Urothelial Cancer Of Upper Urinary Tract Research Articles

The correlation between preoperative renal scintigraphy and postoperative renal function in upper urinary tract urothelial carcinoma patients following radical nephroureterectomy

ObjectiveTo predict the renal function after nephroureterectomy (NUR) for upper urinary tract urothelial cancer (UTUC) based on preoperative technetium-99m mercaptoacetyltriglycine (99mTc-MAG3) renal scintigraphy. Subjects and methodsWe retrospectively reviewed 238 patients who originally underwent nephroureterectomy for UTUC between 2007 and 2010. Of these patients, 129 underwent MAG3 renal scintigraphy before unilateral NUR. Serum creatinine was measured in all of the patients before surgery, and renal function was monitored for one year after surgery. Preoperative and postoperative eGFRs were compared and analyzed based on the preoperative MAG3 renal scintigraphy. ResultsA total of 129 patients, including 62 men (48%) and 67 women (52%) with an average age at surgery of 69.0 years (range from 48 to 87) were included in this study. The mean preoperative creatinine level was 1.42 mg/dL, and the baseline eGFR was 54.76 ml/min/1.73 m2. One year after NUR, the mean creatinine level was 1.89 mg/dL, and the eGFR was 44.44 ml/min/1.73 m2, a mean decrease of 18.73%. The preoperative effective renal plasma flow (ERPF) of the operated kidney was 91.65 ml/min/1.73 m2, and that of the remaining kidney 158.30 ml/ min/1.73 m2. The average preoperative ERPF of the resected kidney accounted for 34% of total preoperative ERPF, which was statistically significant in its relation to the decrease in eGFR. The decrease in eGFR ratio was also significantly correlated with the calculated decrease in ERPF ratio (R2 = 0.279, p < 0.001). The predictive equation of renal function one year after NUR was established as following: eGFR decreased ratio = –0.80 × predictive ERPF decreased ratio +0.72. ConclusionWe developed an equation to predict postnephroureterectomy 1 year eGFR before surgery based on preoperative MAG3 renal scintigraphy results and preoperative eGFR. The equation could be more accurate in the situation if the diseased kidney is not hydronephrotic.

101 - The impact of gender on tumour stage and survival following upper urinary tract urothelial cancer – a population based study

101 - The impact of gender on tumour stage and survival following upper urinary tract urothelial cancer – a population based study

Impact of gender on tumor stage and survival of upper urinary tract urothelial cancer : Apopulation-based study.

SummaryBackgroundThe aim of this study was to analyze the impact of gender on tumor stage, overall and cancer-specific mortality of upper urinary tract urothelial cancer (UTUC) in a population-based, nationwide analysis.MethodsAll Austrian patients with UTUC diagnosed between 1983 and 2010 were included in this study. Overall mortality was estimated by the Kaplan-Meier method. Cancer-specific (UTUC) mortality was estimated by cumulative incidence with mortality due to other causes as a competing risk. The effect of age was adjusted in a descriptive as well as a statistical inferential way.ResultsThis study included 2066 patients (men n = 1169, mean age 68.3 ±11.5 years, women n = 897, 72.6 ±10.4 years). Tumor stage distribution was as follows: pT1: men n = 411, women n = 268, pT2: men n = 263, women n = 187, pT3: men n = 382, women n = 328 and pT4: men n = 113, women n = 114. The male:female ratio continuously declined from 1.5 for pT1 tumors to 1.4 for pT2 tumors, 1.2 for pT3 tumors and 1.0 for pT4-tumors. In the entire cohort the 5‑year cumulative overall mortality was 57 % for women versus 50 % for men (p = 0.0002). For pT1 (women 33 %, men 31 %) and pT2 stage tumors (women 45 %, men 45 %) the 5‑year overall mortality was comparable between both sexes. In pT3 (women 68 %, men 62 %) and pT4 (women 95 %, men 87 %) tumors women had a higher overall mortality rate. The 5‑year cancer-specific mortality (CSM) of the entire cohort was 12 % for women and 10 % for men (p = 0.067): pT1 women 5 % men 3 %, pT2 women 9 % men 10 %, pT3 women 14 % men 11 % and pT4 women 29 % men 27 %.ConclusionsIn this population-based nationwide analysis, sex differences were notable for UTUC. Women tended to have more advanced tumor stages at diagnosis and a higher overall and cancer-specific mortality in advanced tumor stages.

803 Risk stratification model for lymphovascular invasion, pathological T stage, lymph node involvement, and c-reactive protein predicts high-risk patients - who are candidate for adjuvant chemotherapy in upper urinary tract urothelial cancer

803 Risk stratification model for lymphovascular invasion, pathological T stage, lymph node involvement, and c-reactive protein predicts high-risk patients - who are candidate for adjuvant chemotherapy in upper urinary tract urothelial cancer

Editorial Comment from Dr Miyata and Dr Sakai to Impact of multimodal treatment on prognosis for patients with metastatic upper urinary tract urothelial cancer: Subanalysis of the multi-institutional nationwide case series study of the Japanese Urological Association.

Editorial Comment from Dr Miyata and Dr Sakai to Impact of multimodal treatment on prognosis for patients with metastatic upper urinary tract urothelial cancer: Subanalysis of the multi-institutional nationwide case series study of the Japanese Urological Association.

Editorial Comment from Dr Sakano and Dr Matsuyama to Impact of multimodal treatment on prognosis for patients with metastatic upper urinary tract urothelial cancer: Subanalysis of the multi‐institutional nationwide case series study of the Japanese Urological Association

Editorial Comment from Dr Sakano and Dr Matsuyama to Impact of multimodal treatment on prognosis for patients with metastatic upper urinary tract urothelial cancer: Subanalysis of the multi‐institutional nationwide case series study of the Japanese Urological Association

Concurrent bladder cancer in patients undergoing photodynamic diagnostic ureterorenoscopy: how many lesions do we miss under white light cystoscopy?

IntroductionThere is an ongoing debate on panurothelial changes in the upper and lower urinary tract as multifocal presentation of urothelial cancer is well recognised. Concurrent bladder cancer impacts the outcome of the upper urinary tract urothelial cancer treatment, while its detection still relies on the white light cystoscopy.Material and methodsWe retrospectively reviewed all patients who underwent photodynamic diagnostic ureterorenoscopy, choosing those who had synchronous bladder biopsies. Each patient received 20 mg/kg body weight of oral 5-Aminolevulinic acid around 3–4 hours before endoscopy. All procedures were performed by a single endourologist experienced in photodynamic diagnosis and flexible ureterorenoscopy.ResultsBetween July 2009 and June 2013, 69 patients underwent bladder biopsies at the time of photodynamic diagnostic endoscopic inspection of the upper urinary tract. In total, 43.5% (30/69) patients were found to have bladder lesions, of which 43.3% (13/30) were proven to be carcinoma in situ. White light inspection of the bladder missed bladder cancer in 16 (23.1%) patients, of which 12 were carcinoma in situ. There were 14 bladder cancer lesions missed under white light which were concomitant to the upper urinary tract urothelial cancer. Twelve (17.4%) patients developed minor complications relevant to the photosensitizer.ConclusionsThe study raises a concern about missing small bladder cancer/carcinoma in situ lesions on the initial diagnosis or in surveillance of the upper urinary tract urothelial cancer. Higher than previously reported, the rate of concomitant bladder cancer may suggest utilisation of photodynamic diagnosis to ensure the cancer free status of the bladder, but this needs to be ratified in a multi-institutional randomised trial.

Are we closer to seeing carcinoma in situ in the upper urinary tract?

IntroductionThere is observed increase in detection rate of upper urinary tract urothelial cancer worldwide. This is a result of improved imaging as well as implementation of novel technologies of direct visualization of upper urinary tract. Standard techniques still remain insufficient to diagnose flat urothelial lesions. Carcinoma in situ is characterized by flat disordered proliferation of urothelial cells with marked cytologic abnormality, which occur within one cell layer as well as full thickness urothelium and therefore requires a better technology to pick up early and subtle mucosal changes.Material and methodsThe review presents available diagnostic tools in detection of upper urinary tract urothelial cancer and their ability to depict carcinoma in situ. ResultsUreterorenoscopy is an investigation of choice as various promising techniques are under pilot investigations to enhance visualization of upper urinary tract carcinoma in situ. So far only photodynamic diagnosis has been reported to be as effective in detection of carcinoma in situ in the upper as within the lower urinary tract.ConclusionsAlthough we are close to see upper urinary tract carcinoma in situ all new promising diagnostic techniques still require further validation in multicenter clinical trials to indicate any change to current recommendations.

Superficial Urinary Bladder Cancer : Histopathological Findings , Recurrence Rate after Transurethral Resection and Association with Upper Urinary Tract Urothelial Cancer : A Retrospective Analysis

Superficial Urinary Bladder Cancer : Histopathological Findings , Recurrence Rate after Transurethral Resection and Association with Upper Urinary Tract Urothelial Cancer : A Retrospective Analysis

Current status of minimally invasive surgery for treatment of renal stones and tumors using a flexible ureteroscopy

Received: March 30, 2016 Accepted: April 20, 2016 Corresponding author: Hwancheol Son E-mail: volley@snu.ac.kr © Korean Medical Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons. org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Retrograde intrarenal surgery (RIRS) has been accepted as the first-line option for surgical treatment of upper urinary tract pathologies including stones and tumors. With the development of surgical instruments with improved deflection mechanisms, visualization, and durability, RIRS has taken on an expanding role in treating urinary calculi located in the upper urinary tract, as it compensates for the shortcomings of shockwave lithotripsy and percutaneous nephrolithotomy. RIRS can also be considered a conservative treatment option for upper urinary tract urothelial cancer or as a means of intensive postoperative surveillance after radical treatment of urinary tract urothelial cancer. RIRS has a steep learning curve and various surgical techniques can be utilized during operations. The use of particular surgical instruments should take into consideration of the gain in surgical efficiency, decrease in complications, and cost-benefit tradeoff.

Impact of multimodal treatment on prognosis for patients with metastatic upper urinary tract urothelial cancer: Subanalysis of the multi-institutional nationwide case series study of the Japanese Urological Association.

To describe the nature of metastatic upper urinary tract urothelial cancer and determine the prognostic predictors or treatment modality associated with all-cause mortality. Within the nationwide case series study of the Japanese Urological Association, consisting of 1509 patients with urinary tract urothelial cancer diagnosed in 2005, we identified 102 patients with metastatic urinary tract urothelial cancer. Univariate and multivariate survival analyses identified prognostic outcome variables. Predominant sites of distant metastasis at diagnosis were the lungs (54.9%), distant lymph nodes (37.3%), bone (32.4%) and liver (19.6%). Of 102 patients, 70 patients (68.6%) died during the median follow-up period of 6 months, and the 2-year overall survival rate was estimated at 22%. The median survival time to all-cause mortality was 8.5 months (95% confidence interval 6.4-10.7 months). On multivariate analysis, independent predictive factors for all-cause mortality were age (hazard ratio 2.36, P = 0.015) and liver metastasis (hazard ratio 2.35, P = 0.037). Patients who received multimodal treatment including chemotherapy and surgery showed significantly better prognosis (median survival time 25.8 months) compared with patients treated with chemotherapy alone (median survival time 7.3 months) or best supportive care (median survival time 4.3 months). Age at diagnosis and the presence of liver metastasis seem to have an impact on survival of metastatic urinary tract urothelial cancer patients. Multimodal treatment including systemic chemotherapy and surgery might result in better prognosis in some of these patients.

Editorial Comment from Dr Haddad and Dr Margulis to Prognostic factors of recurrent disease in upper urinary tract urothelial cancer after radical nephroureterectomy: Subanalysis of the multi-institutional national database of the Japanese Urological Association.

Editorial Comment from Dr Haddad and Dr Margulis to Prognostic factors of recurrent disease in upper urinary tract urothelial cancer after radical nephroureterectomy: Subanalysis of the multi-institutional national database of the Japanese Urological Association.

Photodynamic diagnostic ureterorenoscopy: A valuable tool in the detection of upper urinary tract tumour

BackgroundPhotodynamic diagnosis increases the detection rate and hence decreases recurrence rates of urothelial cancer (UC) of the bladder. This technique has been implemented in the upper urinary tract and like in the bladder, has shown to increase the detection rate of urothelial lesions. ObjectivesTo determine the sensitivity, specificity, and detection rates for photodynamic diagnostic flexible ureterorenoscopy (PDD-FURS) and white light ureterorenoscopy (WL-FURS).Design between 2009 and 2013, PDD-FURS was performed within 106 Upper urinary tract (UUT) Units (Mean age—72.6±9.5). Indications for the procedure included abnormal upper urinary tract on imaging, normal flexible cystoscopy with abnormal urine cytology, endoscopic treatment and follow-up of UUT UC. Oral 5-aminolevulinic acid was used as the photosensitizer administered 3-4h pre-operatively. Results48 lesions were detected, of which 95.8% (46/48) where visualised by PDD-FURS compared to 47.9% (23/48) shown by WL-FURS (P<0.0001). PDD-FURS detected significantly more carcinoma in situ (CIS) or dysplasia lesions than WL-FURS (93.75% (15/16) vs. 18.75% (3/16), respectively, (P=0.0006)). Furthermore, PDD-FURS detected significantly more UC lesions than WL-FURS (96.9% (31/32) vs. 62.5% (20/32) (P=0.007)).PDD-FURS was more sensitive (95.8; range: 85.7–99.5) than WL-FURS (53.5; range: 37.7–68.8) in detecting UUT-UC (P<0.0001). There was no difference (P=0.716) in the specificity between PDD-FURS (96.6; range: 88.1–99.6) and WL-FURS (95.2; range: 86.7–99). ConclusionsOur results PDD-FURS with oral 5-ALA as photosensitizer suggest higher sensitivity and detection rate of urothelial tumours than WL-FURS, with a good safety profile. In our series, PDD-FURS enhanced the visualisation of flat lesions, such as CIS and dysplasia that otherwise would have been missed.

Prognostic factors of recurrent disease in upper urinary tract urothelial cancer after radical nephroureterectomy: Subanalysis of the multi-institutional national database of the Japanese Urological Association.

To explore predictive factors of disease recurrence after radical nephroureterectomy in patients with upper urinary tract urothelial cancer. A multi-institutional national database promoted by the Japanese Urological Association including 293 institutions and 1172 patients was used for the present study. Patient with non-metastatic upper urinary tract urothelial cancer who underwent primary radical nephroureterectomy with curative intent were analyzed. Univariate analysis using the Kaplan-Meier method and multivariate Cox regression models with stepwise selection was used to evaluate time to recurrence after surgery. The median duration of follow up was 55.8 months, and disease recurred in 325 (27.7%) patients at a median of 11.4 months after radical nephroureterectomy. According to a Cox proportional hazards model, the Union International Contre le Cancer 2002 pathological stage of the primary tumor, lymph node status, presence of lymphatic and/or vascular invasion, infiltrative growth pattern, and age were independent predictors (P < 0.05) of recurrence-free survival. Despite several limitations, our analysis suggests that pathological tumor stage, lymph node status, lymphovascular invasion, infiltrative growth pattern and age represent important prognostic variables after radical nephroureterectomy in Japanese patients with upper urinary tract urothelial cancer. This information could be potentially used to select patients for adjuvant systemic therapy.

Editorial Comment from Dr Kim and Dr Ku to Prognostic factors of recurrent disease in upper urinary tract urothelial cancer after radical nephroureterectomy: Subanalysis of the multi-institutional national database of the Japanese Urological Association.

International Journal of UrologyVolume 22, Issue 11 p. 1021-1021 Editorial Comment Editorial Comment from Dr Kim and Dr Ku to Prognostic factors of recurrent disease in upper urinary tract urothelial cancer after radical nephroureterectomy: Subanalysis of the multi-institutional national database of the Japanese Urological Association Hyung Suk Kim M.D., Hyung Suk Kim M.D. Department of Urology, Seoul National University Hospital, Seoul, KoreaSearch for more papers by this authorJa Hyeon Ku M.D., Ph.D., Ja Hyeon Ku M.D., Ph.D. [email protected] Department of Urology, Seoul National University Hospital, Seoul, KoreaSearch for more papers by this author Hyung Suk Kim M.D., Hyung Suk Kim M.D. Department of Urology, Seoul National University Hospital, Seoul, KoreaSearch for more papers by this authorJa Hyeon Ku M.D., Ph.D., Ja Hyeon Ku M.D., Ph.D. [email protected] Department of Urology, Seoul National University Hospital, Seoul, KoreaSearch for more papers by this author First published: 04 August 2015 https://doi.org/10.1111/iju.12890Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume22, Issue11November 2015Pages 1021-1021 RelatedInformation

MP7-16 MOLECULAR DIAGNOSIS OF LYMPH NODE METASTASIS IN PATIENT WITH UPPER URINARY TRACT CANCER WHO HAD EXTENDED LYMPHADENECTOMY

INTRODUCTION AND OBJECTIVES: In patients with upper urinary tract urothelial cancer (UTUC), the significance of lymphadenectomy not only in diagnostic aspect but also in therapeutic benefit has not been clarified yet. In order to examine its significance, we are currently conducting a prospective clinical trial of extended lymphadenectomy in patients with UTUC. Furthermore, we applied qRT-PCR technique to retrieved lymph nodes by extended lymphadenectomy in patients with UTUC for more accurate and sensitive diagnosis. In addition, We examined the association with the clinicopathologic findings and prognosis. METHODS: We included 41 patients with UTUC who underwent extended lymphadenectomy. Tissue sections of retrieved LNs from each patient were divided in two parts. One of them was assessed by qRT-PCR assay, and the other one was assessed by routine pathological examination. Four kinds of molecules (FXYD3, KRT19, KRT20, UPK2) were selected as markers to detect urothelial cancer cells. In addition, about a representative sample, We performed the immunohistological examination in order to perform a supplementary examination of the qRT-PCR result. We regarded specimen in which all marker molecules was positive as presence of micrometastasis. RESULTS: As total, 21 out of 738 LNs (2.8%) showed amplification of all marker. In 4 out of 41 patients (9.8%), LN metastasis was confirmed by not only qRT-PCR but also by histological examination. In 7 patients (17.1%), amplification of all marker genes was observed by qRT-PCR without evidence of metastasis by histological examination, indicating the presence of micrometastais. Based on this result, We divided the 41 patients into three groups and evaluated the association with conventional prognostic factors or progression free survival. qRT-PCR findings was associated with the lymphovascular invasion (p<0.01; Mann-Whitneyfs U test). But there was no statistically significant difference between three groups in the Kaplan-Meier method about the progression (p1⁄40.27; Logrank test). CONCLUSIONS: We performed extended lymphadenectomy in 41 patients with UTUC and analyzed the presence of micrometastasis to LNs by qRT-PCR. qRT-PCR of 4 kinds of maker genes could distinguish well cancer cells from normal LNs cells.7 out of 41 patients (17.1%) showed micrometastasis which could not be detected by routine histo-pathologic examination. The presence of micrometastasis was related to the lymphovascular invasion, but not to the survival so far. Further analysis should be warranted.

Analysis of tissue and serum microRNA expression in patients with upper urinary tract urothelial cancer.

IntroductionMicroRNAs play an important role in many human malignancies; so far, their expression remains to be studied in upper urinary tract urothelial cancer (UUTUC).Materials and MethodsThe expression of eleven microRNAs (miR-10a, miR-21, miR-96, miR-135, miR-141, miR-182, miR-200b, miR-205, miR-429, miR-520b, miR-1244) formerly shown to be upregulated in urothelial bladder cancer were studied in corresponding normal and cancerous tissue samples of patients undergoing nephroureterectomy for UUTUC. Upregulated microRNAs were then measured in serum samples of patients with UUTUC and patients with non-malignant urological diseases to evaluate their potential as non-invasive biomarkers for UUTUC.ResultsMicroRNA expression allowed differentiation of normal and cancerous tissue: miR-21, miR-96, miR-135, miR-141, miR-182, miR-205, miR-429 and miR-520b were significantly overexpressed. Furthermore, miR-205 was upregulated in poorly differentiated UUTUC. The analysis of circulating RNA in serum demonstrated an increase of miR-141 in patients with UUTUC; receiver operator characteristic analysis demonstrated an area under the curve of 0.726 for miR-141 as a diagnostic biomarker. Furthermore, we observed lower levels of miR-10a and miR-135 in UUTUC patients.ConclusionsMicroRNA expression is altered in UUTUC. The analysis of circulating miR-141 may be useful to identify patients with UUTUC.

Current status of flexible ureteroscopy in urology.

Retrograde intrarenal surgery (RIRS) is being performed for the surgical management of upper urinary tract pathology. With the development of surgical instruments with improved deflection mechanisms, visuality, and durability, the role of RIRS has expanded to the treatment of urinary calculi located in the upper urinary tract, which compensates for the shortcomings of shock wave lithotripsy and percutaneous nephrolithotomy. RIRS can be considered a conservative treatment of upper urinary tract urothelial cancer (UTUC) or for postoperative surveillance after radical treatment of UTUC under an intensive surveillance program. RIRS has a steep learning curve and various surgical techniques can be used. The choice of instruments during RIRS should be based on increased surgical efficiency, decreased complications, and improved cost-benefit ratio.

C133: A role of endourology in a treatment of urothelial cancer of upper urinary tract (UC-UUT)

C133: A role of endourology in a treatment of urothelial cancer of upper urinary tract (UC-UUT)

Optical diagnostics for upper urinary tract urothelial cancer: technology, thresholds, and clinical applications.

Developments in optical diagnostics have potential for less invasive diagnosis of upper urinary tract urothelial carcinoma (UUT-UC). This systematic review provides an overview of technology, applications, and limitations of recently developed optical diagnostics in the upper urinary tract and outlines their potential for future clinical applications. In addition, current evidence was evaluated. A PubMed literature search was performed and articles on narrow band imaging (NBI), photodynamic diagnosis (PDD), Storz professional imaging enhancement system (SPIES), optical coherence tomography (OCT), and confocal laser endomicroscopy (CLE) regarding UUT-UC were reviewed for data extraction. Study quality was reviewed according to Quality Assessment of Diagnostic Accuracy Studies and Innovation, Development, Exploration, Assessment, and Long-term follow-up (IDEAL) standards. Four articles available for quality assessment, demonstrated high level of evidence, but low level of IDEAL stage. NBI and SPIES enhance contrast of mucosal surface and vascular structures, improving tumor detection rate. A first in vivo study showed promising results. PDD uses fluorescence to improve tumor detection rate. However, due to the acute angle of the ureterorenoscopes there is an increased risk of false positives. OCT produces cross-sectional high-resolution images, providing information on tumor grade and stage. A pilot study showed promising diagnostic accuracy. CLE allows ultrahigh-resolution microscopy of tissue resulting in images of the cellular structure. CLE cannot be applied in vivo in the upper urinary tract yet, due to technical limitations. NBI, SPIES, and PDD aim at improving visualization of UUT-UC through contrast enhancement. OCT and CLE aim at providing real-time predictions of histopathological diagnosis. For all techniques, more research has to be conducted before these techniques can be implemented in the routine management of UUT-UC. All techniques might be of value in specific clinical scenarios and allow for integration, for example, OCT with NBI, and could therefore improve tumor detection and staging and help in selecting the optimal treatment for the individual patient.