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Lee JH, Lee CU, Chung JH, Song W, Kang M, Jeon HG, Jeong BC, Seo SI, Jeon SS, Sung HH. Single Early Intravesical Instillation of Epirubicin for Preventing Bladder Recurrence after Nephroureterectomy in Upper Urinary Tract Urothelial Carcinoma. Cancer Res Treat 2024; 56:877-884. [PMID: 38271926 PMCID: PMC11261194 DOI: 10.4143/crt.2023.1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
PURPOSE We aimed to assess the effectiveness of early single intravesical administration of epirubicin in preventing intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma. MATERIALS AND METHODS Patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy between November 2018 and May 2022 were retrospectively reviewed. Intravesical epirubicin was administered within 48 hours if no evidence of leakage was observed. Epirubicin (50 mg) in 50 mL normal saline solution was introduced into the bladder via a catheter and maintained for 60 minutes. The severity of adverse events was graded using the Clavien-Dindo classification. We compared intravesical recurrence rate between the two groups. Multivariate analyses were performed to identify the independent predictors of bladder recurrence following radical nephroureterectomy. RESULTS Epirubicin (n=55) and control (n=116) groups were included in the analysis. No grade 1 or higher bladder symptoms have been reported. A statistically significant difference in the intravesical recurrence rate was observed between the two groups (11.8% at 1 year in the epirubicin group vs. 28.4% at 1 year in the control group; log-rank p=0.039). In multivariate analysis, epirubicin instillation (hazard ratio [HR], 0.43; 95% confidence interval [CI], 0.20 to 0.93; p=0.033) and adjuvant chemotherapy (HR, 0.29; 95% CI, 0.13 to 0.65; p=0.003) were independently predictive of a reduced incidence of bladder recurrence. CONCLUSION This retrospective review revealed that a single immediate intravesical instillation of epirubicin is safe and can reduce the incidence of intravesical recurrence after radical nephroureterectomy. However, further prospective trials are required to confirm these findings.
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Affiliation(s)
- Jong Hoon Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chung Un Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Chung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wan Song
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Minyong Kang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Hu H, Lai S, Wang M, Tang X, Lai CH, Xu K, Xu T, Hu H. Effect of subsequent bladder cancer on survival in upper tract urothelial carcinoma patients post-radical nephroureterectomy: a systematic review and meta-analysis. BMC Urol 2023; 23:212. [PMID: 38129811 PMCID: PMC10734187 DOI: 10.1186/s12894-023-01387-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Radical nephroureterectomy (RNU) is the primary treatment strategy for upper tract urothelial carcinoma (UTUC). However, the intravesical recurrence occurs in 20-50% of all patients. The specific effect of subsequent bladder cancer (SBCa) on survival remains unclear. Therefore, we investigated the effect of SBCa following RNU in patients with UTUC. METHODS PubMed, EMBASE, and Cochrane Library were exhaustively searched for studies comparing oncological outcomes between SBCa and without SBCa. Standard cumulative analyses using hazard ratios (HR) with 95% confidence intervals (CI) were performed using Review Manager (version 5.3). RESULTS Five studies involving 2057 patients were selected according to the predefined eligibility criteria. Meta-analysis of cancer-specific survival (CSS) and overall survival (OS) revealed no significant differences between the SBCa and non-SBCa groups. However, subgroup analysis of pT0-3N0M0 patients suggested that people with SBCa had worse CSS (HR = 5.13, 95%CI 2.39-10.98, p < 0.0001) and OS (HR = 4.00, 95%CI 2.19-7.31, p < 0.00001). CONCLUSIONS SBCa appears to be associated with worse OS in patients with early stage UTUC. However, caution must be taken before recommendations are made because this interpretation is based on very few clinical studies and a small sample size. Research sharing more detailed surgical site descriptions, as well as enhanced outcome data collection and improved reporting, is required to further investigate these nuances.
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Affiliation(s)
- Haopu Hu
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Shicong Lai
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Mingrui Wang
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Xinwei Tang
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Chin-Hui Lai
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Kexin Xu
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Tao Xu
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Hao Hu
- Department of Urology, Peking University People's Hospital, Beijing, China.
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Wang Z, Shi H, Xu Y, Fang Y, Song J, Jiang W, Xia D, Wu Z, Wang L. Intravesical Therapy for Upper Urinary Tract Urothelial Carcinoma: A Comprehensive Review. Cancers (Basel) 2023; 15:5020. [PMID: 37894387 PMCID: PMC10605447 DOI: 10.3390/cancers15205020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/22/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
Upper tract urothelial carcinoma (UTUC) poses unique challenges in diagnosis and treatment. This comprehensive review focuses on prophylactic intravesical therapy for UTUC, summarizing key aspects of intravesical therapy in various clinical scenarios, including concurrent with or following radical nephroureterectomy, kidney-sparing surgery, ureteroscopy-guided biopsy. The incidence of intravesical recurrence in UTUC after surgical treatment is significant, necessitating effective preventive measures. Intravesical therapy plays a vital role in reducing the risk of bladder recurrence following UTUC surgery. Tailoring timing, drug selection, dosage, and frequency is vital in optimizing treatment outcomes and reducing intravesical recurrence risk in UTUC. This review provides a comprehensive summary of the history, clinical trials, guideline recommendations, and clinical applications of intravesical therapy for UTUC. It also discusses the future directions based on current clinical needs and ongoing trials. Future directions entail optimizing dosage, treatment duration, and drug selection, as well as exploring novel agents and combination therapies. Intravesical therapy holds tremendous potential in improving outcomes for UTUC patients and reducing the risk of bladder recurrence. Although advancements have been made in UTUC treatment research, further refinements are necessary to enhance efficacy and safety.
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Affiliation(s)
- Zheng Wang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (Z.W.); (H.S.); (Y.X.); (Y.F.); (J.S.); (W.J.)
| | - Haoqing Shi
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (Z.W.); (H.S.); (Y.X.); (Y.F.); (J.S.); (W.J.)
| | - Yifan Xu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (Z.W.); (H.S.); (Y.X.); (Y.F.); (J.S.); (W.J.)
| | - Yu Fang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (Z.W.); (H.S.); (Y.X.); (Y.F.); (J.S.); (W.J.)
| | - Jiaao Song
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (Z.W.); (H.S.); (Y.X.); (Y.F.); (J.S.); (W.J.)
| | - Wentao Jiang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (Z.W.); (H.S.); (Y.X.); (Y.F.); (J.S.); (W.J.)
| | - Demeng Xia
- Department of Pharmacy, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China;
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (Z.W.); (H.S.); (Y.X.); (Y.F.); (J.S.); (W.J.)
| | - Linhui Wang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (Z.W.); (H.S.); (Y.X.); (Y.F.); (J.S.); (W.J.)
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Zhang JQ, Duan Y, Wang K, Zhang XL, Jiang KH. Metachronous urothelial carcinoma in the renal pelvis, bladder, and urethra: A case report. World J Clin Cases 2023; 11:3062-3069. [PMID: 37215428 PMCID: PMC10198092 DOI: 10.12998/wjcc.v11.i13.3062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/06/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Urothelial carcinoma (UC) is a common malignancy of the urinary system that can occur anywhere from the renal pelvis to the proximal urethra. Most UCs are in the bladder and have multifocal growth. Upper urinary tract UC (UTUC), which occurs in the renal pelvis or ureter, accounts for only 5% to 10% of UCs.
CASE SUMMARY In March 2015, a 70-year-old male who initially presented to a local hospital with a complaint of painless hematuria was diagnosed with UTUC of the right renal pelvis. The doctors administered radical nephroureterectomy and bladder cuff excision. Although the doctors recommended intravesical chemotherapy and regular follow-up, he rejected this advice. In December 2016, the patient presented at our hospital with dysuria. We identified UC in the residual bladder and administered radical cystectomy and left cutaneous ureterostomy. In November 2021, he presented again with urethral bleeding. We detected urethral UC as the cause of urethral orifice bleeding and administered radical urethrectomy. Since then, he has visited regularly for 6-mo follow-ups, and was in stable condition as of December 2022.
CONCLUSION UTUC is prone to seeding and recurrence. Adjuvant instillation therapy and intense surveillance are crucial for these patients.
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Affiliation(s)
- Jian-Qing Zhang
- Department of Urology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
| | - Yu Duan
- Department of Urology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
| | - Kun Wang
- Department of Urology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
| | - Xiao-Li Zhang
- Department of Biomedicine, Guizhou University, Guiyang 550025, Guizhou Province, China
| | - Ke-Hua Jiang
- Department of Urology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
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Qi Z, Liu M, Zhou R, Guo C, Liu A, Yang H, Li F, Duan L, Shen L, Wu Q, Wu N, Liu Z, Pan Y, Liu F, Liu Y, Cai H, He Z, Ke Y. Multiple Lugol-unstained lesions predict higher cumulative risk of malignance in the esophagus. J Gastroenterol Hepatol 2023; 38:416-423. [PMID: 36418206 DOI: 10.1111/jgh.16075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/02/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM The impact of the presence of multiple Lugol-unstained lesions (LULs) in the esophagus on the risk of having severe dysplasia and above (SDA) lesions among asymptomatic individuals is unknown. METHODS We collected demographic factors, behavioral variables, and features of LULs from 1073 participants who were biopsied at baseline endoscopic screening in a population-based screening trial, and these individuals were followed over a median time of 7 years. Outcome events were defined as SDA identified at screening, at reexamination, or during follow-up. "Multiple LULs" were defined as ≥ 2 LULs found in the entirety of the esophagus. Multivariable logistic regression models were fitted to assess the effect of "multiple LULs" on the cumulative risk of SDA. RESULTS There were 147 SDA cases in the current study. After adjustment for potential risk factors and endoscopic features of LULs, the presence of "multiple LULs" slightly increased the cumulative risk of having SDA with no statistical significance (adjusted odds ratio [OR] = 1.26; 95% confidence interval [CI] [0.85, 1.88]). Further stratified analysis showed that this association was strong among subjects with small LULs (≤ 5 mm) (adjusted OR = 3.29; 95% CI [1.39, 7.79]). However, no such association was observed in subjects with larger LULs (adjusted OR = 0.99; 95% CI [0.63, 1.55], P interaction = 0.022). CONCLUSIONS The presence of "multiple small LULs (≤ 5 mm)" in chromoendoscopy indicates a higher cumulative risk of having SDA in the esophagus. We recommend biopsies be taken and surveillance be maintained at a more active level in individuals with relatively small but multiple LULs.
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Affiliation(s)
- Zifan Qi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, China
| | - Mengfei Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, China
| | - Ren Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, China
| | - Chuanhai Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, China
| | - Anxiang Liu
- Endoscopy Center, Anyang Cancer Hospital, Anyang, China, Henan Province, China
| | - Haijun Yang
- Department of Pathology, Anyang Cancer Hospital, Anyang, Henan Province, China
| | - Fenglei Li
- Hua County People's Hospital, China, Henan Province, China
| | - Liping Duan
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China
| | - Lin Shen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Qi Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Nan Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhen Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yaqi Pan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, China
| | - Fangfang Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, China
| | - Ying Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, China
| | - Hong Cai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhonghu He
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yang Ke
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, China
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Meireles S, Dias N, Martins D, Dias C, Gonçalves M, Silva J, Silva CM, Oliveira PD, Soares P, Lopes JM. Prognostic Value of Bladder Involvement in the Outcome of Upper Tract Urothelial Carcinoma. Diagnostics (Basel) 2023; 13:diagnostics13010153. [PMID: 36611446 PMCID: PMC9818601 DOI: 10.3390/diagnostics13010153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
Accurately predicting the clinical prognosis of upper tract urothelial carcinoma (UTUC) seems crucial. We evaluated the effect of the involvement of urothelial bladder carcinoma (UBC) as a potential prognostic factor for overall survival (OS) and progression-free survival (PFS). The cohort included 115 patients with UTUC, subgrouped between January 2009 and December 2019 as follows: (1) only UTUC and (2) UTUC with synchronous or metachronous UBC (UTUC + UBC). Univariate and multivariate analyses were performed to identify independent prognostic factors for OS and PFS. Synchronous or metachronous UBC diagnosis in UTUC patients was an independent predictor of worse PFS (HR 3.326 CI 95% 1.474−7.503, p = 0.004), but it was not identified as a prognostic factor for OS (p > 0.05). Lymphovascular invasion (LVI) was associated with decreased PFS (HR 2.687 CI 95%1.172−6.163, p = 0.020) and OS (HR 4.980 CI 95%1.763−14.064, p = 0.002). This study indicates that concomitant or later UBC could predict a poor PFS, but it is not associated with a significantly worse OS in UTUC patients. The prognostic impact of LVI underlines its inclusion in the tumor staging system of UTUC.
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Affiliation(s)
- Sara Meireles
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Institute of Molecular Pathology, Immunology of the University of Porto (IPATIMUP), Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Medical Oncology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Correspondence: ; Tel.: +351-961313435
| | - Nuno Dias
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Urology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Diana Martins
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Pathology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Carolina Dias
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Institute of Molecular Pathology, Immunology of the University of Porto (IPATIMUP), Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
| | - Marina Gonçalves
- Medical Oncology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - João Silva
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Urology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Carlos Martins Silva
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Urology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Paulo Dinis Oliveira
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Urology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Paula Soares
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Institute of Molecular Pathology, Immunology of the University of Porto (IPATIMUP), Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - José Manuel Lopes
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Institute of Molecular Pathology, Immunology of the University of Porto (IPATIMUP), Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Pathology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
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Seillier L, Peifer M. Reconstructing Phylogenetic Relationship in Bladder Cancer: A Methodological Overview. Methods Mol Biol 2023; 2684:113-132. [PMID: 37410230 DOI: 10.1007/978-1-0716-3291-8_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Bladder cancer (BC) expresses itself as a highly heterogeneous disease both at the histological and molecular level, often occurring as synchronous or metachronous multifocal disease with high risk of recurrence and potential to metastasize. Multiple sequencing studies focusing on both non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC) gave insights into the extent of both inter- and intrapatient heterogeneity, but many questions on clonal evolution in BC remain unanswered. In this review article, we provide an overview over the technical and theoretical concepts linked to reconstructing evolutionary trajectories in BC and propose a set of tools and established software for phylogenetic analysis.
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Affiliation(s)
| | - Martin Peifer
- Department of Translational Genomics, University of Cologne, Cologne, Germany
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Chen CS, Li JR, Yang CK, Cheng CL, Yang CR, Ou YC, Ho HC, Lin CY, Hung SC, Chen CC, Wang SC, Wang SS. Significant predictors of contralateral upper tract recurrence after radical nephroureterectomy for upper tract urothelial carcinoma. Int J Urol 2021; 29:69-75. [PMID: 34608678 DOI: 10.1111/iju.14718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/15/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the significant predictors of contralateral upper tract recurrence after radical nephroureterectomy for upper tract urothelial carcinoma. METHODS Between January 2001 and December 2015, 548 patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy in a single institution were included in this retrospective cohort study. Several clinicopathological characteristics and outcomes were explored. The crucial end-point was the diagnosis of contralateral upper tract recurrence after radical nephroureterectomy. RESULTS Of the 548 patients, the median age was 68 years (range 24-93 years), and the median follow-up time after radical nephroureterectomy was 41 months (range 8-191 months). Contralateral upper tract recurrence occurred in 28 patients (5.1%). The median time period between radical nephroureterectomy and contralateral upper tract recurrence was 15.4 months (range 3.4-52.4 months). In the multivariate analysis, preoperative estimated glomerular filtration rate <30 mL/min/1.73 m2 (hazard ratio 3.08, P = 0.003) and tumor multifocality (hazard ratio 2.16, P = 0.043) were independent risk factors. CONCLUSION Preoperative estimated glomerular filtration rate <30 and tumor multifocality are significant predictors of contralateral upper tract recurrence after radical nephroureterectomy for upper tract urothelial carcinoma.
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Affiliation(s)
- Chuan-Shu Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Jian-Ri Li
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medicine and Nursing, Hungkuang University, Taichung, Taiwan
| | - Cheng-Kuang Yang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chen-Li Cheng
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chi-Rei Yang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - Yen-Chuan Ou
- Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Hao-Chung Ho
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Chang Bing Show-Chwan Memorial Hospital, Changhua, Taiwan
| | - Chia-Yen Lin
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Sheng-Chun Hung
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Cheng-Che Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shu-Chi Wang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shian-Shiang Wang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan
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van Doeveren T, Nakauma-Gonzalez JA, Mason AS, van Leenders GJLH, Zuiverloon TCM, Zwarthoff EC, Meijssen IC, van der Made AC, van der Heijden AG, Hendricksen K, van Rhijn BWG, Voskuilen CS, van Riet J, Dinjens WNM, Dubbink HJ, van de Werken HJG, Boormans JL. The clonal relation of primary upper urinary tract urothelial carcinoma and paired urothelial carcinoma of the bladder. Int J Cancer 2020; 148:981-987. [PMID: 33006377 PMCID: PMC7821318 DOI: 10.1002/ijc.33327] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/11/2020] [Accepted: 09/17/2020] [Indexed: 12/13/2022]
Abstract
The risk of developing urothelial carcinoma of the bladder (UCB) in patients treated by radical nephroureterectomy (RNU) for an upper urinary tract urothelial carcinoma (UTUC) is 22% to 47% in the 2 years after surgery. Subject of debate remains whether UTUC and the subsequent UCB are clonally related or represent separate origins. To investigate the clonal relationship between both entities, we performed targeted DNA sequencing of a panel of 41 genes on matched normal and tumor tissue of 15 primary UTUC patients treated by RNU who later developed 19 UCBs. Based on the detected tumor‐specific DNA aberrations, the paired UTUC and UCB(s) of 11 patients (73.3%) showed a clonal relation, whereas in four patients the molecular results did not indicate a clear clonal relationship. Our results support the hypothesis that UCBs following a primary surgically resected UTUC are predominantly clonally derived recurrences and not separate entities. What's new? Patients treated by radical nephroureterectomy for upper urinary tract cancer have an increased risk of developing bladder carcinoma following surgery. It remains unclear, however, whether the upper urinary tract cancer and subsequent bladder carcinoma are clonally related or have separate origins. This targeted DNA sequencing study shows that almost 75% of patients have tumors that are clonally related, suggesting that seeding of tumor cells is the main mechanism of bladder carcinoma development following radical nephroureterectomy. This result underscores the need to minimalize the risk of seeding during surgery and/or diagnostic ureterorenoscopy plus biopsy, and to apply peri‐operative intravesical instillations with chemotherapy.
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Affiliation(s)
- Thomas van Doeveren
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Jose A Nakauma-Gonzalez
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.,Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.,Cancer Computational Biology Center, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Andrew S Mason
- Jack Birch Unit for Molecular Carcinogenesis, Department of Biology, The University of York, York, UK.,York Biomedical Research Institute, The University of York, York, UK
| | - Geert J L H van Leenders
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Tahlita C M Zuiverloon
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Ellen C Zwarthoff
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Isabelle C Meijssen
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Angelique C van der Made
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Antoine G van der Heijden
- Department of Urology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Kees Hendricksen
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Bas W G van Rhijn
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Charlotte S Voskuilen
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Job van Riet
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.,Cancer Computational Biology Center, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Winand N M Dinjens
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Hendrikus J Dubbink
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Harmen J G van de Werken
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.,Cancer Computational Biology Center, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Joost L Boormans
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
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10
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Strandgaard T, Nordentoft I, Lamy P, Christensen E, Thomsen MBH, Jensen JB, Dyrskjøt L. Mutational Analysis of Field Cancerization in Bladder Cancer. Bladder Cancer 2020. [DOI: 10.3233/blc-200282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND: Morphologically normal tissue, adjacent to tumors, contains multiple molecular changes, the so-called field cancerization. The multifocal and recurrent nature of bladder cancer has been hypothesized to originate from this. However, further studies are required to explore the mutational composition of normal tissue adjacent to tumors. OBJECTIVE: To analyze field cancerization in bladder cancer patients using a non-tumor guided approach. METHODS: We investigated the mutational landscape of normal appearing urothelium and paired bladder tumors from four patients by applying deep-targeted sequencing. RESULTS: Sequencing of 509 cancer driver genes revealed the presence of 2– 13 mutations exclusively localized in normal tissue (average target read depth 634×). Furthermore, 6– 13 mutations were shared between tumor and normal samples and 8– 75 mutations were exclusively detected in tumor samples. More mutations were observed in normal samples from patients with multifocal disease compared to patients with unifocal disease. Mutations in normal samples had lower variant allele fractions (VAF) compared to tumor mutations (p < 2.2*10–16). Furthermore, significant differences in the type of nucleotide changes between tumor, normal and shared mutations (p = 2.2*10–5) were observed, and mutations in APOBEC context were observed primarily among tumor mutations (p = 0.02). No differences in functional impact between normal, shared and tumor mutations were observed (p = 0.61). CONCLUSION: Overall, these findings support the presence of more than one field in the bladder, and document non-tumor specific driver mutations to be present in normal appearing bladder tissue.
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Affiliation(s)
- Trine Strandgaard
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus C, Denmark
| | - Iver Nordentoft
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Philippe Lamy
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Emil Christensen
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus C, Denmark
| | | | - Jørgen Bjerggaard Jensen
- Department of Clinical Medicine, Health, Aarhus University, Aarhus C, Denmark
- Department of Urology, Aarhus University Hospital, Aarhus N, Denmark
| | - Lars Dyrskjøt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus C, Denmark
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11
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Synchronous and metachronous urothelial carcinoma of the upper urinary tract and the bladder: Are they clonally related? A systematic review. Urol Oncol 2020; 38:590-598. [DOI: 10.1016/j.urolonc.2020.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 12/17/2022]
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12
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Park HS, Shin HB, Lee MS, Kim JH, Kim SY, Park J. Seminal Vesicle Involvement by Carcinoma In Situ of the Bladder: Clonal Analysis Using Next-Generation Sequencing to Elucidate the Mechanism of Tumor Spread. Cancer Res Treat 2020; 52:1283-1287. [PMID: 32192274 PMCID: PMC7577816 DOI: 10.4143/crt.2020.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/17/2020] [Indexed: 01/04/2023] Open
Abstract
We present a rare case of urothelial carcinoma in situ (CIS), which invades the prostate and seminal vesicle (SV). A 70-year-old man underwent transurethral resection of bladder (TURB), and the pathologic examination revealed multiple CIS. Although the patient received intravesical bacillus Calmette-Guerin (BCG) therapy following TURB, recurrence of CIS was confirmed in the bladder and left distal ureter at 3 months following BCG. Radical cystectomy was performed due to BCG-refractory CIS. Microscopically, CIS was found throughout the mucosa of the bladder, left ureter, prostatic duct, and both SVs. Next-generation sequencing revealed significant differences in tumor clonality between bladder and SV CIS cells. Among 101 (bladder CIS) and 95 (SV CIS) somatic mutations, only two were shared, and only one gene (ARHGAP23) was common exon coding region gene. In conclusion, multicentric genetic changes, in line with the field-cancerization effect, may result in SV involvement by CIS of the bladder.
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Affiliation(s)
- Hyun Sik Park
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Hyun Bin Shin
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Myung-Shin Lee
- Department of Microbiology and Immunology, Eulji University School of Medicine, Daejeon, Korea
| | - Joo Heon Kim
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Seon-Young Kim
- Personalized Genomic Medicine Research Center, Korea Research Institute of Bioscience & Biotechnology, Daejeon, Korea
| | - Jinsung Park
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
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13
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Zhang X, Bu R, Liu Z, Wu B, Bai S. Development and Validation of a Model for Predicting Intravesical Recurrence in Organ-confined Upper Urinary Tract Urothelial Carcinoma Patients after Radical Nephroureterectomy: a Retrospective Study in One Center with Long-term Follow-up. Pathol Oncol Res 2019; 26:1741-1748. [PMID: 31643022 DOI: 10.1007/s12253-019-00748-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/03/2019] [Indexed: 10/25/2022]
Abstract
Although radical nephroureterectomy is the standard treatment method for upper urinary tract urothelial carcinoma, it is associated with a high risk of intravesical recurrence. There are no models for predicting IVR after RNU in patients with organ-confined UTUC. Therefore, we developed and validated a model for postoperative prediction of IVR after RNU. The development cohort consisted of 416 patients who underwent RNU with bladder cuff excision at our center between 1 January 2007 and 31 December 2015. Patient clinicopathologic data were recorded. Multivariate Cox proportional hazard ratio regression was used to build a predictive model with regression coefficients, backward step-wise selection was applied, and the likelihood ratio test with Akaike's information criterion was used as the stopping rule. An independent cohort consisting of 152 consecutive patients from 1 January 2016 and 31 December 2017 was used for validation. The performance of this predictive model was assessed with respect to discrimination, calibration, and clinical usefulness. The predictors in this model included tumor stage, tumor diameter, tumor location, and tumor grade. In the validation cohort, the model showed good discrimination, with a concordance index of 0.689 (95% CI, 0.629 to 0.748) and good calibration. Decision curve analysis demonstrated that the model was also clinically useful. This study presents a good model that may facilitate individualized postoperative prediction of IVR after RNU in patients with organ-confined UTUC, and thus, may help improve postoperative strategies and facilitate treatment outcomes.
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Affiliation(s)
- Xuanyu Zhang
- Department of Urology, ShengJing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Renge Bu
- Department of Urology, ShengJing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Zeqi Liu
- Department of Urology, ShengJing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Bin Wu
- Department of Urology, ShengJing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Song Bai
- Department of Urology, ShengJing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China.
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14
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Harraz AM, El-Shabrawy M, El-Nahas AR, El-Kappany H, Osman Y. Single Versus Maintenance Intravesical Chemotherapy for the Prevention of Bladder Recurrence after Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Randomized Clinical Trial. Clin Genitourin Cancer 2019; 17:e1108-e1115. [PMID: 31594736 DOI: 10.1016/j.clgc.2019.07.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/25/2019] [Accepted: 07/28/2019] [Indexed: 01/29/2023]
Abstract
INTRODUCTION The objective of this study was to determine the efficiency of 1-year maintenance intravesical chemotherapy (MIC) in reducing bladder recurrence (BR) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma compared with single intravesical instillation (SIC). PATIENTS AND METHODS Between January 2015 and May 2017, patients who underwent RNU were randomized to receive SIC (epirubicin 50 mg) or MIC (once weekly for 6 weeks plus once monthly for 1 year). The primary outcome was the rate of histologically proven BR. The secondary outcomes included chemotherapy-related toxicities and disease-specific survival (DSS). Thirty-five patients in each arm were required to achieve a power of 80%. RESULTS A total of 38 (SIC) and 36 (MIC) patients were analyzed. In SIC, BR developed in 5 (13.2%) over a median follow-up of 3 months (range, 3-6 months) compared with 9 (25%) patients over 12 months (range, 3-28 months) in MIC (P = .08). The 6- and 12-month BR-free survivals were the same (86.8%) in SIC versus 88.9% and 83.3% in MIC, respectively (P = .2). Lymphovascular invasion was significantly associated with BR (P = .04). Post-RNU intravesical chemotherapy regimens did not alter DSS. Blood transfusion and advanced tumor stage were independent predictors for DSS. No significant medication toxicity was reported. CONCLUSIONS Following RNU, MIC did not change the natural course of BR beyond a single instillation apart from potentially delaying its occurrence. Lymphovascular invasion and blood transfusion were associated with worse BR and DSS outcomes, respectively.
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Affiliation(s)
- Ahmed M Harraz
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | | | - Ahmed R El-Nahas
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Hamdy El-Kappany
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Yasser Osman
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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15
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Yamamoto S, Sakamoto S, Imamura Y, Sazuka T, Nakamura K, Inoue T, Chiba K, Miyazaki K, Inoue A, Nagata M, Ichikawa T. Intravesical irrigation might prevent bladder recurrence in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma. Int J Urol 2019; 26:791-796. [PMID: 31081198 DOI: 10.1111/iju.14014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 03/27/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To examine the effectiveness of intravesical irrigation with physiological saline solution or distilled water for the prevention of bladder recurrence in patients undergoing laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma. METHODS This retrospective study involved 109 upper urinary tract urothelial carcinoma patients who underwent laparoscopic nephroureterectomy, and were evaluated at Chiba University Hospital and Yokohama Rosai Hospital between 2001 and 2018. We investigated the outcomes and analyzed various clinical factors including with or without intravesical irrigation related to bladder carcinoma recurrence after surgery. Physiological saline solution or distilled water was used for irrigation, which was carried out only during surgery. RESULTS The median follow-up period after surgery was 26.1 months. Bladder recurrence was confirmed within 2 years for 45 of the 109 patients in the present study. Irrigation was carried out for 48 cases (distilled water, 26 patients; physiological saline solution, 22 patients). Tumor grade (G1-2 vs G3; P = 0.05) and intravesical irrigation (yes vs no; P = 0.0058) were related to bladder recurrence on univariate analyses. On multivariate analyses, intravesical irrigation was the independent factor involved in the prevention of bladder recurrence (P = 0.0051). Comparison between the irrigation and non-irrigation groups showed that bladder recurrence rates were significantly lower in the irrigation group (irrigation group vs non-irrigation group: 25.0% vs 52.5%, P = 0.0066). There was no significant difference in the recurrence rate between the two solutions used for irrigation. CONCLUSIONS Intravesical irrigation during surgery of upper urinary tract urothelial carcinoma might decrease postoperative bladder recurrence rates.
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Affiliation(s)
| | | | - Yusuke Imamura
- Department of Urology, Chiba University Hospital, Chiba, Japan
| | - Tomokazu Sazuka
- Department of Urology, Chiba University Hospital, Chiba, Japan
| | | | - Toshihito Inoue
- Department of Urology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Kazuto Chiba
- Department of Urology, Yokohama Rosai Hospital, Yokohama, Japan
| | | | - Atsushi Inoue
- Department of Urology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Maki Nagata
- Department of Urology, Yokohama Rosai Hospital, Yokohama, Japan
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16
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Milojevic B, Dzamic Z, Bojanic N, Durutovic O, Janicic A, Kajmakovic B, Milojevic IG, Bumbasirevic U, Grubor N, Grujicic SS. Urothelial carcinoma of the upper urinary tract: preoperative pyuria is not correlated with bladder cancer recurrence and survival. Int Urol Nephrol 2019; 51:831-838. [DOI: 10.1007/s11255-019-02133-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 03/20/2019] [Indexed: 01/13/2023]
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17
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Crabb SJ, Douglas J. The latest treatment options for bladder cancer. Br Med Bull 2018; 128:85-95. [PMID: 30371744 DOI: 10.1093/bmb/ldy034] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 10/04/2018] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Bladder cancer carries a high healthcare burden and a poor prognosis once distant metastatic spread has occurred. SOURCES OF DATA We utilised a PubMed/MEDLINE literature search using the terms bladder cancer, chemotherapy, immunotherapy, intra-vesical therapy, surgery and radiotherapy, and current clinical management guidelines (Association of Cancer Physicians, British Association of Urological Surgeons, National Institute for Health and Care Excellence, European Association of Urology). AREAS OF AGREEMENT Optimal bladder cancer management requires a multi-modal approach incorporating surgery, radiotherapy, chemotherapy and immunotherapy. AREAS OF CONTROVERSY Selection criteria for radical surgery, or radiotherapy as a bladder sparing option, and their relative efficacy, remains poorly defined. GROWING POINTS Palliative immunotherapy has been recently established for advanced bladder cancer after prior chemotherapy. Earlier use is under investigation. AREAS TIMELY FOR DEVELOPING RESEARCH Validated predictive biomarkers, potentially from easily repeatable sites ('liquid biopsies'), will be required to optimise use of molecularly targeted treatment options.
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Affiliation(s)
- Simon J Crabb
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - James Douglas
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
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18
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van Doeveren T, van Leeuwen PJ, Aben KKH, van der Aa M, Barendrecht M, Boevé ER, Cornel EB, van der Heijden AG, Hendricksen K, Hirdes W, Kooistra A, Kroon B, Leliveld AM, Meijer RP, van Melick H, Merks B, de Reijke TM, de Vries P, Wymenga LFA, Wijsman B, Boormans JL. Reduce bladder cancer recurrence in patients treated for upper urinary tract urothelial carcinoma: The REBACARE-trial. Contemp Clin Trials Commun 2018; 9:121-129. [PMID: 29696234 PMCID: PMC5898538 DOI: 10.1016/j.conctc.2018.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 01/15/2018] [Accepted: 01/19/2018] [Indexed: 11/28/2022] Open
Abstract
Background Following radical nephro-ureterectomy for urothelial carcinoma of the upper urinary tract (UUT), the reported bladder recurrence rate of urothelial carcinoma is 22–47%. A single intravesical instillation of chemotherapy within 10 days following nephro-ureterectomy has the potential to decrease the risk of a bladder recurrence significantly. Despite recommendation by the European Association of Urology guideline to administer a single instillation postoperatively, the compliance rate is low because the risk of extravasation of chemotherapy. Aim To reduce the risk of bladder cancer recurrence by a single intravesical instillation of Mitomycin immediately (within 3 h) before radical nephro-ureterectomy or partial ureterectomy. Methods Adult patients (age ≥ 18 years) with a (suspicion of a) urothelial carcinoma of the UUT undergoing radical nephro-ureterectomy or partial ureterectomy will be eligible and will receive a single intravesical instillation of Mitomycin within 3 h before surgery. In total, 170 patients will be included in this prospective, observational study. Follow-up will be according to current guidelines. Results The primary endpoint is the bladder cancer recurrence rate up to two years after surgery. Secondary endpoints are: a) the compliance rate; b) oncological outcome; c) possible side-effects; d) the quality of life; e) the calculation of costs of a single neoadjuvant instillation with Mitomycin and f) molecular characterization of UUT tumors and intravesical recurrences. Conclusions A single intravesical instillation of Mitomycin before radical nephro-ureterectomy or partial ureterectomy may reduce the risk of a bladder recurrence in patients treated for UUT urothelial carcinoma and will circumvent the disadvantages of current therapy.
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Affiliation(s)
- T van Doeveren
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - P J van Leeuwen
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - K K H Aben
- Netherlands Comprehensive Cancer Organisation, The Netherlands.,Radboud University Medical Center, Nijmegen, The Netherlands
| | - M van der Aa
- Spaarne Medical Center, Hoofddorp, The Netherlands
| | | | - E R Boevé
- Fransiscus Medical Center, Rotterdam, The Netherlands
| | - E B Cornel
- Ziekenhuis Groep Twente, Almelo and Hengelo, The Netherlands
| | | | - K Hendricksen
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - W Hirdes
- Isala Medical Center, Zwolle, The Netherlands
| | - A Kooistra
- Meander Medical Center, Amersfoort, The Netherlands
| | - B Kroon
- Rijnstate Medical Center, Arnhem, The Netherlands
| | - A M Leliveld
- University Medical Center Groningen, Groningen, The Netherlands
| | - R P Meijer
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - H van Melick
- Sint Antonius Medical Center, Nieuwegein, The Netherlands
| | - B Merks
- Haaglanden Medical Center, Leidschendam, The Netherlands
| | | | - P de Vries
- Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - B Wijsman
- Elisabeth-TweeSteden Medical Center, Tilburg, The Netherlands
| | - J L Boormans
- Erasmus University Medical Center, Rotterdam, The Netherlands
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19
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Warzecha HN, Fend F, Steinhilber J, Abele H, Henes M, Harland N, Staebler A. Non-invasive papillary urothelial carcinoma of the vagina: molecular analysis of a rare case identifies clonal relationship to non-invasive urothelial carcinoma of the bladder. Virchows Arch 2017; 471:347-353. [PMID: 28589387 DOI: 10.1007/s00428-017-2165-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/04/2017] [Accepted: 05/30/2017] [Indexed: 11/25/2022]
Abstract
We present a rare case of non-invasive papillary urothelial carcinoma of the vagina as the initial presentation of a multicentric urothelial carcinoma also involving bladder and renal pelvis and report for the first time in the literature the molecular alterations observed in the vaginal urothelial lesion and the synchronous lesions of the urinary tract. In this case, the non-invasive papillary urothelial carcinoma in the vagina displayed the same genetic alterations in the FGFR3 and PIK3CA genes as those seen in the non-invasive papillary urothelial carcinoma of the bladder contrasting with the wild phenotype observed in the invasive urothelial carcinoma of the renal pelvis. This observation could reinforce the theory of "seeding" of carcinoma cells as a valid and most likely explanation of this multifocality. In addition, we emphasize in this report the importance of recognizing this rare lesion in the female genital tract and its differential diagnosis.
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Affiliation(s)
- Hind N Warzecha
- Department of Pathology, University Hospital Tuebingen, Tuebingen, Germany.
| | - Falko Fend
- Department of Pathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Julia Steinhilber
- Department of Pathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Harald Abele
- Department of Gynecology, University Hospital Tuebingen, Tuebingen, Germany
| | - Melanie Henes
- Department of Gynecology, University Hospital Tuebingen, Tuebingen, Germany
| | - Niklas Harland
- Department of Urology, University Hospital Tuebingen, Tuebingen, Germany
| | - Annette Staebler
- Department of Pathology, University Hospital Tuebingen, Tuebingen, Germany
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20
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Yamashita R, Watanabe R, Ito I, Shinsaka H, Nakamura M, Matsuzaki M, Niwakawa M. Risk factors for intravesical recurrence after nephroureterectomy in patients with upper urinary tract urothelial carcinoma. Int Urol Nephrol 2017; 49:425-430. [DOI: 10.1007/s11255-017-1510-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
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21
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Kishimoto N, Takao T, Kuribayashi S, Yamamichi G, Nakano K, Kawamura M, Tsutahara K, Tanigawa G, Yamaguchi S. The neutrophil-to-lymphocyte ratio as a predictor of intravesical recurrence in patients with upper urinary tract urothelial carcinoma treated with radical nephroureterectomy. Int J Clin Oncol 2016; 22:153-158. [PMID: 27614622 DOI: 10.1007/s10147-016-1040-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/30/2016] [Indexed: 01/29/2023]
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation associated with recurrence and poor prognosis in numerous cancer types. The aim of this study was to evaluate the use of the NLR as a biomarker for intravesical recurrence (IVR) in patients undergoing radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC) for the first time. METHODS We retrospectively analyzed the records of 100 patients with UTUC who had undergone RNU between 1999 and 2015 at our institution. The association between the preoperative NLR and IVR were assessed using multivariate models. RESULTS Among the 100 patients enrolled in the study, 33 developed IVR during a median follow-up of 34 months. The receiver operating characteristic analysis revealed that the optimum cut-off value for the preoperative NLR was >3.8. A high preoperative NLR (n = 21) was associated with a significantly increased risk of lymph node involvement (p = 0.036) and IVR (p = 0.034) compared with a low preoperative NLR (n = 79). IVR-free survival in patients with a high preoperative NLR was significantly worse than that of patients with a low preoperative NLR (p = 0.018). On multivariate analysis, the preoperative NLR [hazard ratio (HR) 2.49; p = 0.015] and tumor multifocality (HR 2.96; p = 0.024) were independent risk factors predictive of IVR. CONCLUSION In our study population of patients with UTUC who had undergone RNU the preoperative NLR was associated with a significantly increased risk of IVR, suggesting that the NRL could be a useful biomarker for predicting IVR.
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Affiliation(s)
- Nozomu Kishimoto
- Department of Urology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan
| | - Tetsuya Takao
- Department of Urology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan.
| | - Sohei Kuribayashi
- Department of Urology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan
| | - Gaku Yamamichi
- Department of Urology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan
| | - Kosuke Nakano
- Department of Urology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan
| | - Masataka Kawamura
- Department of Urology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan
| | - Koichi Tsutahara
- Department of Urology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan
| | - Go Tanigawa
- Department of Urology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan
| | - Seiji Yamaguchi
- Department of Urology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan
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Otsuka M, Taguchi S, Nakagawa T, Kawai T, Morikawa T, Miyazaki H, Fujimura T, Fukuhara H, Kume H, Homma Y. Lower ureteral lesion is an independent predictor of intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma. Urol Oncol 2016; 34:59.e9-13. [DOI: 10.1016/j.urolonc.2015.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/11/2015] [Accepted: 08/25/2015] [Indexed: 12/26/2022]
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23
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Yang CY, Tseng JY, Chen CF, Chou TY, Gao HW, Hua CL, Lin CH, Lin JK, Jiang JK. Genome-wide copy number changes and CD133 expression characterized distinct subset of colon polyps: differentiation between incidental polyps and cancer-associated polyps. Int J Colorectal Dis 2015. [PMID: 26206347 DOI: 10.1007/s00384-015-2319-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Colorectal polyps are generally believed to be the precursors of colorectal cancers (CRC); however, the proportion and speed of progression differed widely in different subsets of polyps. Using microarray-based comparative genomic hybridization (aCGH) platform and CD133 immunostaining, we characterized colon polyps according to their association with CRC that developed in the same individual. PATIENTS AND METHODS aCGH was performed to unveil genomic changes in 18 cancer-synchronous polyps (CSP), and 9 cancer-preceding polyps (CPP), together with their corresponding cancers and 16 cases of incidental polyps (IP), were examined for comparison. aCGH profiles were analyzed to determine the clonal relationship (CR) between the paired adenoma and carcinoma. CD133 expressions in each subset of polyps were quantified by immunohistochemistry (IHC) staining. RESULTS Progressive genomic changes were observed from IP, CSP/CPP to CRC; they encompass an entire chromosomal region in IP and sub-chromosomal region in CSP/CPP and CRC. CR analyses demonstrated that 50 % of CSP and 67 % of CPP were clonally related to the concurrent or later developed carcinomas, respectively. The CD133 expression levels were significantly higher in CSP/CPP than those in IP (P < 0.0001) and even higher in CSP/CPP that were clonally related to their corresponding carcinomas than CSP/CPP that were unrelated (P < 0.05). CONCLUSIONS There were more genomic changes in CSP/CPP than IP; more than half of the CSP/CPP were clonally related to the corresponding carcinomas. Genomic changes at sub-chromosomal regions and/or high CD133 expression were associated with CSP/CPP and highlighted their carcinogenic potential.
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Affiliation(s)
- Chih-Yung Yang
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Ju-Yu Tseng
- Institute of Microbiology and Immunology, National Yang-Ming University, Taipei, Taiwan
| | - Chian-Feng Chen
- VYM Genome Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Teh-Ying Chou
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hong-Wei Gao
- Department of Pathology, Tri-Service General Hospital, Taipei, Taiwan
| | - Chia-Ling Hua
- VYM Genome Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Chi-Hung Lin
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.,Institute of Microbiology and Immunology, National Yang-Ming University, Taipei, Taiwan.,VYM Genome Research Center, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jen-Kou Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Pei-Tou, Taipei, 11217, Taiwan
| | - Jeng-Kai Jiang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Pei-Tou, Taipei, 11217, Taiwan.
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24
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Beothe T, Zubakov D, Kovacs G. Homozygous losses detected by array comparative genomic hybridization in multiplex urothelial carcinomas of the bladder. Cancer Genet 2015; 208:434-40. [DOI: 10.1016/j.cancergen.2015.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/05/2015] [Accepted: 05/11/2015] [Indexed: 11/16/2022]
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25
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Yuan H, Mao X, Bai Y, Li H, Liu L, Pu C, Li J, Tang Y, Wei Q, Han P. The effect of intravesical chemotherapy in the prevention of intravesical recurrence after nephroureterectomy for upper tract urothelial carcinoma: a meta-analysis. J Chemother 2015; 27:195-200. [DOI: 10.1179/1973947815y.0000000034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Ureteral involvement and diabetes increase the risk of subsequent bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma. BIOMED RESEARCH INTERNATIONAL 2015; 2015:527976. [PMID: 25874217 PMCID: PMC4385618 DOI: 10.1155/2015/527976] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/04/2015] [Accepted: 03/06/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To investigate the prognostic factors for bladder recurrence after radical nephroureterectomy (RNU) in patients with upper urinary tract urothelial carcinoma (UUT-UC). METHODS From 1994 to 2012, 695 patients with UUT-UC treated with RNU were enrolled in National Taiwan University Medical Center. Among them, 532 patients with no prior bladder UC history were recruited for analysis. We assessed the impact of potentially prognostic factors on bladder recurrence after RNU. RESULTS The median follow-up period was 47.8 months. In the Cox model, ureteral involvement and diabetes mellitus (DM) were significantly associated with a higher bladder recurrence rate in the multivariate analysis (hazard ratio [HR]: 1.838; P = 0.003 and HR: 1.821; P = 0.010, resp.). In the Kaplan-Meier analysis, DM patients with concomitant ureteral UC experienced about a threefold increased risk of bladder recurrence as compared to those without both factors (HR: 3.222; P < 0.001). Patients with either of the two risk factors experienced about a twofold increased risk as compared to those without both factors (with DM, HR: 2.184, P = 0.024; with ureteral involvement, HR: 2.006, P = 0.003). CONCLUSIONS Ureteral involvement and DM are significantly related to bladder recurrence after RNU in patients with UUT-UC.
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Cha EK, Donahue TF, Bochner BH. Radical transurethral resection alone, robotic or partial cystectomy, or extended lymphadenectomy: can we select patients with muscle invasion for less or more surgery? Urol Clin North Am 2015; 42:189-99, viii. [PMID: 25882561 DOI: 10.1016/j.ucl.2015.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Improvements in the accuracy of clinical staging and refinements in patient selection may allow for improved outcomes of bladder-preservation strategies for muscle-invasive bladder cancer incorporating radical transurethral resection (TUR) and partial cystectomy (PC). Retrospective studies of patients treated with radical cystectomy and pelvic lymph node dissection have reported an association between greater extent of lymphadenectomy and improved clinical outcomes. However, there is no consensus regarding the optimal extent of lymphadenectomy, as there are currently no reports from prospective, randomized trials to address this issue in regards to cancer-specific and overall survival. Future advances in the understanding of the appropriate extent of lymphadenectomy requires well-designed prospective clinical trials that directly compare varying extents of surgery with their ability to provide local and distant disease control and disease-specific survival.
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Affiliation(s)
- Eugene K Cha
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 353 East 68th Street, New York, NY 10065, USA
| | - Timothy F Donahue
- Center for Prostate Disease Research, Uniformed Services University, 1530 East Jefferson Street, Rockville, MD 20852, USA; John P. Murthy Cancer Center, Urology Service, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
| | - Bernard H Bochner
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 353 East 68th Street, New York, NY 10065, USA.
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28
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Narukawa T, Hara T, Arai E, Komiyama M, Kawahara T, Kanai Y, Fujimoto H. Tumour multifocality and grade predict intravesical recurrence after nephroureterectomy in patients with upper urinary tract urothelial carcinoma without a history of bladder cancer. Jpn J Clin Oncol 2015; 45:488-93. [PMID: 25681388 DOI: 10.1093/jjco/hyv019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 01/21/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Patients with upper urinary tract urothelial carcinoma (UUT-UC) without a history of bladder cancer have a different natural history of intravesical recurrence after nephroureterectomy compared with those with a history of bladder cancer. The aim of this study was to identify predictive factors for post-operative intravesical recurrence in patients with non-metastatic upper urinary tract-localized urothelial carcinoma without a history of bladder cancer and who were not taking medication during the perioperative period. METHODS This retrospective study included 133 patients who were treated between 1995 and 2012. Univariate and multivariate analyses were used to evaluate the clinical and pathological factors associated with the cumulative incidence of bladder cancer. RESULTS Of the 133 patients, 51 (38.3%) developed intravesical recurrence during a median follow-up of 71 months (range, 0.8-210.8). In the multivariate analysis, multifocality (P = 0.03) and high tumour grade (P = 0.007) were significantly associated with the cumulative incidence of bladder cancer. We constructed a prediction classification model on the basis of the total number of risk factors. The 2-year cumulative incidence rates were 5.6, 34.8 and 50.0% in individuals with no, one and two risk factors, respectively. There was a significant difference between patients with no risk factors and those with two risk factors (P = 0.01). CONCLUSIONS Although this retrospective study had several limitations, tumour multifocality and tumour grade were found to be potential risk factors for intravesical recurrence in our cases.
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Affiliation(s)
| | - Tomohiko Hara
- Urology Division, National Cancer Center Hospital, Tokyo
| | - Eri Arai
- Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan
| | | | | | - Yae Kanai
- Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan
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Management of transitional cell carcinoma of the urinary bladder in dogs: a review. Vet J 2015; 205:217-25. [PMID: 25747698 DOI: 10.1016/j.tvjl.2015.01.017] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 12/16/2014] [Accepted: 01/19/2015] [Indexed: 01/13/2023]
Abstract
Transitional cell carcinoma (TCC), also referred to as urothelial carcinoma, is the most common form of urinary bladder cancer in dogs, affecting tens of thousands of dogs worldwide each year. Canine TCC is usually a high grade invasive cancer. Problems associated with TCC include urinary tract obstruction, distant metastases in >50% of affected dogs, and clinical signs that are troubling both to the dogs and to their owners. Risk factors for TCC include exposure to older types of flea control products and lawn chemicals, obesity, female sex, and a very strong breed-associated risk. This knowledge is allowing pet owners to take steps to reduce the risk of TCC in their dog. The diagnosis of TCC is made by histopathology of tissue biopsies obtained by cystoscopy, surgery, or catheter. Percutaneous aspirates and biopsies should be avoided due to the risk of tumor seeding. TCC is most commonly located in the trigone region of the bladder precluding complete surgical resection. Medical treatment is the mainstay for TCC therapy in dogs. Although TCC is not usually curable in dogs, multiple drugs have activity against it. Approximately 75% of dogs respond favorably to TCC treatment and can enjoy several months to a year or more of good quality life. Many promising new therapies for TCC are emerging and with the close similarity between TCC in dogs and high grade invasive bladder cancer in humans, new treatment strategies found to be successful in canine studies are expected to help dogs and to be subsequently translated to humans.
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30
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Ishioka J, Saito K, Kijima T, Nakanishi Y, Yoshida S, Yokoyama M, Matsuoka Y, Numao N, Koga F, Masuda H, Fujii Y, Sakai Y, Arisawa C, Okuno T, Nagahama K, Kamata S, Sakura M, Yonese J, Morimoto S, Noro A, Tsujii T, Kitahara S, Gotoh S, Higashi Y, Kihara K. Risk stratification for bladder recurrence of upper urinary tract urothelial carcinoma after radical nephroureterectomy. BJU Int 2015; 115:705-12. [PMID: 24612074 DOI: 10.1111/bju.12707] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To identify risk factors and develop a model for predicting recurrence of upper urinary tract urothelial carcinoma (UTUC) in the bladder in patients without a history of bladder cancer after radical nephroureterectomy (RNU). PATIENTS AND METHODS We retrospectively reviewed 754 patients with UTUC without prior or concurrent bladder cancer or distant metastasis at 13 institutions in Japan. Univariate and multivariate Fine and Gray competing risks proportional hazards models were used to examine the cumulative incidence of bladder recurrence of UTUC. A risk stratification model and a nomogram were constructed. Two prediction models were compared using the concordance index (c-index) focusing on predictive accuracy and decision-curve analysis, which indicate whether a model is appropriate for decision-making and determining subsequent patient prognosis. RESULTS The cumulative incidence rates of bladder UTUC recurrence at 1 and 5 years were 15 and 29%, respectively; the median time to bladder UTUC recurrence was 10 months. Multivariate analysis showed that papillary tumour architecture, absence of lymphovascular invasion and higher pathological T stage were both predictive factors for bladder cancer recurrence. The predictive accuracy of the risk stratification model and the nomogram for bladder cancer recurrence were not different (c-index: 0.60 and 0.62). According to the decision-curve analysis, the risk stratification was an acceptable model because the net benefit of the risk stratification was equivalent to that of the nomogram. The overall cumulative incidence rates of bladder cancer 5 years after RNU were 10, 26 and 44% in the low-, intermediate- and high-risk groups, respectively. CONCLUSIONS We identified risk factors and developed a risk stratification model for UTUC recurrence in the bladder after RNU. This model could be used to provide both an individualised strategy to prevent recurrence and a risk-stratified surveillance protocol.
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Affiliation(s)
- Junichiro Ishioka
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
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Takaoka EI, Miyazaki J, Kimura T, Kojima T, Kawai K, Murata Y, Itoguchi N, Minami Y, Nakamura T, Honda K, Nishiyama H. Concurrent Urothelial Carcinoma in the Renal Pelvis of an Allograft Kidney and Native Recipient Bladder: Evidence of Donor Origin. Jpn J Clin Oncol 2014; 44:366-9. [DOI: 10.1093/jjco/hyu015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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32
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Tanaka N, Kikuchi E, Kanao K, Matsumoto K, Shirotake S, Kobayashi H, Miyazaki Y, Ide H, Obata J, Hoshino K, Hayakawa N, Kosaka T, Oyama M, Miyajima A, Momma T, Nakagawa K, Jinzaki M, Nakajima Y, Oya M. The predictive value of positive urine cytology for outcomes following radical nephroureterectomy in patients with primary upper tract urothelial carcinoma: a multi-institutional study. Urol Oncol 2013; 32:48.e19-26. [PMID: 24055429 DOI: 10.1016/j.urolonc.2013.07.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 06/02/2013] [Accepted: 07/01/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Few studies have addressed the predictive value of positive urine cytology for prognosis in patients with upper tract urothelial carcinoma (UTUC). We investigated whether the status of preoperative urine cytology could provide additional prognostic information following radical nephroureterectomy (RNU). MATERIALS AND METHODS The study included 474 patients with primary nonmetastatic UTUC (pTa-4N0M0) from a retrospective multi-institutional cohort. The median follow-up period was 35 months. Associations between the status of urine cytologic evaluation and outcomes were analyzed using multivariate Cox regression models. Urine cytology was evaluated preoperatively using voided samples. Disease recurrence was defined as any relapse in nonbladder lesions and was coded separately from intravesical recurrence. RESULTS Positive urine cytology was detected in 184 patients (38.8%) preoperatively. Disease recurrence occurred in 127 patients, while intravesical recurrence occurred in 219 patients; 83 patients died of UTUC during follow-up. Kaplan-Meier analysis revealed that only the incidence of intravesical recurrence was significantly associated with the status of urine cytologic evaluation (P = 0.024); the intravesical recurrence-free survival rates at 1 and 3 years following RNU were 61.4% and 46.2% in patients with positive urine cytology and 71.1% and 51.6% in their counterparts, respectively. Multivariate analysis showed that gender (hazard ratio [HR] = 1.74, 95% confidence interval [CI]; 1.28-2.43), tumor multifocality in RNU specimens (HR = 1.64, 95% CI; 1.09-2.47), and positive urine cytology (HR = 1.41, 95% CI; 1.08-1.85) were independent risk factors for subsequent intravesical recurrence. CONCLUSIONS The results showed the prognostic value of positive urine cytology in patients with primary UTUC, and preoperative positive urine cytology may be associated with a significant increase in the prevalence of intravesical recurrence following RNU.
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Affiliation(s)
- Nobuyuki Tanaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Musashino Yowakai Hospital, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.
| | - Kent Kanao
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuhiro Matsumoto
- Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Saiseikai Central Hospital, Tokyo, Japan
| | - Suguru Shirotake
- Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, International Medical Center-Comprehensive Cancer Center, Saitama Medical University, Saitama, Japan
| | - Hiroaki Kobayashi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Kyosai Tachikawa Hospital, Tokyo, Japan
| | - Yasumasa Miyazaki
- Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Ogikubo Hospital, Tokyo, Japan
| | - Hiroki Ide
- Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Saitama City Hospital, Saitama, Japan
| | - Jun Obata
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Katsura Hoshino
- Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Nozomi Hayakawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Saiseikai Central Hospital, Tokyo, Japan
| | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Irumagawa Hospital, Saitama, Japan
| | - Masafumi Oyama
- Department of Urology, International Medical Center-Comprehensive Cancer Center, Saitama Medical University, Saitama, Japan
| | - Akira Miyajima
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Tetsuo Momma
- Department of Urology, National Hospital Organization, Saitama Hospital, Saitama, Japan
| | - Ken Nakagawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yosuke Nakajima
- Department of Urology, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Ito A, Shintaku I, Satoh M, Ioritani N, Tochigi T, Numata I, Namima T, Kambe K, Kyan A, Ueno S, Katoh S, Adachi H, Yamashita S, Yamaguchi T, Arai Y, Aizawa M, Kawamura S, Aoki H, Takeda A, Namiki S, Ikeda Y, Tokuyama S. Intravesical Seeding of Upper Urinary Tract Urothelial Carcinoma Cells During Nephroureterectomy: An Exploratory Analysis from the THPMG Trial. Jpn J Clin Oncol 2013; 43:1139-44. [DOI: 10.1093/jjco/hyt129] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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34
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Ito A, Shintaku I, Satoh M, Ioritani N, Aizawa M, Tochigi T, Kawamura S, Aoki H, Numata I, Takeda A, Namiki S, Namima T, Ikeda Y, Kambe K, Kyan A, Ueno S, Orikasa K, Katoh S, Adachi H, Tokuyama S, Ishidoya S, Yamaguchi T, Arai Y. Prospective Randomized Phase II Trial of a Single Early Intravesical Instillation of Pirarubicin (THP) in the Prevention of Bladder Recurrence After Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma: The THP Monotherapy Study Group Trial. J Clin Oncol 2013; 31:1422-7. [DOI: 10.1200/jco.2012.45.2128] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose We evaluated the efficacy of a single early intravesical instillation of pirarubicin (THP) in the prevention of bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma (UUT-UC). Patients and Methods From December 2005 to November 2008, 77 patients clinically diagnosed with UUT-UC from 11 institutions participating in the Tohoku Urological Evidence-Based Medicine Study Group were preoperatively enrolled in this study. Patients were randomly assigned to receive or not receive a single instillation of THP (30 mg in 30 mL of saline) into the bladder within 48 hours after nephroureterectomy. Cystoscopy and urinary cytology were repeated every 3 months for 2 years or until the occurrence of first bladder recurrence. Results Seventy-two patients were evaluable for efficacy analysis, 21 of whom had a subsequent bladder recurrence. Significantly fewer patients who received THP had a recurrence compared with the control group (16.9% at 1 year and 16.9% at 2 years in the THP group v 31.8% at 1 year and 42.2% at 2 years in the control group; log-rank P = .025). No remarkable adverse events were observed in the THP-treated group. Based on multivariate analysis, THP instillation (hazard rate [HR], 0.26; 95% CI, 0.07 to 0.91; P = .035) and open surgery (HR, 0.28; 95% CI, 0.09 to 0.84; P = .024) were independently predictive of a reduced incidence of bladder recurrence. Conclusion In this prospective randomized phase II study, a single intravesical instillation of THP seemed to reduce bladder recurrence after nephroureterectomy. A phase III, large-scale, multicenter study is needed to confirm these observations.
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Affiliation(s)
- Akihiro Ito
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Ichiro Shintaku
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Makoto Satoh
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Naomasa Ioritani
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Masataka Aizawa
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Tatsuo Tochigi
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Sadafumi Kawamura
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Hiroshi Aoki
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Isao Numata
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Atsushi Takeda
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Shunichi Namiki
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Takashige Namima
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Yoshihiro Ikeda
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Koichi Kambe
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Atsushi Kyan
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Seiji Ueno
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Kazuhiko Orikasa
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Shinnosuke Katoh
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Hisanobu Adachi
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Satoru Tokuyama
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Shigeto Ishidoya
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Takuhiro Yamaguchi
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
| | - Yoichi Arai
- Akihiro Ito, Ichiro Shintaku, Kazuhiko Orikasa, Shigeto Ishidoya, Takuhiro Yamaguchi, and Yoichi Arai, Tohoku University Graduate School of Medicine; Naomasa Ioritani and Masataka Aizawa, Sendai Shakai Hoken Hospital; Takashige Namima and Yoshihiro Ikeda, Tohoku Rosai Hospital, Sendai; Makoto Satoh, Sen-en General Hospital, Tagajo; Tatsuo Tochigi, Sadafumi Kawamura, and Hiroshi Aoki, Miyagi Cancer Center, Natori; Isao Numata, Atsushi Takeda, and Shunichi Namiki, Osaki Citizen Hospital, Osaki; Koichi
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RUNX3 methylation in normal surrounding urothelium of patients with non-muscle-invasive bladder cancer: Potential role in the prediction of tumor progression. Eur J Surg Oncol 2012; 38:1095-100. [DOI: 10.1016/j.ejso.2012.07.116] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 06/06/2012] [Accepted: 07/19/2012] [Indexed: 12/15/2022] Open
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Friedrich MG, Schwaibold H, Wintzer O, Pichlmeier U, Huland H. p53 in noncancerous bladder mucosa as a marker of disease recurrence in patients with superficial transitional cell carcinoma of the bladder. Urol Oncol 2012; 3:125-31. [PMID: 21227117 DOI: 10.1016/s1078-1439(98)00018-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We investigated the prevalence and clinical relevance of p53 nuclear overexpression in histologically benign bladder mucosa in patients with superficial transitional cell cancer (TCC) of the bladder to look for "premalignant" lesions as the source of tumor recurrence. p53 Accumulation in representative tumor and normal-looking bladder mucosa was studied in 53 patients with Ta and T1 TCC. Histologically normal bladder specimens from 20 prostate cancer patients served as controls. We used a biotin streptavidine-peroxidase system to stain deparaffinized tissue sections with the p53 monoclonal antibody DO7. Specimens from 42 (79%) of the 53 TCC patients stained for p53 in the tumor area. There was no statistically significant difference between pTa and pT1 lesions (pTa, 71.4%; pT1, 87.5%), and staining correlated weakly with tumor grade (G1, 62%; G2, 82%; G3, 100%). Evaluation of histologically normal bladder mucosa showed positive p53 staining in 13 (24.5%) of the 53 patients. Disease recurred in 20 patients. Among them, 12 had positive staining in the normal bladder mucosa. Although p53 expression in tumor areas showed only slight correlation with tumor recurrence (p = 0.043, Cochran-Armitage test), p53 accumulation in healthy bladder mucosa correlated strongly with disease recurrence (p < 0.0001, Fisher's exact test). p53 Overexpression in histologically normal bladder mucosa in patients with TCC might identify premalignant alterations in tumor-surrounding areas. Our data suggest that p53 accumulation in histologically benign bladder mucosa of TCC patients is a possible marker of disease recurrence.
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Affiliation(s)
- M G Friedrich
- Clinic of Urology, University of Hamburg, Hamburg, Germany
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Rouprêt M, Colin P. Urothelial carcinomas of the upper urinary tract are now recognised as a true and distinct entity from bladder cancer and belong fully to the broad spectrum of onco-urologic neoplasms. World J Urol 2012; 31:1-3. [DOI: 10.1007/s00345-012-0958-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 09/18/2012] [Indexed: 10/27/2022] Open
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HIRATA TAKESHI, WATANABE MASAMI, KAKU HARUKI, KOBAYASHI YASUYUKI, YAMADA HIROSHI, SAKAGUCHI MASAKIYO, TAKEI KOHJI, HUH NAMHO, NASU YASUTOMO, KUMON HIROMI. REIC/Dkk-3-encoding adenoviral vector as a potentially effective therapeutic agent for bladder cancer. Int J Oncol 2012; 41:559-64. [DOI: 10.3892/ijo.2012.1503] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 03/21/2012] [Indexed: 11/06/2022] Open
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Kim KH, You D, Jeong IG, Hong JH, Ahn H, Kim CS. Muscle-invasive bladder cancer developing after nephroureterectomy for upper urinary tract urothelial carcinoma. Urol Oncol 2012; 31:1643-9. [PMID: 22591745 DOI: 10.1016/j.urolonc.2012.04.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 04/16/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To evaluate the risk factors and prognosis of muscle-invasive bladder cancer (MIBC) developing after nephroureterectomy for upper urinary tract urothelial cell carcinoma (UUT-UC). MATERIALS AND METHODS We reviewed the medical records of 422 patients who underwent nephroureterectomy for UUT-UC between 1990 and 2010, and identified 173 (40.9%) with intravesical recurrence and 28 (6.6%) with MIBC. We evaluated the clinicopathologic features, risk factors, and cancer-specific survival (CSS) using the Kaplan-Meier method and the Cox proportional hazards regression models. RESULTS The median intervals from nephroureterectomy to intravesical recurrence and the development of MIBC were 8 and 17 months, respectively. On multivariate analysis, the pathologic stage (≥ pT3 vs. Ta/T1, HR 5.03, P = 0.001) and ureteral tumor location (HR 2.79, P = 0.011) were independent risk factors for the development of MIBC, whereas a history of previous or concomitant bladder tumor was the only significant risk factor for intravesical recurrence. The probability of developing MIBC 5 years after nephroureterectomy was 12.6% in patients with 1 risk factor and 20.6% in patients with both risk factors. Patients with MIBC had significantly worse CSS than those without MIBC (P = 0.004), whereas CSS rates were similar in patients with and without intravesical recurrence (P = 0.593). However, stratification analysis for matching pathology revealed that CSS rates were not significantly different in patients with pT2 or higher stage of UUT-UC. CONCLUSIONS Approximately 5% of the patients developed MIBC after nephroureterectomy with a median interval of 17 months. Patients with advanced pathologic stage (≥ pT3) and a ureteral tumor location are at increased risk of developing MIBC after nephroureterectomy.
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Affiliation(s)
- Kwang Hyun Kim
- Department of Urology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
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Cosentino M, Palou J, Gaya JM, Breda A, Rodriguez-Faba O, Villavicencio-Mavrich H. Upper urinary tract urothelial cell carcinoma: location as a predictive factor for concomitant bladder carcinoma. World J Urol 2012; 31:141-5. [PMID: 22552732 DOI: 10.1007/s00345-012-0877-2] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 04/16/2012] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE To investigate the existence of predictive factors for concomitant, primary UUT-UCC and BC. Upper urinary tract urothelial cell carcinoma (UUT-UCC) is a pan-urothelial disease of the transitional epithelial cells. Although several studies have shown the association of bladder recurrence following UUT-UCC, little is known on the incidence of concomitant UUT-UCC and bladder cancer (BC) without previous BC. MATERIALS AND METHODS A retrospective review of 673 patients diagnosed and treated for UUT-UCC was performed. Patients with history of BC were excluded. We investigated age, sex, location of the upper tract tumor (calyx, renal pelvis, upper ureter, mid-ureter, lower ureter), multifocality, clinical symptoms, tumor grade and pathological stage. Contingency tables and chi-square test were used for categorical variables and analysis of variance (ANOVA) for quantitative variables. RESULTS 450 patients eligible for inclusion were identified. Of these, 76 (17 %) presented concomitant primary UUT-UCC and BC. Location of primary UUT-UCC was in calyx and/or renal pelvis in 25 patients (34 %), upper ureter 8 (11 %) and lower ureter 37 (49 %). In 6 patients (8 %), data were missing. Concomitant BC was found in 10, 18, and 33 % of patients with primary caliceal/renal pelvis, upper ureter and lower ureter UUT-UCC, respectively. On multivariate analysis, location of UUT-UCC was the only predictive factor for concomitant bladder tumor (OR: 1.7; 95 % CI, 1.007-2.906 p = 0.047). CONCLUSIONS Our findings suggest that the possibility of concomitant BC in primary diagnosed patient with UUT-UCC is as high as 33 % and mainly depends on upper tract tumor location.
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Affiliation(s)
- Marco Cosentino
- Urology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, c/Cartagena 340, 08025, Barcelona, Spain.
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Nishiyama N, Arai E, Chihara Y, Fujimoto H, Hosoda F, Shibata T, Kondo T, Tsukamoto T, Yokoi S, Imoto I, Inazawa J, Hirohashi S, Kanai Y. Genome-wide DNA methylation profiles in urothelial carcinomas and urothelia at the precancerous stage. Cancer Sci 2010; 101:231-40. [PMID: 19775289 PMCID: PMC11159941 DOI: 10.1111/j.1349-7006.2009.01330.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
To clarify genome-wide DNA methylation profiles during multistage urothelial carcinogenesis, bacterial artificial chromosome (BAC) array-based methylated CpG island amplification (BAMCA) was performed in 18 normal urothelia obtained from patients without urothelial carcinomas (UCs) (C), 17 noncancerous urothelia obtained from patients with UCs (N), and 40 UCs. DNA hypo- and hypermethylation on multiple BAC clones was observed even in N compared to C. Principal component analysis revealed progressive DNA methylation alterations from C to N, and to UCs. DNA methylation profiles in N obtained from patients with invasive UCs were inherited by the invasive UCs themselves, that is DNA methylation alterations in N were correlated with the development of more malignant UCs. The combination of DNA methylation status on 83 BAC clones selected by Wilcoxon test was able to completely discriminate N from C, and diagnose N as having a high risk of carcinogenesis, with 100% sensitivity and specificity. The combination of DNA methylation status on 20 BAC clones selected by Wilcoxon test was able to completely discriminate patients who suffered from recurrence after surgery from patients who did not. The combination of DNA methylation status for 11 BAC clones selected by Wilcoxon test was able to completely discriminate patients with UCs of the renal pelvis or ureter who suffered from intravesical metachronous UC development from patients who did not. Genome-wide alterations of DNA methylation may participate in urothelial carcinogenesis from the precancerous stage to UC, and DNA methylation profiling may provide optimal indicators for carcinogenetic risk estimation and prognostication.
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Affiliation(s)
- Naotaka Nishiyama
- Pathology Division, National Cancer Center Research Institute, Tokyo, Japan
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pcDNA3.1tdTomato Is Superior to pDsRed2-N1 for Optical Fluorescence Imaging in the F344/AY-27 Rat Model of Bladder Cancer. Mol Imaging Biol 2009; 12:509-19. [DOI: 10.1007/s11307-009-0275-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 05/28/2009] [Accepted: 10/08/2009] [Indexed: 10/20/2022]
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Azémar MD, Comperat E, Richard F, Cussenot O, Rouprêt M. Bladder recurrence after surgery for upper urinary tract urothelial cell carcinoma: frequency, risk factors, and surveillance. Urol Oncol 2009; 29:130-6. [PMID: 19762256 DOI: 10.1016/j.urolonc.2009.06.003] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Revised: 06/10/2009] [Accepted: 06/11/2009] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To highlight the main risk factors for metachronous bladder recurrence after treatment of an upper urinary tract urothelial cell carcinomas (UUT-UCCs) based on the recent literature. MATERIALS AND METHODS Data on urothelial malignancies after UUT-UCCs management in the literature were searched using MEDLINE and by matching the following key words: urinary tract cancer; bladder carcinomas, urothelial carcinomas, upper urinary tract, renal pelvis, ureter prognosis, carcinoma, transitional cell, renal pelvis, ureter, bladder cancer, cystectomy, nephroureterectomy, minimally invasive surgery, recurrence, and survival. RESULTS No evidence level 1 information from prospective randomized trials was available. A range of 15% to 50% of patients with a UUT-UCC will subsequently develop a metachronous bladder UCC. Intraluminal tumor seeding and pan-urothelial field change effect have both been proposed to explain intravesical recurrences. In most cases, bladder cancer arises in the first 2 years after UUT-UCC management. However the risk is lifelong and repeat episodes are common. The identification of variables that allow accurate risk stratification of UUT-UCC patients with regards to future bladder relapse is disappointing. No factors have been identified to date that can reliably predict bladder recurrences. A history of bladder cancer prior to UUT-UCC management and upper tract tumor multifocality are the only frequently reported clinical risk factors among current literature. CONCLUSION Prior histories of bladder cancer and upper tract tumor multifocality are the most frequently reported risk factors for bladder tumors following UUT-UCCs. Surveillance regimen is based on cystoscopy and on urinary cytology for at least 5 years.
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Affiliation(s)
- Marie-Dominique Azémar
- Department of Urology, Pitié-Salpêtrière and Tenon Hospitals, GHU Est, AP-HP, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
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[Primary upper urinary tract tumors and subsequent location in the bladder]. Prog Urol 2009; 19:583-8. [PMID: 19800544 DOI: 10.1016/j.purol.2009.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Accepted: 03/30/2009] [Indexed: 11/20/2022]
Abstract
The urothelium is the epithelium that lines the upper and lower urinary tract. Over 95% of urothelial carcinomas are derived from urothelium. They can be located in the lower tract (bladder, urethra) or upper tract (pyelocaliceal cavities, ureter). Urothelial carcinomas are the fourth most common tumours after prostate (or breast) cancer, lung cancer and colorectal cancer. On one hand, bladder tumours account for 90-95% of urothelial carcinomas. It is the most common malignancy of the urinary tract and the second most common malignancy of the urogenital tract after prostate cancer. It accounts for 5-10% of all cancers diagnosed each year in Europe. On the other hand, upper urinary tract urothelial cell carcinomas (UUT-UCC) are scarce and account for only 5-10% of urothelial carcinomas. Recurrence in the bladder after primary UUT-UCC occurs in 15-50% of UUT-UCC. Differences in treatment modalities of the primary UUT-UCC do not play a key role in the subsequent appearance of a bladder recurrence. However, others factors have been described such as stage and location in the upper tract of the primary tumour or upper tract tumour multifocality. Previous history of bladder tumour is also associated with the risk that another tumour arises in the bladder subsequently. However, it becomes difficult to distinguish between natural history of bladder tumour and evolution of UUT-UCC in these cases. In most cases, bladder cancer occurs in the first two years after UUT-UCC management. Surveillance protocol is based on cystoscopy and on urinary cytology during at least every three months for two years. Current surveillance regimen have a low level of evidence considering the paucity of UUT-UCC.
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Ham WS, Kim WT, Jeon HJ, Lee DH, Choi YD. Long-Term Outcome of Simultaneous Transurethral Resection of Bladder Tumor and Prostate in Patients With Nonmuscle Invasive Bladder Tumor and Bladder Outlet Obstruction. J Urol 2009; 181:1594-9; discussion 1599. [DOI: 10.1016/j.juro.2008.11.099] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Won Sik Ham
- Departments of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Tae Kim
- Departments of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Jin Jeon
- Departments of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hoon Lee
- Departments of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Departments of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Maddineni SB, Clarke NW, Sutherland DE, Jarrett TW. Aetiology, diagnosis and management of urothelial tumours of the renal pelvis and ureter. BJU Int 2008; 102:1302-6. [DOI: 10.1111/j.1464-410x.2008.07974.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Genomic imbalances in urothelial cancer: intratumor heterogeneity versus multifocality. ACTA ACUST UNITED AC 2008; 17:134-40. [PMID: 18382360 DOI: 10.1097/pdm.0b013e31815ce4e6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Comparative genomic hybridization and fluorescence in situ hybridization were used to define genetic changes associated with multifocal bladder cancer and to investigate whether the genetic relationship between synchronous urothelial tumors is similar to that observed within different parts of the same tumor. We investigated 8 synchronous urothelial tumors from 3 patients and macroscopically different parts of the same tumor from 2 other patients. The most frequent imbalances were gains of 1q, 2p, and 17q, and losses in 4q. The high number of chromosome imbalances detected in the present report confirms that a high level of chromosome instability could be characteristic of multicentric bladder tumors. Comparative genomic hybridization profiles obtained from independent tumors belonging to the same patient allowed us to elaborate cytogenetic pedigrees portraying the accumulation of chromosome alterations as a form of clonal evolution from a single precursor cell. The analysis of different macroscopic parts of the same tumor allowed us to detect chromosomal heterogeneity and to delineate intratumor clonal evolution. Some chromosome regions that appeared as a gain in one subpopulation were amplified in others indicating a genetic evolution process. Identical processes were observed in different tumors of the same patient. Expansion of chromosome gains and losses between different parts of the same tumor as well as in different tumors of the same patient was also observed. Our results not only provide further evidence of a clonal relationship between different synchronous bladder tumors but also show that the intratumor heterogeneity present in different subpopulations of the same tumor reproduces the behavior of independent synchronous tumors in a same patient.
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Ham WS, Kim WT, Jeon HJ, Lee DH, Choi YD. The Significance of Simultaneous Transurethral Resection of Bladder Tumor and the Prostate in Patient who have Superficial Bladder Cancer with Bladder Outlet Obstruction. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.9.791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Won Sik Ham
- Department of Urology and the Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Tae Kim
- Department of Urology and the Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Jin Jeon
- Department of Urology and the Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hoon Lee
- Department of Urology and the Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology and the Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Rouprêt M. Anatomical location of urothelial carcinomas of the urinary tract leads to perspectives of specific treatment. Future Oncol 2007; 3:595-9. [DOI: 10.2217/14796694.3.6.595] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Morgan Rouprêt
- Academic Urology Department, Hopital Pitié, Assistance Publique Hôpitaux de Paris, University Paris 6, 47–83 bvd de l’Hopital, 75013 Paris, France
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Wang P, Luo JD, Wu WF, Wang S, Cai SL, Shen BH, Shi SF, Wei KX, Zhang ZG, Chen ZD. Multiple factor analysis of metachronous upper urinary tract transitional cell carcinoma after radical cystectomy. Braz J Med Biol Res 2007; 40:979-84. [PMID: 17653452 DOI: 10.1590/s0100-879x2006005000104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Accepted: 02/02/2007] [Indexed: 11/22/2022] Open
Abstract
Transitional cell carcinoma (TCC) of the urothelium is often multifocal and subsequent tumors may occur anywhere in the urinary tract after the treatment of a primary carcinoma. Patients initially presenting a bladder cancer are at significant risk of developing metachronous tumors in the upper urinary tract (UUT). We evaluated the prognostic factors of primary invasive bladder cancer that may predict a metachronous UUT TCC after radical cystectomy. The records of 476 patients who underwent radical cystectomy for primary invasive bladder TCC from 1989 to 2001 were reviewed retrospectively. The prognostic factors of UUT TCC were determined by multivariate analysis using the COX proportional hazards regression model. Kaplan-Meier analysis was also used to assess the variable incidence of UUT TCC according to different risk factors. Twenty-two patients (4.6%). developed metachronous UUT TCC. Multiplicity, prostatic urethral involvement by the bladder cancer and the associated carcinoma in situ (CIS) were significant and independent factors affecting the occurrence of metachronous UUT TCC (P = 0.0425, 0.0082, and 0.0006, respectively). These results were supported, to some extent, by analysis of the UUT TCC disease-free rate by the Kaplan-Meier method, whereby patients with prostatic urethral involvement or with associated CIS demonstrated a significantly lower metachronous UUT TCC disease-free rate than patients without prostatic urethral involvement or without associated CIS (log-rank test, P = 0.0116 and 0.0075, respectively). Multiple tumors, prostatic urethral involvement and associated CIS were risk factors for metachronous UUT TCC, a conclusion that may be useful for designing follow-up strategies for primary invasive bladder cancer after radical cystectomy.
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Affiliation(s)
- P Wang
- Department of Urology, The First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, Zhejiang Province, China
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