Ureteral Urothelial Carcinoma Research Articles

Giant ureteral fibro-epithelial polyp: A rare but important differential of ureteral urothelial cell carcinoma

Background: Fibro-epithelial polyps (FEPs) of the ureter are rare benign tumours and constitute an important differential for ureteral urothelial cell carcinoma (UCC). Case presentation: We describe a case of a 56-year-old lady presenting with gross haematuria. On initial evaluation elsewhere, she was diagnosed with lower ureteric UCC and was advised left nephroureterectomy. Careful evaluation at our centre established the diagnosis of a left ureteral FEP. Robot-assisted excision of the ureteral FEP was successfully done. Conclusion: Diagnosis of these rare tumours may be made with a combination of imaging, ureteroscopy and histopathological analysis. Resection of giant FEPs may be done with a robot-assisted technique. Proper diagnosis and management of these tumours are essential to avoid unnecessary nephroureterectomies. Level of evidence: 4

Atezolizumab (atezo) therapy for upper tract (UT) urothelial carcinoma (UC): Subgroup analysis of the single-arm international SAUL study in pretreated locally advanced/metastatic urinary tract carcinoma.

488 Background: UTUC is rarer than bladder UC and typically responds poorly to standard chemotherapy. Analysis of 220 biomarker-evaluable atezo-treated patients (pts) in phase II/III trials suggested worse outcomes in UT vs lower tract UC [Galsky, ESMO 2018]. We explored clinical outcomes in pts with UTUC (renal pelvis or ureter) treated with atezo in the SAUL study. Methods: The single-arm SAUL study (NCT02928406) [Sternberg, Eur Urol 2019] enrolled a broader pt population, including pts with poor clinical characteristics and/or immune-mediated conditions, more representative of real-world practice than typically enrolled in randomized phase III immunotherapy trials. Pts with urinary tract carcinoma received atezo 1200 mg q3w until disease progression/unacceptable toxicity. Baseline characteristics, safety and efficacy were analyzed in subgroups of pts with UTUC (subdivided into renal pelvis or ureter UC) vs bladder UC. Results: Baseline characteristics in the 4 subgroups were generally similar, except for a numerically lower proportion of pts with 0 prior lines of therapy for metastatic disease in the UTUC vs bladder UC subgroup (30% vs 41%). Treatment exposure, safety and efficacy are shown below. Conclusions: These exploratory analyses of SAUL showed very similar efficacy and safety in UT vs bladder UC. This provides reassurance that atezo is active and has an acceptable safety profile in pts with UTUC, who are generally expected to have worse outcomes than bladder UC pts. Clinical trial information: NCT02928406 . [Table: see text]

Prognosis and risk factors of patients with upper urinary tract urothelial carcinoma and postoperative recurrence of bladder cancer in central China

BackgroundTo investigate the prognostic risk factors and postoperative recurrence of bladder cancer in patients with upper urinary tract urothelial carcinomas (UTUCs).MethodsData of 439 UTUC patients were retrospectively analyzed. Follow-up and analysis of smoking effects, consumption of traditional Chinese medicine containing aristolochic acid, history of bladder cancer, age, sex, presence or absence of diabetes mellitus (DM), metformin use, tumor characteristics (number, location, stage, grade), and open or laparoscopic surgery on the prognosis of UTUCs were performed. Cox proportional hazard regression analysis was performed to analyze the relationship between various factors and the postoperative survival rate. The survival rate was analyzed using the Kaplan-Meier method. Moreover, logistic regression analysis was performed to analyze the relationship between the above mentioned factors and postoperative recurrence of bladder cancer.ResultsOverall, 439 patients met, including 236 males (53.7%) and 203 females (46.3%), the criteria for the final statistical analysis, and the average age was 66.7 years. The 1-, 3-, and 5-year overall survival rates of 439 UTUC patients were 90.0, 76.4, and 67.7%, respectively. The 5-year survival rates of T1, T2, T3, and T4 patients were 90.2%, 78%, 43.8%, and 18.5%, respectively. Factors influencing the long-term survival rate of UTUC patients were smoking, taking traditional Chinese medicine containing aristolochic acid, history of bladder cancer, age, tumor size, tumor stage, tumor grade, and lymph node metastasis. The risk factors related to postoperative bladder cancer recurrence were advanced tumor stage, high grade tumor, preoperative ureteroscopy, ureteral urothelial carcinoma, no postoperative bladder perfusion chemotherapy and DM without metformin use.ConclusionsAdvanced tumor stage and presence of a high-grade tumor were risk factors for not only poor UTUC prognosis but also BC recurrence. In addition, preoperative ureteroscopy, ureteral urothelial carcinoma and DM without metformin use were high risk factors for BC recurrence, whereas regular postoperative bladder perfusion chemotherapy was a protective factor.

Ureteral tumor in an ectopic duplex system: a case report

IntroductionUreteral ectopia is a rarely observed anomaly. It may be totally asymptomatic. An association with a duplex system is exceptional. Diagnostic and therapeutic approaches are challenging. Carcinologic surgery must consider the anatomic variant, mainly related to the ectopic site of the ureteral orifice.ObservationWe report a case of a ureteral urothelial carcinoma in a North African 52-year-old male patient, in a right duplex system. Radiological explorations concluded a non-functional upper right kidney.A suspect mass was observed in the lumbar part of the ureter of the right upper system. The meatus of the tumorous ureter ended in the right lobe of the prostate. A right hemi-nephro-ureterectomy was performed. A histological examination concluded a pT2G2 urothelial carcinoma.ConclusionEven if malignancy is rarely observed in ureteral ectopia, it should be evoked mainly in cases of hematuria with risk factors for urothelial tumors.

Long-term outcomes of total ureterectomy with ileal-ureteral substitution treatment for ureteral cancer: a single-center experience

BackgroundTo explore the feasibility and long-term outcomes of renal preservation in a retrospective cohort of patients with ureteral urothelial carcinoma undergoing total ureterectomy with ileal-ureteral substitution.MethodsA retrospective review of the data from patients treated with total ureterectomy with ileal-ureteral substitution from 1988 to 2016 was performed. The pre-operative oncological status, long-term oncological outcome, long-term renal functional outcome, early and late complications were analyzed.ResultsA total of eight patients with a median age of 70 years were included. The median follow-up time was 109 months. Six patients had multi-focal tumor involvement over the target ureter, and six patients had bilateral upper tract involvement. Only one patient encountered the upper-tract recurrence. The 2 and 5-year cancer-specific survival rates were 87.5 and 75.0%, respectively. The renal function was well-preserved in most patients, with only one patient needed life-long postoperative hemodialysis. Five patients experienced early complications and four patients experienced late complications. No perioperative mortality happened.ConclusionsA total ureterectomy with an ileal-ureteral substitution is feasible for treating ureteral urothelial carcinoma when a renal-sparing procedure is indicated. It provides good long-term oncological outcomes over the upper tract, and it also preserves the renal function.

Plasmacytoid Variant of Urothelial Carcinoma in Ureter

Plasmacytoid Variant of Urothelial Carcinoma in Ureter

Prediction of high-grade ureteral urothelial carcinoma on CT urography.

Objective:To evaluate the correlation between CT urography (CTU) findings and histological grade of ureteral urothelial carcinoma (UUC), and to identify predictors of high-grade UUC.Methods:CTU images of 73 patients with pathologically proven UUC via nephroureterectomy were independently reviewed by two radiologists for tumour size, tumour location, hydronephrosis grade, periureteral infiltration, presence of enlarged retroperitoneal lymph nodes and tumour enhancement value. Interobserver agreement was assessed with kappa statistics. Histological grade was classified as either low or high according to the WHO 2004 classification system and pathologic T stage was assessed according to the TNM staging system. Binary logistic regression, Spearman correlation analysis and receiver operating characteristic curves were used to evaluate relationships between CTU findings and histological grade.Results:58 patients had high-grade UUCs and 15 had low-grade UUCs. Among CTU features, only hydronephrosis grade was significantly correlated with high tumour grade for both readers (p < 0.001). Multivariate logistic regression revealed that hydronephrosis of Grade 3 or higher was a significantly independent predictor of high-grade UUC for both readers (p ≤ 0.004). Interobserver agreement was excellent for hydronephrosis grade (к = 0.862). With the cut-off value of hydronephrosis Grade 3, the sensitivity, specificity and area under the curve for predicting high-grade UUC were, respectively, 88%, 79% and 0.830 for reader 1 and 86%, 80% and 0.763 for reader 2.Conclusion:Hydronephrosis of Grade 3 or higher on CTU may be predictive of high-grade UUC.Advances in knowledge:Radical surgery should be considered for UUC causing hydronephrosis of Grade 3 or higher on CTU, even in small tumours without periureteral infiltration.

Negative pathology of ureteral carcinoma significantly delaying the diagnosis of the primary tumor of osteoblastic metastases: A case report and review of the literature.

Ureteral urothelial carcinoma (UC) is a rare malignant tumor. The most common clinical manifestations of ureteral UC are hematuria, increased urinary frequency, dysuria and pain. The diagnosis of ureteral UC is made via radiography, endoscopy and pathology. Although osteoblastic destruction is usually observed in metastasis of prostate cancer, UC can also be a reason for osteoblastic metastasis. The present study reports the case of a 66-year-old man presenting with osteoblastic metastases, in which the primary tumor was finally diagnosed as a ureteral UC. However, the lack of pathological evidence significantly delayed the diagnosis of the primary tumor (>6 months), even though the results of radiographic examination, and the type and mode of bone metastases significantly suggested a ureteral UC. The case reveals that a suitable screening test should be recommended for patients at high risk due to the possibility of a negative pathology result for ureteral UC. Additionally, a more efficient diagnostic method is required. Moreover, the possibility of new diagnostic criterion that do not rely on the pathology of primary foci in ureteral UC should be considered in future.

Co-insidental, Ipsilateral Renal Cell Carcinoma and Urothelial Carcinoma of Ureter: A Rare Case

Co-insidental, Ipsilateral Renal Cell Carcinoma and Urothelial Carcinoma of Ureter: A Rare Case

Semi-rigid ureteroscopy with thullium laser for the treatment of ureter urothelial carcinoma: Experience of mackay memorial hospital

Semi-rigid ureteroscopy with thullium laser for the treatment of ureter urothelial carcinoma: Experience of mackay memorial hospital

AB112. Long-term result of ileal-ureter substitution in ureteral urothelial carcinoma patients: a single-center experience

ObjectiveIn the southwest coast of Taiwan, the high prevalence rate of upper tract urothelial carcinomas (UTUCs) has been described. Renal preserving surgeries are of great importance when ureteral urothelial carcinoma (UC) happens in solitary kidney, in bilateral upper urinary tract simultaneously, or in patients with chronic kidney disease. We present the single center experience of total ureterectomy plus ileal-ureteral substitution for the ureteral UCs in the southwest of Taiwan over the last two decades.MethodsWe retrospectively reviewed patients who had undergone total ureterectomy plus ileal-ureteral substitution for ureteral UC at our center from January 1988 to December 2013. Chart review was done to obtain the information including age, sex, underlying medical diseases, oncology status before the surgery, baseline renal function, long-term renal function, duration of hospitalization, perioperative surgical complications, long-term complications, and oncological outcomes.ResultsOverall, 8 patients were treated with ileal ureteral substitution for ureteral UC, with a mean follow-up period of 66.5 months. All the resected ureters had confirmed to have UC on the final pathology reports. A total of four major complications (grade III) and 1 minor complication (grade I-II) developed according to the Clavien-Dindo complication grading system during a 30-day post-operative period. No perioperative mortality occurred in these patients. There were 3 patients (37.5%) who experienced long-term complications, including recurrent urinary tract infection and recurrent gross hematuria. At the end of follow-up, the renal function remained stable in 4 patients (50.0%), improved in 2 patients (25.0%), and deteriorated in 2 patients (25.0%). Only one of the deteriorated patient required long-term hemodialysis (12.5%). About the oncological outcome, only 1 patient (12.5%) was found to have tumor recurrence over the pelvic-ileal anastomotic site.ConclusionsIleal-ureteral substitution has been described as a reserved procedure for an extensively diseased ureter that other reconstructive procedures are not feasible. It provides good long-term outcomes for preservation of renal function, and also has acceptable safety concerns. In carefully selected patients, the procedure can also be carried out as nephro-sparing surgery for patients who have ureteral malignancy.

T categorization of urothelial carcinomas of the ureter with CT: preliminary study of new diagnostic criteria proposed for differentiating T2 or lower from T3 or higher.

The purposes of this study were to propose and evaluate new diagnostic criteria for the differentiation of category T2 or lower from T3 or higher ureteral urothelial carcinomas on contrast-enhanced CT (CECT) images and to investigate the diagnostic applicability of the criteria. The study included 30 patients with ureteral urothelial carcinoma who underwent CECT before surgery. For all patients, unenhanced and contrast-enhanced images (nephrographic and excretory phases) were acquired with a 16- or 64-MDCT scanner. The slice thickness of axial images was 5 mm. A grading system was devised that focused on spiculation and mass formation along the ureter on CECT images to differentiate T2 or lower from T3 or higher tumors. Three radiologists not specialized in abdominal radiology participated in an observer performance study to investigate the diagnostic utility of the criteria. Jackknife ROC analysis was used to compare the radiologists' diagnostic performance without and with the proposed diagnostic criteria. In addition, two board-certified radiologists used consensus to determine the CT grade, and the correlation between CT and pathologic findings was assessed. The mean AUCs for the three radiologists without and with the proposed criteria were 0.54 (SD, 0.09) and 0.73 (SD, 0.08), indicating a statistically significant difference (p<0.01). For the CT-pathologic correlation, the diagnostic sensitivity and specificity of the proposed criteria with respect to pT3 and higher tumors were 87.5% (14/16) and 92.9% (13/14). The proposed CT grading system was accurate for differentiating T2 or lower from T3 or higher ureteral urothelial carcinoma.

Chylous ascites as a complication of nephroureterectomy

Chylous ascites may be the result of many pathological conditions, including congenital defects of the lymphatic system, nonspecific bacterial, parasitic and tuberculous peritoneal infection, liver cirrhosis, malignant neoplasm, blunt abdominal trauma, and surgical injury. A 62-year-old woman presented with chylous ascites after undergoing nephroureterectomy and bladder cuff excision for her left ureteral urothelial carcinoma. The diagnosis of chylous ascites is made when the ratio of ascitese versus serum triglyceride is > 2. Patients with chylous ascites may be treated conservatively with total parenteral nutrition and/or a diet containing low fat and medium chain triglycerides. Refractory cases may require more aggressive intervention. We report a case of postoperative chylous ascites that was treated successfully with total parenteral nutrition for 14 days. A review of the relevant literature is presented and chylous ascites treatment is also discussed.

Impact of surgical wait time on oncologic outcomes in upper urinary tract urothelial carcinoma.

To assess the effect of surgical wait time on the oncologic outcomes of patients with upper urinary tract urothelial carcinoma (UTUC), particularly in the ureter. Using an optimal surgical wait time cutoff value of 30.5 days, we allocated patients to an early group or a late group. Cancer specific survival (CSS) and local/distant recurrence-free survival (RFS) rates were estimated using the Kaplan-Meier method. Factors influencing CSS and RFS after radical surgery were identified using Cox proportional hazards regression models. Subgroup analysis was performed on ureteral urothelial carcinoma using the same methods. Of the 138 UTUC patients, CSS and RFS were not significantly different between the two groups. However, subgroup analysis of the 80 patients with ureteral urothelial carcinoma showed that CSS and RFS were significantly higher in the early subgroup, and multivariate analysis showed that a surgical wait time of >1 month was an independent prognostic factor of CSS and RFS in ureteral urothelial carcinoma (P = 0.04 and P < 0.001). A surgical wait time of >1 month in ureteral urothelial carcinoma was found to be an independent prognostic factor of disease recurrence and cancer-specific mortality.

Robot-assisted nephroureterectomy for upper tract urothelial carcinoma: the Taiwan Robot Urological Surgery Team (TRUST) experience.

BackgroundTo report Taiwan’s experience in robot-assisted laparoscopic nephroureterectomy (RANU) for upper tract urothelial carcinoma (UTUC).MethodsTwenty patients with a diagnosis of renal pelvic or ureteral urothelial carcinoma underwent RANU at three medical centers. We performed RANU by re-docking the robot after the nephrectomy with or without repositioning for excision of the distal ureter and bladder cuff.ResultsFrom November 2010 to July 2013, a total of 20 patients with a mean age of 70.1 +/- 9.9 years (range 43 to 92 years) and mean body mass index (BMI) of 22.9 +/-3.8 kg/m2 underwent RANU for renal pelvic or ureteral urothelial carcinoma. Mean operative time was 251.6 +/- 126.7 minutes (range 110 to 540 minutes), estimated blood loss was 50.0 +/- 42.9 mL (range 10 to 200 mL), and mean length of hospital stay was 6.7 +/- 2.4 days (range 4 to 12 days). Pathology data revealed 19 high and one low-grade urothelial carcinoma and staged Ta for three, T1 for five, T2 for five and T3 for seven. With a mean follow-up of 14.7 months (range 2 to 34 months), three intravesical recurrences developed in the bladder, and four of them also developed metastatic disease.ConclusionsThe TRUST early experience showed that RANU is a safe and feasible minimally invasive procedure for UTUC.

P0136 Surgery combined with I125 radioactive seed implantation for transitional cell carcinoma of the renal pelvis or ureter

<h3>Background</h3> We aimed to evaluate the role of I¹²⁵ radioactive seed implantation for transitional cell carcinoma of the renal pelvis or ureter. <h3>Methods</h3> We retrospectively reviewed a series of 50 patients with transitional cell carcinoma of the renal pelvis or ureter. Twenty patients received I¹²⁵ radioactive seed implantation following surgery. Thirty patients received surgery alone. The local control rates and survival rates were calculated by the Kaplan–Meier method and compared by logrank test in univariate analysis. Cox regression was used for multivariate analysis. <h3>Findings</h3> The local recurrence rate in the radioactive seed implantation group was 36.7% and was 10% in the surgery alone group (<i>p</i><0.05). There were no significant differences between groups. Univariate and multivariate analyses showed that T stage and vascular invasion were correlated with overall survival (<i>X</i>²=15.89, <i>p</i>=0.000, and <i>X</i>²=3.92, <i>p</i>=0.048. respectively). <h3>Interpretation</h3> Surgery plus I¹²⁵ radioactive seed implantation for advanced renal pelvis and ureteral urothelial carcinoma is a simple, safe, and effective way to reduce the local recurrence rate. However, I¹²⁵ radioactive seed implantation does not improve overall survival in this group of patients. Advanced T stage and vascular invasion are associated with poorer prognosis.

Template-based lymphadenectomy in urothelial carcinoma of the renal pelvis: a prospective study.

Recent studies showed the therapeutic benefit of lymphadenectomy in advanced stage urothelial carcinoma of the upper urinary tract, but there is still a lack of prospective studies and standardization of the extent of lymphadenectomy. The aim of this multi-institutional study was to examine the role of lymphadenectomy in urothelial carcinoma of the upper urinary tract. From January 2005 to September 2012, 77 patients undergoing nephroureterectomy and lymphadenectomy for non-metastatic (cN0M0) urothelial carcinoma of the upper urinary tract were included in a prospective study at two Japanese institutions(lymphadenectomy group). Lymphadenectomies were carried out according to definite anatomical template. Results from this group were compared with those from a control group of 89 patients who did not receive lymphadenectomy during the study period (no lymphadenectomy group). In patients with urothelial carcinoma of the upper urinary tract in the renal pelvis of pathological stage 2 or higher, template-based lymphadenectomy resulted in significantly higher cancer-specific survival (89.8% and 51.7%, P = 0.01) and overall survival (86.1% and 48.0%, P = 0.01). Disease-free survival tended to be higher in the lymphadenectomy group(77.8% and 50.0%, P = 0.06). Template-based lymphadenectomy was a significant independent factor for reducing the risk of cancer death in patients with renal pelvic cancer of ≥ pT2 by multivariate analysis. In contrast, cancer-specific survival of patients with ureteral urothelial carcinoma of the upper urinary tract was not significantly different between the lymphadenectomy and no lymphadenectomy groups. This multi-institutional prospective study further supports the therapeutic role of template-based lymphadenectomy in patients with advanced-stage urothelial carcinoma of the upper urinary tract in the renal pelvis. This is not the case for patients with ureteral urothelial carcinoma of the upper urinary tract.

The value of serum CYFRA21-1 examination in the detection of urothelial carcinoma

Objective To evaluate the value of CYFRA21-1 examination in the detection of urothelial carcinoma (UC).Methods Serum concentrations of CYFRA21-1 were examined by electrochemiluminescence technique in 65 cases with UC,61 cases of non-UC patients (including 21 cases of renal carcinoma,20 cases of benign prostatic hyperplasia,10 cases of prostatic carcinoma,10 cases of urolithiasis) and 43 hea]thy individuals.Sixty-five UC cases including 9 renal pelvis UC cases,4 ureter UC cases,52 bladder UC cases,61 non-UC cases including 21 renal carcinoma cases,20 benign prostatic hyperplasia cases,10 prostatic carcinoma cases,10 urolithasis cases.Results The serum CYFRA21-1 concentration in UC patients (7.57± 12.76) μg/L was significantly higher than the healthy controls (2.58±0.97) μg/L and also the non-UC patients (2.75± 1.34) μg/L (P＜0.01).The difference between the healthy individuals and the nonUC patients was not significant (P＞0.05).According to the manual in the reagent kit,the positive value of serum CYFRA21-1 was defined as greater than 3.3 μg/L.The false positive rate in healthy controls and the non-UC patients was 10％-30％.The positive percentage of serum CYFRA21-1 of the 65 UC patients was 67.7％ (44/65).In low,middle and high grade UC cases,the positive rates were 50.0％ (10/20),62.5％ (5/8) and 78.3％ (29/37) respectively.The difference of the positive rates between the high grade group and middle,low grade groups was significant (x2 =4.55,P＜0.05).The positive rates in non-muscle invasive (Ta-Ti) UC and in healthy controls were 40.9％ (9/22) and 23.2％ (10/43) respectively,and the difference between the two groups was not significant (x2=2.19,P＞0.05).The positive rate in muscle invasive (T2-T3) UC was 78.6％ (22/28) and the difference compared with healthy controls was significant (x2=20.96,P＜0.01).The positive rate in local advanced and metastatic UC (＞T3) was 86.7％ (13/15).The positive rates were not significantly deferent between the T2-T3 group and the ＞ T3 group (x2 =1.97,P＞0.05).Conclusions The serum CYFRA21-1 positive rate is 67.7％ in UC patients,which was higher than non-UC patients and healthy controls,and associated positively with the pathologic grade and the clinical stage of UC.Monitoring the serum CYFRA21-1 is effective in assessing the outcomes and prognosis of UC,if the serum CYFRA21-1 was positive.The serum CYFRA21-1 test has some significance in distinguishing UC from renal carcinoma and prostatic carcinoma. Key words: Urothelium; Carcinoma; Tumor markers; Keratins

Segmental ureterectomy does not compromise the oncologic outcome compared with nephroureterectomy for pure ureter cancer

PurposePure ureter cancers are rare and account for only 1–3 % of urothelial carcinomas with limited data. Nowadays, nephron-sparing methods are reserved mainly for imperative cases. This study intends to assess the oncologic outcome between segmental ureterectomy (SU) and radical nephroureterectomy (RNU) for pure ureteral urothelial carcinoma.MethodsFrom July 2004 to August 2010, 112 patients at a single tertiary referral center were included. Perioperative data were obtained from our institutional database. Postoperative CT scan, cystoscopy, and contralateral renal echo were performed regularly for survey of disease recurrence.ResultsThe mean length of follow-up was 43.8 and 48.3 months for the RNU and SU group, respectively. The bladder recurrences, local recurrences, distant metastasis, and cancer-specific survival rates showed no significant differences between RNU and SU (36.4 vs. 34.2 %, p = 0.83; 23.4 vs. 14.3 %, p = 0.27; and 16.9 vs. 8.6 %, p = 0.244, and 13.0 vs. 5.7 %, p = 0.249, respectively).ConclusionThe study suggested that SU is not inferior to RNU for ureter cancer in oncologic outcomes and is less invasive and better nephron preservation.

Template‐based lymphadenectomy in urothelial carcinoma of the renal pelvis: A prospective study

ObjectivesRecent studies showed the therapeutic benefit of lymphadenectomy in advanced stage urothelial carcinoma of the upper urinary tract, but there is still a lack of prospective studies and standardization of the extent of lymphadenectomy. The aim of this multi‐institutional study was to examine the role of lymphadenectomy in urothelial carcinoma of the upper urinary tract.MethodsFrom January 2005 to September 2012, 77 patients undergoing nephroureterectomy and lymphadenectomy for non‐metastatic (cN0M0) urothelial carcinoma of the upper urinary tract were included in a prospective study at two Japanese institutions (lymphadenectomy group). Lymphadenectomies were carried out according to definite anatomical template. Results from this group were compared with those from a control group of 89 patients who did not receive lymphadenectomy during the study period (no lymphadenectomy group).ResultsIn patients with urothelial carcinoma of the upper urinary tract in the renal pelvis of pathological stage 2 or higher, template‐based lymphadenectomy resulted in significantly higher cancer‐specific survival (89.8% and 51.7%, P = 0.01) and overall survival (86.1% and 48.0%, P = 0.01). Disease‐free survival tended to be higher in the lymphadenectomy group (77.8% and 50.0%, P = 0.06). Template‐based lymphadenectomy was a significant independent factor for reducing the risk of cancer death in patients with renal pelvic cancer of ≥pT2 by multivariate analysis. In contrast, cancer‐specific survival of patients with ureteral urothelial carcinoma of the upper urinary tract was not significantly different between the lymphadenectomy and no lymphadenectomy groups.ConclusionsThis multi‐institutional prospective study further supports the therapeutic role of template‐based lymphadenectomy in patients with advanced‐stage urothelial carcinoma of the upper urinary tract in the renal pelvis. This is not the case for patients with ureteral urothelial carcinoma of the upper urinary tract.