An Analysis of Staging and Treatment Trends for Upper Tract Urothelial Carcinoma in the National Cancer Database

Browne, Brendan; Stensland, Kristian; Moynihan, Matthew; Canes, David

doi:10.1016/j.clgc.2018.01.015

Cited by 46 publications

(35 citation statements)

References 24 publications

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“…RNU still remains the gold standard, but from 2004 to 2014, its use in the USA decreased by 2.9%, whereas endourological management increased by 1.7% reaching an overall of 11% of treatments. 13 In the present cohort, 3% of cases were endourological. Notably, an increase in the adoption of endourological treatment of UTUC in the past decade corresponded to a higher interest from the scientific community.…”

Section: Discussionmentioning

confidence: 50%

“…Indeed, a recent population‐based analysis showed a clinical trend in favor of endoscopic treatment for UTUC. RNU still remains the gold standard, but from 2004 to 2014, its use in the USA decreased by 2.9%, whereas endourological management increased by 1.7% reaching an overall of 11% of treatments 13 . In the present cohort, 3% of cases were endourological.…”

Section: Discussionmentioning

confidence: 60%

“…Notably, an increase in the adoption of endourological treatment of UTUC in the past decade corresponded to a higher interest from the scientific community 14 . If endourological approaches were mostly carried out for renal pelvis tumors, indications have more recently expended to tumors with ureteral location, and it can be postulated this trend was driven by improved technology allowing better endoscopic visualization 13 . Nevertheless, SU represented most (93%) of the KSS procedure in the ureteral tumors group.…”

Section: Discussionmentioning

confidence: 99%

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Ureteral location is associated with survival outcomes in upper tract urothelial carcinoma: A population‐based analysis

et al. 2020

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Objectives: To evaluate the prognostic value of tumor location in patients with upper tract urothelial carcinoma. Methods: Within the Surveillance, Epidemiology and End Results Incidence Database, 6619 upper tract urothelial carcinoma cases were identified, including 3719 confined to the renal pelvis and 2971 to the ureter. Predictors of surgical technique (kidney sparing surgery versus radical nephroureterectomy), as well as 2-and 5-year cancer-specific survival and overall survival were evaluated. Results: Median follow-up time was 29 months (interquartile range 0-126 months) for both groups. Multivariate logistic analysis showed tumor dimension as the only factor associated with radical nephroureterectomy (odds ratio 1.02; P < 0.001). Ureteral 2-and 5-year overall survival were lower (log-rank P = 0.001) compared with renal pelvis. When stratifying tumor location according to dimensions, a ureteral carcinoma >3 cm was associated with the worst 2-and 5-year cancer-specific mortality (Pepe-Mori P < 0.001), and overall survival (log-rank P < 0.001). The 2-and 5-year cancer-specific mortality (Pepe-Mori P < 0.001) and overall survival were the worst for ureteral ≥T3 tumors (log-rank P < 0.001). The 2-and 5-year cancer-specific mortality (Pepe-Mori P < 0.001) and overall survival (log-rank P < 0.001) were the worst for ureteral grade III-IV cancers. Ureteral tumor location (subdistribution hazard ratio 1.18, P < 0.001), tumor dimension ≥3 (subdistribution hazard ratio 1.25, P < 0.001), T staging (T2-4 all P < 0.001), grading (grade III subdistribution hazard ratio 2.20, P = 0.001; grade IV subdistribution hazard ratio 2.39, P < 0.001) were found to be associated with higher cancer mortality. Conclusions: Ureteral tumor location in upper tract urothelial carcinoma seems to be associated with worse oncological outcomes, especially in the case of advanced disease. Although the type of surgical treatment does not seem to impact survival, surgeons should use caution in adopting a kidney-sparing surgery for patients with ureteral upper tract urothelial carcinoma.

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

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Ureteral location is associated with survival outcomes in upper tract urothelial carcinoma: A population‐based analysis

et al. 2020

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“…It is not possible to state if the selection process identified more high-grade than lowgrade cases or if UTUC patients had an eventual prevalence of high-grade case histologies. 2 The third is that almost 50% of renal pelvis tumors and 36% of ureteral tumors have a pT category greater than pT2. This finding, again, might indicate how UTUC is still diagnosed late, and both cancer-specific and overall mortality are highly affected by stage, especially for ureteral tumors, as outlined by the authors, oralternativelyhigher-stage disease eventually distinguishes UTUC patients.…”

mentioning

confidence: 99%

“…Second, the vast majority of UTUC were high‐grade disease. It is not possible to state if the selection process identified more high‐grade than low‐grade cases or if UTUC patients had an eventual prevalence of high‐grade case histologies 2 . The third is that almost 50% of renal pelvis tumors and 36% of ureteral tumors have a pT category greater than pT2.…”

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confidence: 99%

Editorial Comment to Ureteral location is associated with survival outcomes in upper tract urothelial carcinoma: A population‐based analysis

Nazzani

Nicolai

2020

Int J of Urology

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Metastatic upper tract urothelial carcinoma with nest‐like features presenting as malignant pleural effusion

Arienzo,

Valenti,

Ricci

et al. 2024

Diagnostic Cytopathology

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Metastatic urothelial carcinoma is a rare cause of pleural effusions. We report a case of urothelial carcinoma of the upper urinary tract in an oldest‐old male patient, a smoker, with situs inversus totalis, that presented uniquely with malignant pleural effusion at presentation without evidence of a primary tumor on imaging. Cytological smears of the massive left pleural effusion revealed epithelioid neoplastic cells arranged in short cords, small‐to‐large clusters, and raspberry‐like morules, mimicking mesothelioma; cell block preparations highlighted the presence of tubules and nest‐like structures. The tumor cells showed a high nuclear‐to‐cytoplasmic ratio, nuclear grooves, and mitotic figures. Cytomorphologic features coupled with the immunophenotype of neoplastic cells (p63, GATA3, and uroplakin II positive) allowed the diagnosis of metastatic urothelial carcinoma and a possible nested subtype. These findings were supported by a total body computed tomography (CT) showing no evidence of a mass in the bladder or elsewhere in the urinary tract but a concentric parietal thickening of the proximal left ureter, suggesting malignancy. To our knowledge, a malignant effusion as a primary manifestation of urothelial carcinoma with nest‐like features originating in the upper urinary tract has never been described previously. Our case focuses on the value of cell block in the working‐up of neoplastic effusions by revealing the architectural pattern of an uncommon malignancy and the correlation between cytopathology and imaging gross findings to reach an accurate diagnosis.

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An Analysis of Staging and Treatment Trends for Upper Tract Urothelial Carcinoma in the National Cancer Database

Cited by 46 publications

References 24 publications

Ureteral location is associated with survival outcomes in upper tract urothelial carcinoma: A population‐based analysis

Ureteral location is associated with survival outcomes in upper tract urothelial carcinoma: A population‐based analysis

Editorial Comment to Ureteral location is associated with survival outcomes in upper tract urothelial carcinoma: A population‐based analysis

Metastatic upper tract urothelial carcinoma with nest‐like features presenting as malignant pleural effusion

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