High rates of advanced disease, complications, and decline of renal function after radical nephroureterectomy

Raman, Jay D.; Lin, Yu Hung; Kaag, Matthew; Atkinson, Timothy; Crispen, Paul L.; Wille, Mark; Smith, Norm D.; Hockenberry, Mark; Guzzo, Thomas J.; Peyronnet, B.; Bensalah, Karim; Simhan, Jay; Kutikov, Alexander; Cha, Eugene; Herman, Michael; Scherr, Douglas S.; Shariat, Shahrokh F.; Boorjian, Stephen A.

doi:10.1016/j.urolonc.2013.06.015

Cited by 58 publications

(40 citation statements)

References 29 publications

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“…On the contrary, Raman et al. reported that AC improved cancer‐specific survival by 15% (HR 0.85, P = 0.05). In our present study, AC did not reduce UTUC‐related mortality for all patients, but only in those at the highest risk for disease recurrence, that is those with pT3–4 N+ disease.…”

Section: Discussionmentioning

confidence: 95%

The role of adjuvant chemotherapy for lymph node‐positive upper tract urothelial carcinoma following radical nephroureterectomy: a retrospective study

et al. 2015

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ObjectiveTo evaluate the effect of adjuvant chemotherapy (AC) on mortality after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) with positive lymph nodes (LNs) and to identify patient subgroups that are most likely to benefit from AC. Patients and methodsWe retrospectively analysed data of 263 patients with LNpositive UTUC, who underwent full surgical resection. In all, 107 patients (41%) received three to six cycles of AC, while 156 (59.3%) were treated with RNU alone. UTUC-related mortality was evaluated using competing-risks regression models. ResultsIn all patients (T all N+), administration of AC had no significant impact on UTUC-related mortality on univariable (P = 0.49) and multivariable (P = 0.11) analysis. Further stratified analyses showed that only N+ patients with pT3-4 disease benefited from AC. In this subgroup, AC reduced UTUC-related mortality by 34% (P = 0.019). The absolute difference in mortality was 10% after the first year and increased to 23% after 5 years. On multivariable analysis, administration of AC was associated with significantly reduced UTUC-related mortality (subhazard ratio 0.67, P = 0.022). Limitations of this study are the retrospective non-randomised design, selection bias, absence of a central pathological review and different AC protocols. ConclusionsAC seems to reduce mortality in patients with pT3-4 LNpositive UTUC after RNU. This subgroup of LN-positive patients could serve as target population for an AC prospective randomised trial.

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Section: Discussionmentioning

confidence: 95%

The role of adjuvant chemotherapy for lymph node‐positive upper tract urothelial carcinoma following radical nephroureterectomy: a retrospective study

et al. 2015

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“…These observations highlight that current treatment paradigms may need to be augmented with multimodal therapy, including peri-operative chemotherapy [20]. However, as we have reported previously, a relatively low percentage of patients with adverse pathological features after RNU actually receive adjuvant chemotherapy [10]. The rationale behind the infrequent use of chemotherapy in these patients at high risk was unclear, but probably includes patient and physician preference, decreased renal function and the potential confounding impact of operative complications [21].…”

Section: Variablementioning

confidence: 85%

Preoperative nomogram to predict the likelihood of complications after radical nephroureterectomy

et al. 2016

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“…UTUC has an aggressive biology, and previous studies including the present study have reported that one‐third to one‐half of patients have stage T3 or greater disease at the time of surgery . Although RNU with bladder cuff excision is the gold standard for the treatment of localized UTUC, the oncological outcomes for patients with high‐grade or non‐organ‐confined disease remain poor, with 5‐year cancer‐specific survival rates of approximately 50% .…”

Section: Discussionmentioning

confidence: 59%

Predictive ability of renal cortex enhancement in dynamic computed tomography for residual renal function after nephroureterectomy: Comparison with ^99mTc‐diethylenetriaminopentacetic acid renography and validation study

et al. 2018

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Objective To estimate postoperative residual renal function after radical nephroureterectomy for upper tract urothelial carcinoma using the preoperative dynamic computed tomography renal cortex enhancement ratio in comparison with the split kidney glomerular filtration rate measured by 99mTc‐diethylenetriaminopentacetic acid renography. Methods A total of 47 patients who received radical nephroureterectomy and underwent both preoperative dynamic computed tomography and renography were the model‐development cohort; and 109 patients who underwent dynamic computed tomography alone were the validation cohort. Postoperative renal function of the unremoved kidney was estimated using the following formulas: preoperative estimated glomerular filtration rate × the percentage of total renal cortex radiodensity for the intact kidney in Hounsfield units obtained from corticomedullary phase images in the computed tomography‐based model, or the percentage of the total glomerular filtration rate measured by renography in the nuclear model. The correlation between observed and estimated postoperative renal function was determined. The computed tomography‐based prediction model derived from linear regression analysis was validated externally. Results The correlation of computed tomography‐based split renal function with the observed postoperative estimated glomerular filtration rate (r = 0.80) was equivalent to that of nuclear split renal function (r = 0.78). In the validation cohort, the computed tomography‐based prediction model showed an equivalently strong correlation (r = 0.78). Conclusions The present study showed that the percentage of total renal cortex radiodensity for the intact kidney is a useful tool for predicting unremoved kidney function in upper tract urothelial carcinoma patients, thereby allowing appropriate patient selection for perioperative cisplatin‐based combination chemotherapy.

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High rates of advanced disease, complications, and decline of renal function after radical nephroureterectomy

Cited by 58 publications

References 29 publications

The role of adjuvant chemotherapy for lymph node‐positive upper tract urothelial carcinoma following radical nephroureterectomy: a retrospective study

The role of adjuvant chemotherapy for lymph node‐positive upper tract urothelial carcinoma following radical nephroureterectomy: a retrospective study

Preoperative nomogram to predict the likelihood of complications after radical nephroureterectomy

Predictive ability of renal cortex enhancement in dynamic computed tomography for residual renal function after nephroureterectomy: Comparison with ^99mTc‐diethylenetriaminopentacetic acid renography and validation study

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High rates of advanced disease, complications, and decline of renal function after radical nephroureterectomy

Cited by 58 publications

References 29 publications

The role of adjuvant chemotherapy for lymph node‐positive upper tract urothelial carcinoma following radical nephroureterectomy: a retrospective study

The role of adjuvant chemotherapy for lymph node‐positive upper tract urothelial carcinoma following radical nephroureterectomy: a retrospective study

Preoperative nomogram to predict the likelihood of complications after radical nephroureterectomy

Predictive ability of renal cortex enhancement in dynamic computed tomography for residual renal function after nephroureterectomy: Comparison with 99mTc‐diethylenetriaminopentacetic acid renography and validation study

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Predictive ability of renal cortex enhancement in dynamic computed tomography for residual renal function after nephroureterectomy: Comparison with ^99mTc‐diethylenetriaminopentacetic acid renography and validation study