Tract Urothelial Carcinoma Research Articles

MP69-06 CHARACTERISTICS OF UPPER URINARY TRACT UROTHELIAL CARCINOMA DEFICIENT IN LYNCH SYNDROME-RELATED MISMATCH REPAIR GENE EXPRESSION PROTEIN ON IMMUNOHISTOCHEMISTRY

You have accessJournal of UrologyCME1 Apr 2023MP69-06 CHARACTERISTICS OF UPPER URINARY TRACT UROTHELIAL CARCINOMA DEFICIENT IN LYNCH SYNDROME-RELATED MISMATCH REPAIR GENE EXPRESSION PROTEIN ON IMMUNOHISTOCHEMISTRY Tanabe Kenji, Nakanishi Yasukazu, Yasujima Rikuto, Hirose Kohei, Umino Yosuke, Okubo Naoya, Kataoka Madoka, Miyazaki Saori, Yajima Shugo, Kuwata Takeshi, Watanabe Reiko, and Masuda Hitoshi Tanabe KenjiTanabe Kenji More articles by this author , Nakanishi YasukazuNakanishi Yasukazu More articles by this author , Yasujima RikutoYasujima Rikuto More articles by this author , Hirose KoheiHirose Kohei More articles by this author , Umino YosukeUmino Yosuke More articles by this author , Okubo NaoyaOkubo Naoya More articles by this author , Kataoka MadokaKataoka Madoka More articles by this author , Miyazaki SaoriMiyazaki Saori More articles by this author , Yajima ShugoYajima Shugo More articles by this author , Kuwata TakeshiKuwata Takeshi More articles by this author , Watanabe ReikoWatanabe Reiko More articles by this author , and Masuda HitoshiMasuda Hitoshi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lynch syndrome (LS) is an autosomal formed inherited disorder that is a susceptibility syndrome for several cancers. Four mismatch repair (MMR) genes (MLH1, MSH2/6, PMS2) are thought to be involved in LS. Colorectal cancer, a representative cancer of LS, is known to develop at a younger age and have a better prognosis than non-LS colorectal cancer. Upper urinary tract urothelial carcinoma (UTUC) is third major cancer that occur with increased frequency in LS, but details are not well known. In this study, we examined MMR gene-related protein defects on immunohistochemistry (IHC) in UTUC and analyzed their characteristics. METHODS: A total of 150 consecutive patients with UTUC who underwent surgical resection between February 2012 and December 2020 at National Cancer Center Hospital East (Chiba, Japan) were included in this study. The expression of four MMR gene-related proteins was examined by IHC, and the association with clinical and oncological characteristics was analyzed retrospectively. RESULTS: Six patients (4%) were found to be deficient in some MMR gene-related protein on IHC. Three patients were deficient in MSH2 and one patient each in MLH1, MSH6 and PMS2. No patient had more than 2 deficiencies. The median age was 74 years for the MMR-deficient group and 72 years for the non-deficient group. Compared to the non-deficient group, the MMR-deficient group had more female (83% vs 26%; p=0.0025) and right-side tumor (100% vs 44%; p=0.0075). History of LS-related cancer tended to be more in the MMR-deficient group (33% vs 9%; p=0.051). (Table 1) There were no differences in pathologic characteristics nor oncological outcome between the two groups. Of the 150 patients, 4 met Amsterdam Criteria II. One of them showed MSH2 gene-related protein defects, while the other three had no MMR defects. Five patients did not meet Amsterdam Criteria II but showed some MMR defect. One female patient with a history of colorectal cancer was genetically diagnosed with LS who had mutation in MLH1, did not meet Amsterdam Criteria II, but was deficient in MLH1-related protein. CONCLUSIONS: The characteristics of LS-related UTUC may be different from those of LS-related colorectal cancer. The impact of LS in UTUC remains unclear and requires a large-scale study. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e965 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tanabe Kenji More articles by this author Nakanishi Yasukazu More articles by this author Yasujima Rikuto More articles by this author Hirose Kohei More articles by this author Umino Yosuke More articles by this author Okubo Naoya More articles by this author Kataoka Madoka More articles by this author Miyazaki Saori More articles by this author Yajima Shugo More articles by this author Kuwata Takeshi More articles by this author Watanabe Reiko More articles by this author Masuda Hitoshi More articles by this author Expand All Advertisement PDF downloadLoading ...

PD46-11 ASSESSING THE ROLE OF NEOADJUVANT CHEMOTHERAPY IN UPPER TRACT UROTHELIAL CARCINOMA EVOLUTION

You have accessJournal of UrologyCME1 Apr 2023PD46-11 ASSESSING THE ROLE OF NEOADJUVANT CHEMOTHERAPY IN UPPER TRACT UROTHELIAL CARCINOMA EVOLUTION Neeta D'Souza, Andrew B. Katims, Ali Mouzannar, Eugene J. Pietzak, David Solit, Kwanghee Kim, and Jonathan A. Coleman Neeta D'SouzaNeeta D'Souza More articles by this author , Andrew B. KatimsAndrew B. Katims More articles by this author , Ali MouzannarAli Mouzannar More articles by this author , Eugene J. PietzakEugene J. Pietzak More articles by this author , David SolitDavid Solit More articles by this author , Kwanghee KimKwanghee Kim More articles by this author , and Jonathan A. ColemanJonathan A. Coleman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003359.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Systemic neoadjuvant chemotherapy (NAC) may apply selective pressure on tumors and shape cancer evolution. In bladder cancer, intratumor genetic heterogeneity can help predict response to NAC, with RB1, ERCC2, ATM, and FANCC mutations significantly associated with a positive response to NAC. Molecular studies have shown upper tract urothelial carcinoma (UTUC) to be genetically distinct from bladder cancer with a significantly worse response to NAC, yet still harboring significant intratumor heterogeneity. This study aims to assess the effect of NAC in selecting chemotherapy-resistant mutations among the intratumor heterogeneity in UTUC. METHODS: We identified patients with UTUC who underwent platinum-based NAC followed by nephroureterectomy treated at Memorial Sloan Kettering Cancer Center. Patients with complete response to NAC were excluded. Pre-NAC biopsy and post-NAC nephroureterectomy samples underwent next generation targeted gene sequencing through MSK-IMPACT. Mutational frequency among the 505 tested genes was compared in the pre-and post- treatment cohorts to assess for significant changes (p<0.05). RESULTS: We identified 15 patients with UTUC that had an incomplete response/progression of disease after NAC with gemcitabine/cisplatin as determined by final pathology at radical nephroureterectomy. The median age at the time of NAC was 60 (IQR 55-70). The most common mutations are seen in Figure 1. The most common mutated genes in pre-NAC UTUC biopsy were TERT (53.3%), KMT2D (40.0%), and ARID1A (33.3%). Post-chemotherapy, the most common mutations were TERT (56.3%), FGFR3 (31.3%), and KMT2D (31.3%). There were no significant differences between the frequency of mutations pre- and post-NAC. There was no decrease in the frequency of RB1, ERCC2, ATM, and FANCC post-NAC. CONCLUSIONS: Administration of NAC did not select for specific resistant mutations in the global tumor landscape. It is possible that changes to the tumor microenvironment, sub-clonal expansion, or differences in expression may be identified through RNA based studies. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1174 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Neeta D'Souza More articles by this author Andrew B. Katims More articles by this author Ali Mouzannar More articles by this author Eugene J. Pietzak More articles by this author David Solit More articles by this author Kwanghee Kim More articles by this author Jonathan A. Coleman More articles by this author Expand All Advertisement PDF downloadLoading ...

Metanephric adenoma in a young female: a rare case report from Nepal

Introduction: Metanephric adenomas (MAs) of the kidney are rare benign epithelial lesions in the kidney that have been described in the literature, mainly through case reports, representing ~0.2% of renal masses. No prior case reports have been published from Nepal. We report one such case with MA presented to our center. Case presentation: A 25-year-old lady presented with complaints of recurrent hematuria for the past 6 months. Ultrasound of the abdomen revealed left gross hydronephrosis and reduced left renal parenchyma. A contrast-enhanced computerized scan of the abdomen and pelvis showed a heterogeneously enhancing soft tissue density lesion 65 mm×57 mm at the left renal pelvis extending into mid calyx and distally to proximal ureter, ~34 mm distal to pelviureteric junction causing moderate hydronephrosis, likely urothelial cell carcinoma. Urine cytology was negative for malignancy. Laparoscopic left nephroureterectomy with bladder cuff excision lymphadenectomy was done. The histopathology report came out to be consistent with MA and the lymph nodes were negative for malignancy. Immunohistochemistry study showed that the cells were positive for PAX8. During follow-up, she did not have hematuria and her postoperative period was uneventful. Discussion: From this report, we want to highlight the need to consider MA as a differential diagnosis of renal mass and differentiate MA from upper tract urothelial carcinoma, renal cell carcinoma, Wilms tumor, and papillary adenomas. Conclusion: MA is a rare renal lesion that may present as upper tract urothelial carcinoma. MA should be evaluated through histology and immunohistochemistry studies.

MP69-17 NECESSITY OF PROPHYLACTIC DRAINAGE TUBE IN RETROPERITONEAL LAPAROSCOPIC NEPHROURETERECTOMY WITH OPEN DISTAL URETERECTOMY: A MATCHED-PAIR ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP69-17 NECESSITY OF PROPHYLACTIC DRAINAGE TUBE IN RETROPERITONEAL LAPAROSCOPIC NEPHROURETERECTOMY WITH OPEN DISTAL URETERECTOMY: A MATCHED-PAIR ANALYSIS Hiroki Hagimoto, Mutsushi Kawakita, and Toshinari Yamasaki Hiroki HagimotoHiroki Hagimoto More articles by this author , Mutsushi KawakitaMutsushi Kawakita More articles by this author , and Toshinari YamasakiToshinari Yamasaki More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess the necessity of prophylactic drain placement in retroperitoneal laparoscopic nephroureterectomy with open distal ureterectomy for upper tract urothelial cancer. METHODS: Between July 2011 and March 2021, 200 patients with localized clinical Tis-T3 upper urinary tract urothelial carcinoma underwent laparoscopic nephroureterectomy with open distal ureterectomy. After removing the specimen, drainage tubes were placed on the renal beds and/or in the retrovesical spaces. Drain tubes were omitted for most patients after 2017. We compared the postoperative outcomes between the patients with drain placement (D+ group) and without drain placement (D- group) by propensity score matching. RESULTS: A total of 164 patients (90 in the D+ group and 74 in the D- group) were enrolled, and matched pairs of 108 patients were analyzed. There was no significant difference in the incidence of complications according to Clavien–Dindo grade in the two groups after the propensity score matching. There was no significant difference in the incidence of postoperative lymphocele (n=5 vs. 9, p=0.395) and symptomatic lymphocele (n=1 vs. 1, p=1) between the two groups. The length of hospital stay was significantly shorter in the D- group (11 vs. 8 days, p<0.0001). CONCLUSIONS: Omitting the drainage tube after laparoscopic radical nephroureterectomy does not increase postoperative complications or lymphocele and shortens the post-hospital stay. Source of Funding: No funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e971 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hiroki Hagimoto More articles by this author Mutsushi Kawakita More articles by this author Toshinari Yamasaki More articles by this author Expand All Advertisement PDF downloadLoading ...

MP69-16 INPATIENT OUTCOMES OF RADICAL NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CANCER, WITH TRENDS IN UTILIZATION AND IMPACT OF ROBOTIC SURGERY: A NATIONAL INPATIENT SAMPLE ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP69-16 INPATIENT OUTCOMES OF RADICAL NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CANCER, WITH TRENDS IN UTILIZATION AND IMPACT OF ROBOTIC SURGERY: A NATIONAL INPATIENT SAMPLE ANALYSIS Sohrab Arora, Samantha Wilder, Matthew Davis, Nicholas Corsi, Ivan Rakic, Chase Morrison, Rafe Affas, Akshay Sood, Riccardo Autorino, Craig Rogers, and Firas Abdollah Sohrab AroraSohrab Arora More articles by this author , Samantha WilderSamantha Wilder More articles by this author , Matthew DavisMatthew Davis More articles by this author , Nicholas CorsiNicholas Corsi More articles by this author , Ivan RakicIvan Rakic More articles by this author , Chase MorrisonChase Morrison More articles by this author , Rafe AffasRafe Affas More articles by this author , Akshay SoodAkshay Sood More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Craig RogersCraig Rogers More articles by this author , and Firas AbdollahFiras Abdollah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Our primary aim was to evaluate the inpatient morbidity, mortality, and cost of radical nephroureterectomy (NU) for upper tract urothelial cancer (UTUC). We also aimed to evaluate the trends in utilization of robotic surgery for this procedure, and to assess the difference between robotic NU and open NU in terms of the above outcomes from within the National Inpatient Sample (NIS). METHODS: We focused on 9581 records of adult patients with nonmetastatic UTUC undergoing radical NU from 2003-14, representing an estimated 47204 NUs performed in the US during this period. Data after 2014 was excluded due to International Classification of Diseases (ICD) coding change in 2015. ICD-9 code for robotics was introduced in 2008, so data before 2008 was not used when comparing surgical approaches. ICD-9 codes were used to define complications. Complex-survey procedures were used to study descriptive characteristics, and outcomes of patients undergoing NU. Cost of admission was inflation-adjusted to 2014 US dollars. Table: Descriptive statistics and outcomes of radical NU for upper tract urothelial carcinoma in 47204 records from the NIS from 2008-2014, stratified by surgical approach. RESULTS: Overall, the median age of the patients was 72 (IQR 63-79) years. 22974 (49%) patients had a Charlson comorbidity index of 3 or more. 33693 (71%) patients had Medicare/Medicaid insurance. 14692 (31%) patients had complications, with 6814 (14%) having major complications. Significant trend towards use of robotic approach was seen during the study period. Overall, 4635 NUs were performed robotically: accounting for 33% of NUs in 2014. Table 1 shows the outcomes after stratification by approach. Robotic surgery was associated with significantly lower rate of any complications 962 (21%) vs 7675 (33%) for open; p<0.001. This was also true for in hospital mortality (0.3% vs 1.2%; p 0.02), and major complications (10% vs 19%; p<0.001). CONCLUSIONS: Nephroureterectomy is associated with a high inpatient morbidity and mortality. There is increasing utilization of robotic approach in the US. Robotic surgery is associated with lower morbidity and in hospital mortality in these patients. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e970 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sohrab Arora More articles by this author Samantha Wilder More articles by this author Matthew Davis More articles by this author Nicholas Corsi More articles by this author Ivan Rakic More articles by this author Chase Morrison More articles by this author Rafe Affas More articles by this author Akshay Sood More articles by this author Riccardo Autorino More articles by this author Craig Rogers More articles by this author Firas Abdollah More articles by this author Expand All Advertisement PDF downloadLoading ...

V06-08 UPPER TRACT TUMOR EN BLOC ENUCLEATION: A NOVEL APPROACH TO THE DIAGNOSIS AND MANAGEMENT OF UPPER TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyCME1 Apr 2023V06-08 UPPER TRACT TUMOR EN BLOC ENUCLEATION: A NOVEL APPROACH TO THE DIAGNOSIS AND MANAGEMENT OF UPPER TRACT UROTHELIAL CARCINOMA Joshua Jue and Noel Armenakas Joshua JueJoshua Jue More articles by this author and Noel ArmenakasNoel Armenakas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003274.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The identification of high grade disease and subepithelial connective tissue invasion (pT1 disease) are important prognostic factors which guide treatment options in upper tract urothelial carcinoma (UTUC). We aim to describe and demonstrate our novel en bloc enucleation technique for the endoscopic diagnosis and treatment of upper tract tumors. METHODS: We detail the instruments required for this procedure, as well as the surgical technique to perform an en bloc enucleation and specimen removal. Endoscopic video of a 2 cm renal pelvis tumor demonstrates all aspects of the technique, and histopathologic slides illustrate the diagnostic information obtained. RESULTS: A ureteral access sheath is inserted distal to the upper tract tumor, and a flexible ureteroscope is used to visualize the extent of upper tract disease and tumor characteristics. A 200 mm thulium fiber laser partially ablates the tumor surface to create an edge for tissue biopsy and post-ablation urine cytology. The tumor base is identified and the subepithelial connective tissue is carefully entered with low ablation laser settings. The correct tissue plane is extended by maintaining the ureteroscope in the subepithelial connective tissue and continuing the dissection along the entire width of the tumor base. Once the tumor is enucleated, a Nitinol stone retrieval basket is used to remove the specimen(s) and a ureteral stent is placed. CONCLUSIONS: En bloc enucleation is a safe technique that provides extensive histopathologic information in upper tract urothelial carcinoma. In cases where complete enucleation is not feasible, this procedure affords a mechanism for large caliber biopsies, enhancing diagnostic accuracy. This technique can be therapeutic in low grade and stage disease, but also offers a mechanism for large caliber biopsy if complete enucleation cannot be performed. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e511 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Jue More articles by this author Noel Armenakas More articles by this author Expand All Advertisement PDF downloadLoading ...

MP69-19 EFFICACY OF FISH ANALYSIS ON URINARY SPECIMENS DURING ENDOSCOPIC MANAGEMENT OF UPPER TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyCME1 Apr 2023MP69-19 EFFICACY OF FISH ANALYSIS ON URINARY SPECIMENS DURING ENDOSCOPIC MANAGEMENT OF UPPER TRACT UROTHELIAL CARCINOMA Orel Carmona, Nir Kleinmann, Dorit E. Zilberman, Zohar A. Dotan, and Asaf Shvero Orel CarmonaOrel Carmona More articles by this author , Nir KleinmannNir Kleinmann More articles by this author , Dorit E. ZilbermanDorit E. Zilberman More articles by this author , Zohar A. DotanZohar A. Dotan More articles by this author , and Asaf ShveroAsaf Shvero More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: FISH analysis (Fluorescence in-situ hybridization) is a laboratory technique used to detect chromosomal aberrations typical to malignant cells in body fluids. The EAU and NCCN guidelines on the management of upper tract urothelial carcinoma (UTUC) do not include recommendations relating to FISH analysis as part of the follow-up regimen of UTUC. The objective of this study was to examine the efficacy of FISH analysis on selective urine samples of patients undergoing endoscopic management for UTUC. METHODS: The medical records of all patients who managed endoscopically for UTUC at our institute between 2014-2022 were retrospectively analyzed. Demographic and clinical data, histology, cytology, and FISH results were collected. FISH analysis was considered malignant if It showed more than 4 cells with hyperploidy of chromosomes 3, 7, 17 or more than 12 cells with deletion of 9p21 locus on chromosome 9. RESULTS: During the study period, 62 patients underwent 561 ureteroscopies as part of the treatment and follow-up of UTUC. Cytology and FISH tests were performed in 376 and 273 cases, respectively. In 206 (75.4% of FISH studies) the FISH analysis was different from the cytology results: Out of the 58 cases found as benign in a cytology test, FISH analysis showed chromosomal aberrations in 9 (15.5%) cases. In all the 197 cases that a cytology test reported atypia, FISH analysis successfully classified the cells as benign (93 cases, 47.2%) or malignant (104 cases, 52.8%). Table 1 demonstrates the difference between cytology and FISH results in 133 cases in which the ureteroscopy showed no suspicious lesions, and both cytology and FISH analysis was performed. Out of the 217 endoscopies that resulted in biopsy-proven UTUC, cytology was taken in 143 cases and demonstrated malignant cells in 10 (7%) cases and atypical cells in 97 (67.8%) cases. FISH analysis was performed on 108 of these samples and successfully classified the cells as malignant in 59 (54.6%) cases. CONCLUSIONS: FISH analysis should be a part of the follow-up regimen of patients undergoing endoscopic management for UTUC. When cytology reported cellular atypia, FISH analysis successfully classified the cells as malignant or benign in all cases. There is an added value to perform FISH analysis when cytology test was performed. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e972 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Orel Carmona More articles by this author Nir Kleinmann More articles by this author Dorit E. Zilberman More articles by this author Zohar A. Dotan More articles by this author Asaf Shvero More articles by this author Expand All Advertisement PDF downloadLoading ...

PD13-04 DEVELOPMENT OF A NOVEL GENE EXPRESSION SCORING SYSTEM FOR RECURRENCE IN NON-MUSCLE-INVASIVE BLADDER CANCER AFTER TRANSURETHRAL RESECTION OF BLADDER TUMOR

You have accessJournal of UrologyCME1 Apr 2023PD13-04 DEVELOPMENT OF A NOVEL GENE EXPRESSION SCORING SYSTEM FOR RECURRENCE IN NON-MUSCLE-INVASIVE BLADDER CANCER AFTER TRANSURETHRAL RESECTION OF BLADDER TUMOR Emina Kayama, Motohide Uemura, Yusuke Kirihana, Akifumi Onagi, Seiji Hoshi, Tomoyuki Koguchi, Tomohiko Yanagida, Fusao Murakami, and Yoshiyuki Kojima Emina KayamaEmina Kayama More articles by this author , Motohide UemuraMotohide Uemura More articles by this author , Yusuke KirihanaYusuke Kirihana More articles by this author , Akifumi OnagiAkifumi Onagi More articles by this author , Seiji HoshiSeiji Hoshi More articles by this author , Tomoyuki KoguchiTomoyuki Koguchi More articles by this author , Tomohiko YanagidaTomohiko Yanagida More articles by this author , Fusao MurakamiFusao Murakami More articles by this author , and Yoshiyuki KojimaYoshiyuki Kojima More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003260.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Non-muscle-invasive bladder cancer (NMIBC) frequently recurs after transurethral resection of bladder tumor (TURBT). However, clinical prognostic factors do not always accurately predict tumor recurrence. Therefore, we developed a new gene expression scoring system that is practical for distinguishing between high- and low-risk NMIBC that recur after TURBT. METHODS: We included 89 patients (median age 75) diagnosed with NMIBC after initial TURBT without prior or concurrent upper tract urothelial carcinoma at our institution between 2008 and 2019. This study obtained the approval of the institutional ethics board and the patient's consent. Variations in the expression signature of 14,400 genes within each patient were measured by our microarray analysis which has no mRNA amplification bias, not requiring validation by quantitative reverse transcriptase PCR. A hierarchical cluster analysis was performed to identify a set of genes that discriminates between high- and low-risk NMIBC. RESULTS: Eleven genes were extracted that predict tumor recurrence after TURBT. The cumulative equivalent of the 11 genes (microarray score) was obtained from each sample, and the optimal cutoff score was calculated to be 1.29 (area under the curve 0.83). A Kaplan-Meier curve showed the 5-year recurrence-free survival (RFS) rate was 38.2% in the “high microarray score group” (microarray score ≥1.29, n=39), which was significantly lower than in the “low microarray score group” (82.6%, p=0.002, Figure 1). The 5-year RFS rate in patients with single, Ta low grade tumor <3 cm in diameter without CIS (n=15) was 90.0%, which was higher than in the rest (55.2%); however, no significant difference was observed (p=0.063). Multivariate Cox regression analysis showed that a microarray score ≥1.29 was an independent factor for disease recurrence (hazard ratio 3.89, p=0.005), but clinical factors were not. CONCLUSIONS: Our novel gene expression scoring system proved to be more useful in predicting recurrence in patients with NMIBC after TURBT than clinical prognostic factors. This scoring system may enable individualized strategic management of high-risk NMIBC patients. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e406 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emina Kayama More articles by this author Motohide Uemura More articles by this author Yusuke Kirihana More articles by this author Akifumi Onagi More articles by this author Seiji Hoshi More articles by this author Tomoyuki Koguchi More articles by this author Tomohiko Yanagida More articles by this author Fusao Murakami More articles by this author Yoshiyuki Kojima More articles by this author Expand All Advertisement PDF downloadLoading ...

MP69-07 ONCOLOGICAL OUTCOMES OF SECOND-LOOK URETEROSCOPY FOR UPPER TRACT UROTHELIAL CARCINOMA: A SINGLE CENTER EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023MP69-07 ONCOLOGICAL OUTCOMES OF SECOND-LOOK URETEROSCOPY FOR UPPER TRACT UROTHELIAL CARCINOMA: A SINGLE CENTER EXPERIENCE Andrea Gallioli, Giuseppe Basile, Paolo Verri, Angelo Territo, Paula Izquierdo, Jose Maria Gaya, Francesco Sanguedolce, Alessandro Uleri, Julia Aumatell, Jorge Huguet, Joan Palou, and Alberto Breda Andrea GallioliAndrea Gallioli More articles by this author , Giuseppe BasileGiuseppe Basile More articles by this author , Paolo VerriPaolo Verri More articles by this author , Angelo TerritoAngelo Territo More articles by this author , Paula IzquierdoPaula Izquierdo More articles by this author , Jose Maria GayaJose Maria Gaya More articles by this author , Francesco SanguedolceFrancesco Sanguedolce More articles by this author , Alessandro UleriAlessandro Uleri More articles by this author , Julia AumatellJulia Aumatell More articles by this author , Jorge HuguetJorge Huguet 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.0000000000003332.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: According to EAU guidelines, second-look ureteroscopy (SU) could be performed 6-8 weeks after primary endoscopic treatment. We aimed at assessing the impact of positive SU on radical nephroureterectomy-free survival (RNU-FS) and cancer specific survival (CSS) in patients endoscopically treated (URS) for a suspicion of upper tract urothelial carcinoma (UTUC). METHODS: We relied on a prospectively maintained single-institution database (2015-2021) of patients with a suspicion of UTUC. Kaplan-Meyer method estimated the 2-year RNU-FS and CSS according to SU results. Multivariable Cox regression (MCR) analyses were implemented to investigate the relationship between SU outcome and the probability of RNU-FS and CSS after adjusting for age, previous radical cystectomy, tumor grade, focality and dimension. Finally, multivariable logistic regression (MLR) analysis investigated predictors of negative SU after adjusting for tumor and patients’ characteristics. RESULTS: Overall, among 360 patients undergone URS, 85 (23.6%) patients underwent SU. No difference emerged between the two cohorts (positive vs negative SU) in terms of previous history of urothelial cancer, tumor focality and histology grading of the primary lesion. In positive SU group, tumors were larger (>20mm, p=0.03) and classified as high-risk (p<0.001). SU detected tumors in 38 (44.7%) cases. After a median follow-up of 35 (IQR: 15-56) months, 2 (5.2%) and 11 (28.9%) underwent upfront and subsequent RNU in the positive SU cohort, respectively. When comparing the two cohorts, the 2-yr RNU-FS rates were 96.7% (95% CI 90.7-100) and 64.7% (95% CI 50.9-82.2) (p=0.001), while the 2-yr CSS rates were 97.8% (95% CI 93.6-100) and 90.3% (95% CI 80.4-100) (p=0.32), respectively. At MCR analyses, positive SU (HR: 4.56, 95%CI 0.91-22.81, p=0.04) and tumor grade (HR: 3.87, 95%CI 1.08-13.77, p=0.03) were predictors of radical treatment. At MLR, patients with unifocal, low grade tumor with a dimension <10mm had higher probability to have a negative SU (OR: 3.68, 95%CI 1.50-9.44, p=0.005) compared to patients with large, high grade and multifocal tumor. CONCLUSIONS: Almost 45% of candidates to SU are diagnosed with UTUC, especially when harboring high-risk features at first URS. Positive SU is associated with higher rates of subsequent radical treatment, which reflects in a similar CSS when compared to patients with negative SU. In patients with unifocal, low grade and small UTUC, the replacement of SU with CT scan could be considered. 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 Andrea Gallioli More articles by this author Giuseppe Basile More articles by this author Paolo Verri More articles by this author Angelo Territo More articles by this author Paula Izquierdo More articles by this author Jose Maria Gaya More articles by this author Francesco Sanguedolce More articles by this author Alessandro Uleri More articles by this author Julia Aumatell More articles by this author Jorge Huguet More articles by this author Joan Palou More articles by this author Alberto Breda More articles by this author Expand All Advertisement PDF downloadLoading ...

PD46-10 GENDER DISPARITIES IN UPPER TRACT UROTHELIAL CELL CARCINOMA

You have accessJournal of UrologyCME1 Apr 2023PD46-10 GENDER DISPARITIES IN UPPER TRACT UROTHELIAL CELL CARCINOMA Jeffrey Orf, Mohammad Mahmoud, and Zachary Hamilton Jeffrey OrfJeffrey Orf More articles by this author , Mohammad MahmoudMohammad Mahmoud More articles by this author , and Zachary HamiltonZachary Hamilton More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003359.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous literature has demonstrated the existence of gender disparities for urothelial cell carcinoma (UCC) of the bladder including higher stage at presentation in women, higher rates of complications, and worsened survival. Similar outcomes are not well characterized for upper tract urothelial carcinoma (UTUC). Our goal was to analyze patterns of presentation, neoadjuvant chemotherapy (NAC) use and survival outcomes for UTUC across genders. METHODS: The National Cancer Database was queried for all patients with UTUC of the renal pelvis from 2004 to 2016 undergoing nephroureterectomy. Patients were stratified based on female or male sex. Demographics, clinical stage and use of NAC were evaluated. Outcomes including 30 and 90 day readmission, positive margins, and mortality were analyzed. RESULTS: 31,411 patients were identified with 58.6% male and 41.4% female. Females were older (72.4 vs 70.1 years, p<0.001), and more likely to be of black race (p<0.001). Males were more likely to have higher Charlson comorbidity scores (p<0.001). Clinical tumor and nodal stage did not vary between men and women, however women were more likely to present with high grade disease (p<0.001). Outcomes including positive margin, 30 day readmission, and all-cause mortality did not differ based on sex. When stratified by pT stage, we found females to have improved median survival time with pT0/1 (99 vs 91 months, p=0.02) but there was no gender difference for median survival with pT2-4 disease or when accounting for all pT stages together (Figure). On a subset analysis of patients with high grade disease receiving NAC, we found females were more likely to downstage to pT0 disease (11.2 vs 2.9%, p<0.001) CONCLUSIONS: The gender disparities previously reported with UCC of the bladder are not readily evident with UTUC of the renal pelvis. Taken together, this suggests the underlying urothelial histopathology does not contribute to UCC gender disparity; however, unmeasured diagnostic and clinical factors are contributory. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1173 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Orf More articles by this author Mohammad Mahmoud More articles by this author Zachary Hamilton More articles by this author Expand All Advertisement PDF downloadLoading ...

V09-09 SINGLE PORT ROBOTIC URETERONEOCYSTOSTOMY: A VERSATILE APPROACH FOR URETERAL RECONSTRUCTION

You have accessJournal of UrologyCME1 Apr 2023V09-09 SINGLE PORT ROBOTIC URETERONEOCYSTOSTOMY: A VERSATILE APPROACH FOR URETERAL RECONSTRUCTION Zeyad Schwen, Ethan Ferguson, Mahmoud Abou Zeinab, Jaya Sai Chavali, Roxana Ramos, Alp Tuna Beksac, Mohamed Eltemamy, and Jihad Kaouk Zeyad SchwenZeyad Schwen More articles by this author , Ethan FergusonEthan Ferguson More articles by this author , Mahmoud Abou ZeinabMahmoud Abou Zeinab More articles by this author , Jaya Sai ChavaliJaya Sai Chavali More articles by this author , Roxana RamosRoxana Ramos More articles by this author , Alp Tuna BeksacAlp Tuna Beksac More articles by this author , Mohamed EltemamyMohamed Eltemamy More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003317.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Minimally invasive and robotic distal ureteral reconstruction has significantly reduced the perioperative morbidity associated with robotic ureteral reimplantation. We present our initial series of single-port (SP) robotic ureteral reimplantation which aims to demonstrate the feasibility of the approach and versatility of the SP platform as well as the favorable perioperative morbidity. METHODS: Inclusion indications for 14 consecutive patients included various benign and malignant conditions including ectopic ureter, distal ureteral stricture, bladder diverticula, renal autotransplantation, and distal ureterectomy for upper tract urothelial carcinoma. The primary outcome of this study was demonstration of the feasibility and versatility of the technique for a variety of benign and malignant conditions as well as evaluation of its perioperative morbidity. Patients are placed in the supine position and access is obtained using a floating dock technique. The SP is docked in addition to the robotic scissors, Maryland bipolar, and cadiere grasper. Following mobilization of the ureter, the bladder is freed to facilitate a tension-free anastomosis with or without a psoas hitch. The ureter is spatulated and anastomosed to the bladder dome in a water-tight fashion over a ureteral stent. RESULTS: Patients had a median age of 41 and ASA class of 2 (Table 1). All SP ureteroneocystotomies were performed successfully without any conversions to open (Table 2). Four patients required a psoas hitch. Median anastomosis operative time was 31.5 minutes and a median blood loss of 87.5cc. Hospital length of stay ranged from 1 to 19 days, with a median of 3.5 days, however was 1.5 days when renal autotransplants were excluded. Patients had excellent preservation of renal function at a median follow up of 4.5 months. CONCLUSIONS: We demonstrate the versatility of the SP approach for ureteral reimplantation for a variety of benign and malignant conditions. Patients had favorable perioperative morbidity and preservation of renal function at follow up. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e839 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zeyad Schwen More articles by this author Ethan Ferguson More articles by this author Mahmoud Abou Zeinab More articles by this author Jaya Sai Chavali More articles by this author Roxana Ramos More articles by this author Alp Tuna Beksac More articles by this author Mohamed Eltemamy More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement PDF downloadLoading ...

MP69-13 HOLMIUM:YAG VERSUS THULIUM:YAG LASER IN ENDOSCOPIC ABLATION OF UPPER TRACT UROTHELIAL CARCINOMA: A COMPARISON ON PERIOPERATIVE OUTCOMES AND SHORT-TERM FOLLOW-UP

You have accessJournal of UrologyCME1 Apr 2023MP69-13 HOLMIUM:YAG VERSUS THULIUM:YAG LASER IN ENDOSCOPIC ABLATION OF UPPER TRACT UROTHELIAL CARCINOMA: A COMPARISON ON PERIOPERATIVE OUTCOMES AND SHORT-TERM FOLLOW-UP Elena Morini, Davide Perri, Umberto Besana, Federica Mazzoleni, Andrea Pacchetti, Lorenzo Berti, Matteo Corinti, Maria Chiara Sighinolfi, Bernardo Rocco, Salvatore Micali, Javier Romero Otero, Jean Baptiste Roche, Antonio Luigi Pastore, and Giorgio Bozzini Elena MoriniElena Morini More articles by this author , Davide PerriDavide Perri More articles by this author , Umberto BesanaUmberto Besana More articles by this author , Federica MazzoleniFederica Mazzoleni More articles by this author , Andrea PacchettiAndrea Pacchetti More articles by this author , Lorenzo BertiLorenzo Berti More articles by this author , Matteo CorintiMatteo Corinti More articles by this author , Maria Chiara SighinolfiMaria Chiara Sighinolfi More articles by this author , Bernardo RoccoBernardo Rocco More articles by this author , Salvatore MicaliSalvatore Micali More articles by this author , Javier Romero OteroJavier Romero Otero More articles by this author , Jean Baptiste RocheJean Baptiste Roche More articles by this author , Antonio Luigi PastoreAntonio Luigi Pastore More articles by this author , and Giorgio BozziniGiorgio Bozzini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Holmium-YAG (Ho:YAG) laser is the most widely used laser in urology for both the treatment of stones and soft tissues. However, the Thulium-YAG (Tm:YAG) laser has become a reliable alternative for soft tissue treatment. The aim of our study is to increase evidence on the safety and efficacy of endoscopic management of upper tract urothelial carcinoma (UTUC) with the Ho:YAG and Tm:YAG lasers. METHODS: 111 patients with a diagnosis of low-risk UTUC were enrolled. Exclusion criteria comprised patients with a bilateral or multifocal disease and use of antiplatelet/anticoagulant therapy. In all cases a preoperative computed tomography (CT) scan was performed with evidence of contrast-enhanced solid tissue inside the upper urinary tract. In all cases indication to ureteroscopy was given to confirm diagnosis and to perform biopsy. Endoscopic laser ablation was decided with respect to EAU guidelines recommendations: unifocal disease, tumor size <2 cm, negative or low-grade cytology, low-grade biopsy and no invasive aspect on CT. Laser ablation was performed with Tm:YAG and Ho:YAG in 62 (Group A, 55.9%) and 49 (Group B, 44.1%) patients respectively. Three months after surgery CT scan and ureteroscopy were performed. Afterwards, CT scan was performed every 6 months. RESULTS: Mean tumor size was 18.1 mm. Tumor was localised in the renal calyxes in 30 cases (27.0%), in the renal pelvis in 41 cases (37.0%) and inside the ureter in 40 cases (36.0%). Preoperative features were comparable between the two groups. Mean operative time was 18.2 min and 21.7 min in Groups A and B respectively (p=0.09). Mean haemoglobin drop at first postoperative day was 0.8 g/dl and 0.6 g/dl in Groups A and B (p=0.10). However, despite haemoglobin drop was not significantly different between the two treatments, a more consistent bleeding and a lower visibility were subjectively reported with the use of holmium laser. At a median follow-up of 42.3 months we observed a local recurrence in 12 patients (19.3%) in Group A and 18 (36.7%) patients in Group B (p=0.02). CONCLUSIONS: Despite perioperative outcomes were comparable between groups, a higher recurrence rate was observed after UTUC ablation with Ho:YAG laser. Lower intraoperative bleeding and better intraoperative vision were subjectively reported during surgery. These features along with a higher vaporisation effect with Tm:YAG laser may explain our results. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e969 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elena Morini More articles by this author Davide Perri More articles by this author Umberto Besana More articles by this author Federica Mazzoleni More articles by this author Andrea Pacchetti More articles by this author Lorenzo Berti More articles by this author Matteo Corinti More articles by this author Maria Chiara Sighinolfi More articles by this author Bernardo Rocco More articles by this author Salvatore Micali More articles by this author Javier Romero Otero More articles by this author Jean Baptiste Roche More articles by this author Antonio Luigi Pastore More articles by this author Giorgio Bozzini More articles by this author Expand All Advertisement PDF downloadLoading ...

PD46-03 UTILITY OF URINARY TUMOR DNA DETECTION IN TREATMENT-NA&amp;IUML;VE UTUC

You have accessJournal of UrologyCME1 Apr 2023PD46-03 UTILITY OF URINARY TUMOR DNA DETECTION IN TREATMENT-NA&IUML;VE UTUC Heather Huelster, Facundo Davaro, Kyle Rose, Billie Gould, Tiantian Zheng, Prithvi Murthy, Shreyas Naidu, Lucia Camperlengo, Pan Du, Shidong Jia, Aram Vosoughi, and Roger Li Heather HuelsterHeather Huelster More articles by this author , Facundo DavaroFacundo Davaro More articles by this author , Kyle RoseKyle Rose More articles by this author , Billie GouldBillie Gould More articles by this author , Tiantian ZhengTiantian Zheng More articles by this author , Prithvi MurthyPrithvi Murthy More articles by this author , Shreyas NaiduShreyas Naidu More articles by this author , Lucia CamperlengoLucia Camperlengo More articles by this author , Pan DuPan Du More articles by this author , Shidong JiaShidong Jia More articles by this author , Aram VosoughiAram Vosoughi More articles by this author , and Roger LiRoger Li More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003359.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urine-based molecular biomarkers correlate with tumor variants in urothelial carcinoma of the bladder, showing promise for noninvasive detection of newly diagnosed tumors. However, the utility of next-generation sequencing (NGS) to detect urinary tumor DNA (utDNA) in upper tract urothelial carcinoma (UTUC) remains to be explored. Herein, we prospectively sequenced tumors and utDNA at the time of and serially after radical nephroureterectomy (RNU) to examine the feasibility of using utDNA in detection and surveillance of UTUC. METHODS: Fourteen systemic therapy naïve patients with high-grade, clinically-localized UTUC undergoing RNU were prospectively accrued. Urine was collected preoperatively on the day of surgery and urinary supernatant and cell pellets (UCP) processed for extraction of utDNA. NGS used shallow whole-genome sequencing (WGS) to detect genome-wide copy number changes and a 152-pancancer panel (PredicineCARE) to profile single nucleotide variants, small insertions/deletions, and gene-level copy number changes. Variants with mutation allele frequency ≥0.25% in supernatant, ≥0.3% in UCP, and cancer hotspot variants >0.1% were reported. RESULTS: Prior to RNU, utDNA variants were detected in 11/11 (100%) of urinary supernatants and 9/14 (64%) of UCPs using NGS. The most common alterations detected in the urine were in TP53 (81%), TERT promoter (55%), FGFR3 (55%), and ERBB2 (45%). More tumor variants were detected in urine supernatant than UCP (22.9 vs 2.4, p=0.004). Use of a bespoke tumor-informed approach to adjust MAF thresholds for calling variants increased utDNA detection by a mean 0.5 (range 0-3) variants in urinary supernatant and mean 2.3 (range 0-7) variants in UCP. There was no significant difference in the number of variants detected in urine of patients with UTUC staged as <pT2 compared to ≥pT2 or pN+. CONCLUSIONS: UTUC tumor variants are detectable in the urine of treatment-naïve patients undergoing RNU for UTUC using both a panel-based approach and WGS. utDNA detection and dynamics may present an opportunity for personalized monitoring of UTUC. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1170 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Heather Huelster More articles by this author Facundo Davaro More articles by this author Kyle Rose More articles by this author Billie Gould More articles by this author Tiantian Zheng More articles by this author Prithvi Murthy More articles by this author Shreyas Naidu More articles by this author Lucia Camperlengo More articles by this author Pan Du More articles by this author Shidong Jia More articles by this author Aram Vosoughi More articles by this author Roger Li More articles by this author Expand All Advertisement PDF downloadLoading ...

MP63-10 THE DIAGNOSTIC VALUE OF URINARY CYTOLOGY VERSUS DNA METHYLATION URINE BIOMARKER TEST FOR SURVEILLANCE OF NON-MUSCLE INVASIVE BLADDER CANCER

You have accessJournal of UrologyCME1 Apr 2023MP63-10 THE DIAGNOSTIC VALUE OF URINARY CYTOLOGY VERSUS DNA METHYLATION URINE BIOMARKER TEST FOR SURVEILLANCE OF NON-MUSCLE INVASIVE BLADDER CANCER Seyedeh Sanam Ladi Seyedian, Margot Van Den Sigtenhorst Fijlstra, Sina Sobhani, Sidney Roberts, Natalie Liu, Andrew Udov, Farshad Sheybaee Moghadam, Alireza Ghoreifi, Paolo Piatti, Benjamin Jara, Lucy Sanossian, Hooman Djaladat, Anne Schuckman, Gangning Liang, and Siamak Daneshmand Seyedeh Sanam Ladi SeyedianSeyedeh Sanam Ladi Seyedian More articles by this author , Margot Van Den Sigtenhorst FijlstraMargot Van Den Sigtenhorst Fijlstra More articles by this author , Sina SobhaniSina Sobhani More articles by this author , Sidney RobertsSidney Roberts More articles by this author , Natalie LiuNatalie Liu More articles by this author , Andrew UdovAndrew Udov More articles by this author , Farshad Sheybaee MoghadamFarshad Sheybaee Moghadam More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Paolo PiattiPaolo Piatti More articles by this author , Benjamin JaraBenjamin Jara More articles by this author , Lucy SanossianLucy Sanossian More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , Gangning LiangGangning Liang More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003321.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder cancer (BC) has a variable clinical course. With frequent recurrence, cystoscopy and urine cytology are routinely employed during follow-up of patients with a history of non-muscle invasive bladder cancer (NMIBC). Although there are multiple FDA approved urine-based tests for BC detection and surveillance, diagnostic accuracy of these urine-based assays is still suboptimal. Here, we compare the diagnostic value of urine cytology and a newly developed urine-based DNA methylation test for surveillance of NMIBC. METHODS: We included patients undergoing blue-light surveillance cystoscopy for NMIBC between February 2019 and September 2021. Urine samples were collected at each surveillance cystoscopy. Samples were analyzed with Bladder CARE, a urine-based assay that measures methylation levels of 3 bladder cancer specific biomarkers (TRNA-Cys, SIM2, and NKX1-1) and two internal control loci using methylation-sensitive restriction enzymes coupled with qPCR. Results are reported as Bladder CARE Index (BCI) score and categorized as “positive” (BCI>5), “high risk” (2.5<BCI£5) or “negative” (BCI£2.5). Association between BCI score and category, cytology and cystoscopy findings were assessed. RESULTS: A total of 503 samples were collected from 159 patients (median age of 73, 77% male). 103 biopsies were performed during surveillance cystoscopies, of which 26 (25%) showed evidence of cancer recurrence. BCI was positive in all but four (high-risk) of the positive biopsies. While cytology was atypical in 7(27%) and highly suspicious in 2(8%) of the positive biopsies. Among 77 negative biopsies, BCI was positive in 27 samples from 20 patients, of whom 8 patients developed recurrence detected during subsequent follow ups. Cytology was only atypical in 2/8 patients. Three patients had normal cystoscopies and positive BCIs who developed upper tract urothelial carcinoma later. BCI was able to predict the recurrence within a median of 7 months prior. The Receiver Operating Characteristic (ROC) curve using the BCI values demonstrated the sensitivity, specificity, positive predictive values, and negative predictive value of 93%, 65%, 73.5%, and 89.5%, respectively. CONCLUSIONS: Urine cytology had low sensitivity and PPV for urothelial carcinoma in this cohort. Our findings demonstrated the necessity of more accurate urine biomarkers in the surveillance of NMIBC patients. Our preliminary results showed that Bladder CARE has high sensitivity and can potentially predict future recurrences. Source of Funding: Zymo Research Corp © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e875 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seyedeh Sanam Ladi Seyedian More articles by this author Margot Van Den Sigtenhorst Fijlstra More articles by this author Sina Sobhani More articles by this author Sidney Roberts More articles by this author Natalie Liu More articles by this author Andrew Udov More articles by this author Farshad Sheybaee Moghadam More articles by this author Alireza Ghoreifi More articles by this author Paolo Piatti More articles by this author Benjamin Jara More articles by this author Lucy Sanossian More articles by this author Hooman Djaladat More articles by this author Anne Schuckman More articles by this author Gangning Liang More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement PDF downloadLoading ...

MP63-01 AN INTERIM ANALYSIS OF A PHASE II CLINICAL STUDY OF INTRAVESICAL PHOTO DYNAMIC THERAPY IN PATIENTS WITH BCG-UNRESPONSIVE NON-MUSCLE INVASIVE BLADDER CANCER (NMIBC) CARCINOMA IN-SITU (CIS)

MP63-01 AN INTERIM ANALYSIS OF A PHASE II CLINICAL STUDY OF INTRAVESICAL PHOTO DYNAMIC THERAPY IN PATIENTS WITH BCG-UNRESPONSIVE NON-MUSCLE INVASIVE BLADDER CANCER (NMIBC) CARCINOMA IN-SITU (CIS)

MP69-01 ESTABLISHMENT OF A NOVEL ANIMAL MODEL IN CARCINOGENESIS OF UPPER TRACT UROTHELIAL CARCINOMA AND ITS GENE PROFILE

You have accessJournal of UrologyCME1 Apr 2023MP69-01 ESTABLISHMENT OF A NOVEL ANIMAL MODEL IN CARCINOGENESIS OF UPPER TRACT UROTHELIAL CARCINOMA AND ITS GENE PROFILE Akinaru Yamamoto, Atsunari Kawashima, Kentaro Jingushi, Yuichi Motoyama, Satoshi Nojima, Sassi Nesrine, Yohei Okuda, Toshiki Oka, Toshihiro Uemura, Gaku Yamamichi, Eisuke Tomiyama, Kosuke Nakano, Makoto Matsushita, Yu Ishizuya, Yoshiyuki Yamamoto, Taigo Kato, Koji Hatano, Tsujikawa Kazutake, and Norio Nonomura Akinaru YamamotoAkinaru Yamamoto More articles by this author , Atsunari KawashimaAtsunari Kawashima More articles by this author , Kentaro JingushiKentaro Jingushi More articles by this author , Yuichi MotoyamaYuichi Motoyama More articles by this author , Satoshi NojimaSatoshi Nojima More articles by this author , Sassi NesrineSassi Nesrine More articles by this author , Yohei OkudaYohei Okuda More articles by this author , Toshiki OkaToshiki Oka More articles by this author , Toshihiro UemuraToshihiro Uemura More articles by this author , Gaku YamamichiGaku Yamamichi More articles by this author , Eisuke TomiyamaEisuke Tomiyama More articles by this author , Kosuke NakanoKosuke Nakano More articles by this author , Makoto MatsushitaMakoto Matsushita More articles by this author , Yu IshizuyaYu Ishizuya More articles by this author , Yoshiyuki YamamotoYoshiyuki Yamamoto More articles by this author , Taigo KatoTaigo Kato More articles by this author , Koji HatanoKoji Hatano More articles by this author , Tsujikawa KazutakeTsujikawa Kazutake More articles by this author , and Norio NonomuraNorio Nonomura More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Upper urinary tract (UT) and bladder are known to differ from the embryology stage. There have been numerous reports of mouse models of bladder carcinogenesis, but there are few reports of mouse models of upper tract urothelial carcinogenesis. The aim of this study is to establish a novel mouse model of upper tract urothelial carcinogenesis. METHODS: We used two strains including C57/BL6 of male and female mice. We fed 0.05% N-butyl-N-(4-hydro-oxybutyl) nitorosamine (BBN) from 6 weeks old to the harvest day. The harvested organs were diagnosed by two different pathologists with histopathological evaluation using Hematoxylin and Eosin staining. Both sides of UT from mouse drinking BBN were subjected to whole transcriptome sequencing (WTS). In human samples, 74 upper tract urothelial carcinoma (UTUC) tissues and 73 adjacent normal (AN) tissues also subjected to WTS from 74 UTUC patients. RESULTS: Female mice of certain strain showed early weight loss compared to the others. They showed high incidence of UTUC with less incidence of bladder cancer (Figure 1), while the others rarely had UTUC. The total incidence of UTUC in this mouse strain was 83.3%, with the earliest UTUC observed at 8 weeks after the start of BBN drinking. The incidence of bilateral UTUC was 22.2%, and these individuals showed weight loss relatively early after the start of BBN drinking. The cancerous side of UT expressed a basal type of mRNA expression profile, with increased expression of Cd44, Cdh3, and Krt14, similar to previous reports of bladder carcinogenesis mouse model (Figure 2). We detected 593 differential expressed genes between cancerous side and non-cancerous side of UT in this mouse model, which could also classify human UTUC and AN samples. In pathway enrichment analysis of these genes, several pathways associated with DNA replication were commonly upregulated in cancer tissues between mouse and human samples. CONCLUSIONS: We have established the novel animal model developing UTUC with high probability. This model could reflect the human UTUC. Source of Funding: This work was supported by a KAKENHI grant (21K20968, 22K09523) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e963 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akinaru Yamamoto More articles by this author Atsunari Kawashima More articles by this author Kentaro Jingushi More articles by this author Yuichi Motoyama More articles by this author Satoshi Nojima More articles by this author Sassi Nesrine More articles by this author Yohei Okuda More articles by this author Toshiki Oka More articles by this author Toshihiro Uemura More articles by this author Gaku Yamamichi More articles by this author Eisuke Tomiyama More articles by this author Kosuke Nakano More articles by this author Makoto Matsushita More articles by this author Yu Ishizuya More articles by this author Yoshiyuki Yamamoto More articles by this author Taigo Kato More articles by this author Koji Hatano More articles by this author Tsujikawa Kazutake More articles by this author Norio Nonomura More articles by this author Expand All Advertisement PDF downloadLoading ...

MP26-02 SURGICAL OUTCOMES OF RETROPERITONEOSCOPIC NEPHROURETERECTOMY FOR PATIENTS WITH SEVERE HYDRONEPHROSIS

You have accessJournal of UrologyCME1 Apr 2023MP26-02 SURGICAL OUTCOMES OF RETROPERITONEOSCOPIC NEPHROURETERECTOMY FOR PATIENTS WITH SEVERE HYDRONEPHROSIS Pei-Hsin Lee and Chien Hui Ou Pei-Hsin LeePei-Hsin Lee More articles by this author and Chien Hui OuChien Hui Ou More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003254.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For upper tract urothelial carcinoma (UTUC), the severity of hydronephrosis was reported to be correlated to the advanced disease. Besides, previous studies revealed that retroperitoneal nephroureterectomy seemed to show better progression free survival than transperitoneal approach in patients with UTUC. However, when large hydronephrosis presented, the difficulty of retroperitoneal approach was elaborated. This study aimed to emphasize the efficacy of the pre-operative volume reduction procedures, which would make retroperitoneoscopic nephroureterectomy more feasible. METHODS: The 18 patients with severe hydronephrosis, who underwent retroperitoneoscopic nephroureterectomy performed by one experienced operator, from December 2005 to July 2022 in the tertiary center were retrospectively included. All the patients received the pre-operative volume reduction procedures. Primary outcomes, such as estimated blood loss, total operative time and hospitalized stay were documented. RESULTS: In our study, the three types of volume reduction procedures were implemented. In benign lesions, a percutaneous nephrostomy catheter would be inserted for drainage. For possible malignant lesions, intra-operative retrograde ureteral catheter insertion or incision at the proximal site of obstructive upper ureter was performed other than percutaneous approach, for minimizing the risk of tumor seeding. Under such managements, retroperitoneoscopic nephroureterectomy could be implemented with less blood loss (mean=25 ml, range<10 to 150), shortened operative time (mean=123.3 minutes, range 86 to 169) and lower hospital day (mean=7.2 days, range 5 to 10). Only one complication (5.6%, 1/18) was noted with hypovolemic shock. CONCLUSIONS: In the patients with severe hydronephrosis, retroperitoneoscopic nephroureterectomy might be a safe, low-risk and time-saving approach after pre-operative volume reduction of hydronephrosis. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e352 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pei-Hsin Lee More articles by this author Chien Hui Ou More articles by this author Expand All Advertisement PDF downloadLoading ...

MP69-04 KYNURENINE PATHWAY IS STRONGLY ASSOCIATED WITH CLINICOPATHOLOGICAL FEATURES AND RESPONSE TO NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyCME1 Apr 2023MP69-04 KYNURENINE PATHWAY IS STRONGLY ASSOCIATED WITH CLINICOPATHOLOGICAL FEATURES AND RESPONSE TO NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA Kenji Zennami, Makoto Sumitomo, Takuhisa Nukaya, Masashi Takenaka, Manabu Ichino, Kiyoshi Takahara, Hitomi Sasaki, Maeda Yasuhiro, and Ryoichi Shiroki Kenji ZennamiKenji Zennami More articles by this author , Makoto SumitomoMakoto Sumitomo More articles by this author , Takuhisa NukayaTakuhisa Nukaya More articles by this author , Masashi TakenakaMasashi Takenaka More articles by this author , Manabu IchinoManabu Ichino More articles by this author , Kiyoshi TakaharaKiyoshi Takahara More articles by this author , Hitomi SasakiHitomi Sasaki More articles by this author , Maeda YasuhiroMaeda Yasuhiro More articles by this author , and Ryoichi ShirokiRyoichi Shiroki More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Metabolomics offers a potential role for discovering biomarkers and therapeutic targets by comprehensive screening of metabolites from patients with various cancers. However, metabolomic analysis using upper tract urothelial carcinoma (UTUC) tissue has not been reported. Therefore, we aimed to identify metabolites associated with clinicopathological features and response to neoadjuvant chemotherapy (NAC) in patients with UTUC. METHODS: Patients receiving treatment following a clinical diagnosis of UTUC at the Fujita Health University between October 2019 and August 2022 were enrolled in this study. We assessed 47 consecutive patients for whom a tumor tissue sample and nontumor tissue sample. Concentrations of metabolites were determined by high-performance liquid chromatography–tandem mass spectrometry (HPLC-MS/MS). For the analysis of the associations of kynurenine (Kyn) /tryptophan (Trp) metabolism with the patients’ clinicopathological characteristics and response to NAC, the Kyn/Trp ratio (KTR) in tissue samples and the tumor/nontumor (T/N) ratio of Kyn and Trp were determined. RESULTS: We first screened tissue concentrations of 58 metabolites and found that Kyn was the key metabolite. Mann-Whitney U tests revealed significant differences in the tissue Kyn T/N ratio and KTR T/N ratio with pathological stage (p=0.03 and p=0.03; Figure 1A and 1B). The tissue Kyn T/N ratio and KTR T/N ratio were also associated with tumor grade (p=0.02 and p=0.01; Figure 1C and 1D). KTR T/N ratio showed significant association with the presence of lymphovascular invasion (LVI) (p=0.01; Figure 1F), while Kyn T/N ratio was not statistically significant although there was a similar tendency (p=0.08; Figure 1E). In addition, the tissue Kyn T/N ratio and KTR T/N ratio were significantly associated with pathological downstaging (pDS) (p=0.003 and p=0.01; Figure 1G and 1H). CONCLUSIONS: Our study found that Try-Kyn pathway has a key role in the clinicopathological features of UTUC including stage, grade, and LVI. Since Kyn and KTR were associated with pDS, evaluation of Try-Kyn pathway using biopsy sample could be a predictive biomarker in NAC sensitivity, as well as appropriate adjuvant immune checkpoint inhibitors (ICIs) in NAC resistant case. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e964 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kenji Zennami More articles by this author Makoto Sumitomo More articles by this author Takuhisa Nukaya More articles by this author Masashi Takenaka More articles by this author Manabu Ichino More articles by this author Kiyoshi Takahara More articles by this author Hitomi Sasaki More articles by this author Maeda Yasuhiro More articles by this author Ryoichi Shiroki More articles by this author Expand All Advertisement PDF downloadLoading ...

PD46-09 IS THERE A RACIAL DISPARITY IN THE OUTCOMES OF PATIENTS WITH NON-METASTATIC UPPER TRACT UROTHELIAL CARCINOMA WHO ARE TREATED SURGICALLY? A NORTH AMERICAN NATIONWIDE ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023PD46-09 IS THERE A RACIAL DISPARITY IN THE OUTCOMES OF PATIENTS WITH NON-METASTATIC UPPER TRACT UROTHELIAL CARCINOMA WHO ARE TREATED SURGICALLY? A NORTH AMERICAN NATIONWIDE ANALYSIS Ivan Rakic, Matthew Davis, Nicholas Corsi, Alexander Stephens, Sohrab Arora, Taylor Malchow, Rafe Affas, Akshay Sood, Alexander Cole, Quoc-Dienh Trinh, and Firas Abdollah Ivan RakicIvan Rakic More articles by this author , Matthew DavisMatthew Davis More articles by this author , Nicholas CorsiNicholas Corsi More articles by this author , Alexander StephensAlexander Stephens More articles by this author , Sohrab AroraSohrab Arora More articles by this author , Taylor MalchowTaylor Malchow More articles by this author , Rafe AffasRafe Affas More articles by this author , Akshay SoodAkshay Sood More articles by this author , Alexander ColeAlexander Cole More articles by this author , Quoc-Dienh TrinhQuoc-Dienh Trinh More articles by this author , and Firas AbdollahFiras Abdollah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003359.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Non-Hispanic Black (NHB) patients with urological cancers, such as prostate or bladder cancer, have been reported to have worse survival outcomes than their Non-Hispanic White (NHW) counterparts. While the reasons for these differences are still controversial, it is plausible that both access to care and genetics play an important role. Our aim is to examine the impact of race on the overall survival (OS) of surgically treated patient with Upper Tract Urothelial Carcinoma (UTUC). METHODS: Our cohort included 9750 cM0 UTUC patients who underwent a radical nephroureterectomy (RNU), between 2004 and 2015, within the National Cancer Database (NCDB). The main variable of interest was race, and it was categorized as NHW, NHB, and others. Kaplan-Meier curves and log-rank test were used to depict and compare survival curves. Cox regression analysis tested the impact of race on OS after accounting for available covariates: age, sex, year of diagnosis Charlson Comorbidity Index, income, treatment center type, insurance status, pathological tumor stage, nodal stage, and pathological LVI status. p-values <0.001 were determined to be significant. RESULTS: Mean (SD) ages at diagnosis for NHW, NHB, and other race were 71.1(10.8), 66.9(12.1), and 71.09(10.9), respectively. Overall, NHW, NHB, and other race was reported in 92.4%, 4.30%, and 3.34%, respectively. The rate of advanced stage (pT3 or higher), pN+disease, and LVI was respectively 39.0%, 5.77%, and 14.5% in NHW, 41.5%, 0.32%, and 13.0% in NHB, and 39.6%, 0.217%, and 16.7% in other race. The mean (SD) follow-up was 42.86±35.3 months. At 5-years, the OS rate was 49.3% in NHW, vs. 46.8% in NHB, and 53.6% in other race (p=0.254). On multivariable analysis, NHB was not an independent predictor of OS outcomes (HR: 1.30, 95% CI: 1.10-1.56, p=0.015), and neither was other (HR 0.90, 95% CI: 0.71-1.15, p=0.015). CONCLUSIONS: Our results indicate that in patients with UTUC treated surgically, NHB patients don’t have a higher stage at diagnosis, and they have similar OS to their NHW counterparts. This is different from other urological cancers, such as prostate cancer where they are very significant differences in terms stage at diagnosis and OS based on race favoring NHW patients. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1173 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ivan Rakic More articles by this author Matthew Davis More articles by this author Nicholas Corsi More articles by this author Alexander Stephens More articles by this author Sohrab Arora More articles by this author Taylor Malchow More articles by this author Rafe Affas More articles by this author Akshay Sood More articles by this author Alexander Cole More articles by this author Quoc-Dienh Trinh More articles by this author Firas Abdollah More articles by this author Expand All Advertisement PDF downloadLoading ...

MP60-19 SYSTEMATIC OXIDATIVE STRESS INDEXES PREDICTS THE PROGNOSIS IN PATIENTS WITH UROTHELIAL CARCINOMA OF THE UPPER URINARY TRACT AFTER RADICAL NEPHROURETERECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP60-19 SYSTEMATIC OXIDATIVE STRESS INDEXES PREDICTS THE PROGNOSIS IN PATIENTS WITH UROTHELIAL CARCINOMA OF THE UPPER URINARY TRACT AFTER RADICAL NEPHROURETERECTOMY Jianyong Liu Jianyong LiuJianyong Liu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003318.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Upper urinary tract urothelial carcinoma (UTUC) which is an aggressive malignant tumor usually has a very poor prognosis with 5-year specific survival reaching<10% for pT4 UTUC. Oxidative stress plays an important factor in the occurrence and development of malignancy. However, the relationship between oxidative stress and UTUC prognosis remains elusive. The study aims to evaluate the prognostic value of systematic oxidative stress indexes as a predictor of patient outcomes in UTUC after radical nephroureterectomy. METHODS: The clinical data of 483 patients with UTUC who underwent radical nephroureterectomy were analyzed. Patients were categorized according to an optimal value of systematic oxidative stress indexes (SOSI), including fibrinogen (Fib), gamma-glutamyl transpeptidase (γ-GGT), creatinine (CRE), lactate dehydrogenase (LDH) albumin (ALB). Kaplan–Meier analyses were used to investigate associations of SOSI with overall survival (OS) and progression-free survival (PFS). Moreover, the associations between SOSI and OS were assessed with univariate and Multivariate analyses. RESULTS: The Kaplan–Meier survival analysis showed a significant discriminatory ability for death and progression risks in the two groups based on the SOSI.Multivariate Cox proportional hazards models manifested that SOSI was an independent prognostic indicator for OS (p=0.006). SOSI and clinical variables were selected to establish the nomogram.The calibration curves of the nomogram showed high consistencies between the predicted and observed survival probability. Decision curve analysis curves showed that the nomogram could better predict the 1-year, 3-year, and 5-year OS. CONCLUSIONS: The SOSI is an independent unfavorable predictor of OS in patients diagnosed with UTUC undergoing RNU.Therefore, incorporating SOSI into currently available clinical parameters may improve clinical decision-making. Source of Funding: No © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e850 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jianyong Liu More articles by this author Expand All Advertisement PDF downloadLoading ...