor location (HR, 1.35; p = 0.071) was associated with IVR, although statistical significance was not achieved. In patients with renal pelvic tumor, URS-Bx HR, 1.98; p = 0.020 was the only risk factor for IVR. However, URS-Bx was not associated with IVR in patients with ureteral tumor, although previous bladder tumor HR, 1.74; p = 0.028 was a risk factor for IVR. URS-Bx is a significant risk factor for IVR in patients with renal pelvic tumor and should be performed after sufficient consideration in these patients if other examinations are uncertain.

The neutrophil-to-lymphocyte ratio as a predictor of intravesical recurrence in patients with upper urinary tract urothelial carcinoma treated with radical nephroureterectomy.

The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation associated with recurrence and poor prognosis in numerous cancer types. The aim of this study was to evaluate the use of the NLR as a biomarker for intravesical recurrence (IVR) in patients undergoing radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC) for the first time. We retrospectively analyzed the records of 100 patients with UTUC who had undergone RNU between 1999 and 2015 at our institution. The association between the preoperative NLR and IVR were assessed using multivariate models. Among the 100 patients enrolled in the study, 33 developed IVR during a median follow-up of 34months. The receiver operating characteristic analysis revealed that the optimum cut-off value for the preoperative NLR was >3.8. A high preoperative NLR (n=21) was associated with a significantly increased risk of lymph node involvement (p=0.036) and IVR (p=0.034) compared with a low preoperative NLR (n=79). IVR-free survival in patients with a high preoperative NLR was significantly worse than that of patients with a low preoperative NLR (p=0.018). On multivariate analysis, the preoperative NLR [hazard ratio (HR) 2.49; p=0.015] and tumor multifocality (HR 2.96; p=0.024) were independent risk factors predictive of IVR. In our study population of patients with UTUC who had undergone RNU the preoperative NLR was associated with a significantly increased risk of IVR, suggesting that the NRL could be a useful biomarker for predicting IVR.

1056 Detection of FGFR3 mutations from urine sediment DNA to predict the risk of intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma

1056 Detection of FGFR3 mutations from urine sediment DNA to predict the risk of intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma

331 Multicenter external validation of a post-operative nomogram for predicting the risk of intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma

331 Multicenter external validation of a post-operative nomogram for predicting the risk of intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma

333 Diagnostic ureteroscopy increases the risk of intravesical recurrence in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy

333 Diagnostic ureteroscopy increases the risk of intravesical recurrence in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy

Conditional Survival After Radical Nephroureterectomy for Upper Tract Carcinoma

BackgroundConditional survival (CS) provides better estimates of the survival probability at each follow-up time, and its usefulness has been proven in several solid malignancies. ObjectiveTo assess the changes in 5-yr CS rates after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) and to determine how well-established prognostic factors evolve over time. Design, setting, and participantsWe analysed data from 3544 patients treated with RNU at 15 international academic centres between 1989 and 2012. InterventionRNU. Outcomes measurements and statistical analysisConditional intravesical recurrence-free (IVRFS), cancer-specific survival (CSS), and overall survival (OS) estimates were calculated using the Kaplan-Meier method. A multivariable Cox regression model was used to calculate proportional hazard ratios for the prediction of mortality. Results and limitationsThe 5-yr bladder cancer recurrence-free survival, CSS, and OS rates were 54.9%, 72.2%, and 62.6%, respectively. Given a 1-, 2-, 3-, and 4-yr survivorship, the 5-yr conditional OS rates improved to 65.2%, 69.3%, 71.5%, and 73.0%, respectively. The 5-yr CS improvement was primarily noted among surviving patients with advanced-stage disease. The impact of pathologic parameters on CS estimates decreased over time for both CSS and OS, whereas the impact of age and gender increased with survivorship. No survival benefit was noted regarding the adjuvant chemotherapy status. Findings were confirmed upon multivariable analyses. Tumour location, the presence of carcinoma in situ, and the type of bladder cuff excision were continuously predictive for IVRFS whatever the survivorship. A limitation is the retrospective design. ConclusionsCS analysis demonstrates that the patient risk profile evolves during the post-RNU follow-up. The probability of survival markedly increases over time in patients having high-stage disease. The impact of prognostic pathologic features decreases over time and can disappear for long-term CS. Patient summaryIn this study, we found that the risk of intravesical recurrence, cancer-specific survival, and overall mortality evolves over the follow-up after surgery. Taking into account the survivorship provides better estimates of the survival probability at each follow-up time.

PD35-08 RISK FACTORS FOR INTRAVESICAL RECURRENCE AFTER RADICAL NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA: A META-ANALYSIS

You have accessJournal of UrologyBladder Cancer: Upper Tract Tumors I1 Apr 2014PD35-08 RISK FACTORS FOR INTRAVESICAL RECURRENCE AFTER RADICAL NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA: A META-ANALYSIS Haichao Yuan, Ping Han, and Qiang Wei Haichao YuanHaichao Yuan More articles by this author , Ping HanPing Han More articles by this author , and Qiang WeiQiang Wei More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2421AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The standard management for upper tract urothelial carcinoma (UTUC) is radical nephroureterectomy (RNU) with bladder cuff excision, but after surgery, approximately 22% to 47% of patients with UTUC develop subsequent intravesical recurrence (IVR), and recurrence in the contralateral upper tract is observed in 26% of patients. Considering this high incidence of IVR after RNU, several risk factors were reported as predictive for IVR after RNU. Until recently, most of the risk factors were still under debate. The aim of our study is to conduct a meta-analysis based on the recent literature to explore the risk factors for IVR after RNU for UTUC. METHODS An electronic search of the Medline, Embase, Cochrane Library, CancerLit and ClinicalTrials.gov databases was performed to identify relevant studies published prior to May 2013. The studies were included if they reported risk factors related to bladder or intravesical recurrence after RNU for UTUC. Studies were excluded from the analysis if they were case reports, meeting abstracts or conference proceedings. The studies which included neoadjuvant or adjuvant chemotherapy or intravesical instillation chemotherapy after RNU were excluded. RESULTS Forty studies, with 12,010 patients, were included in our meta-analysis. Our study indicated that a statistically significant difference in IVR after RNU was found in the male vs. female (OR: 0.72; 95%CI: 0.59 to 0.85), ureteral vs. renal pelvis (OR: 1.18; 95%CI: 1.00 to 1.36), T2-4 vs. Tis and Ta,1 (OR: 0.53; 95%CI: 0.40 to 0.66), larger vs. smaller tumor size (OR: 1.02; 95%CI: 1.01 to 1.03) and previous/synchronous bladder cancer vs. the absence of bladder cancer (OR: 1.59; 95%CI: 1.26 to 1.9). No significant differences in IVR after RNU were found in the high vs. low age, multifocal tumors vs. single tumor, G3 vs. G1,2, high vs. low grade, N0 vs. N+, concomitant carcinoma in situ (CIS) vs. the absence of CIS, positive vs. negative lymphovascular invasion, open versus laparoscopic nephroureterectomy and endoscopic vs. transvesical technique. CONCLUSIONS our study showed that female patient, ureteral tumor, larger tumor, low T stage (Tis, a, 1) and the history of bladder cancer were significant risk factors related to IVR after nephroureterectomy. The age, tumor multifocality, G grade, lymph node status, lymphovascular invasion, Concomitant CIS, type of surgery and management of the bladder cuff were not significantly associated with the risk of IVR after nephroureterectomy. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e893-e894 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Haichao Yuan More articles by this author Ping Han More articles by this author Qiang Wei More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Tumour recurrence after radical nephroureterectomy for UTUC

Bladder cancer recurrence after radical nephroureterectomy for upper tract urothelial carcinoma (UTUC) is a common occurrence. A new nomogram, based on retrospective analysis of a large multicentre cohort, has been shown to predict the risk of intravesical recurrence. Despite limitations, this model could help clinicians to provide personalized postoperative management.

Clinical outcome of conservative therapy for stage T1, grade 3 transitional cell carcinoma of the bladder.

The objective of this study was to retrospectively investigate the effectiveness of transurethral resection of bladder tumor (TURBT) and intravesical instillation therapy for stage T1, grade 3 (T1G3) transitional cell carcinoma (TCC) of the urinary bladder. Between January 1995 and December 1997, 97 patients with T1G3 TCC of the urinary bladder were treated by TURBT and adjuvant intravesical instillation with bacillus Calmette-Guérin (BCG) or other anticancer agents. The recurrence-free survival rates were evaluated according to several clinicopathological factors. The cases that progressed to muscle invasive disease were also analysed. In this series, the median follow-up period was 25 months (range, 5- 41) after the initial TURBT. Intravesical recurrence was noted in 44 patients (45%), and the 1, 2, and 3 year recurrence-free survival rates were 72%, 58%, and 42%, respectively. Multivariate analyses revealed that the risk of intravesical recurrence was significantly higher for patients who did not receive BCG therapy, irrespective of age, gender, tumor size, multiplicity, pathological stage, concomitant carcinoma in situ, and lymphovascular involvement. Moreover, after a median of 10 months, disease progression occurred in seven patients (7%), of which only one patient was treated by BCG therapy after initial TURBT. These findings suggest that intravesical instillation with BCG combined with TURBT is an effective conservative treatment for T1G3 TCC of the bladder. Patients with negative prognostic factors should be treated by BCG rather than other anticancer agents after TURBT.

FLOW CYTOMETRIC DNA ANALYSIS IN PREDICTION OF INTRAVESICAL RECURRENCE FROM HUMAN BLADDER-CANCER

A series of 128 patients undergoing diagnostic and/or therapeutic transurethral resection for primary urothelial bladder carcinoma was prospectively studied in order to evaluate the relative importance of DNA-ploidy and S-phase fraction (SPF) by flow cytometry and of several clinicopathological features in predicting disease-free survival. Only frozen tissue was used. The mean follow-up was 22 months (range: 3-61 months). DNA-aneuploidy was present in 64% of the cases (82/128), while multiclonality was found in 29% of the DNA-aneuploid cases (24/82). In the univariate statistical analysis, high stage, DNA-aneuploidy (mono- and multiclonal patterns) and high SPF value (>11.6%) proved to be significantly related to the risk of intravesical recurrence, while a significant trend was present for histological grade. In the multivariate analysis only high SPF value (>11.6%) and DNA-aneuploidy were independently related to risk of relapse (RR of 2.39 and 2.40 respectively).