Improving management of upper tract urothelial carcinoma

Tay, Li June; Chatterton, Kathryn; Colemeadow, Josie; Nair, Rajesh; Bultitude, Matthew; Thomas, Kay

doi:10.1111/bju.15068

Cited by 8 publications

(7 citation statements)

References 7 publications

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“…Whilst some centres adopt this policy for all patients to reduce the negative ‘non‐urothelial’ RNU specimen (quoted at 7% in the One Dose Mitomycin C [ODMIT‐C] trial [2], and 10.6% in 2012 BAUS Audit of RNU Practice [3]), there are downsides with an extra invasive procedure, potential delays to definitive treatment and increased risk of intravesical recurrence. In this series, 43% did not undergo ureteroscopy prior to RNU (which is similar to our practice at 46% [4]). This study has confirmed previous reports and meta‐analyses of a higher risk of intravesical recurrence after ureteroscopy [5].…”

supporting

confidence: 61%

“…In an attempt to reduce ‘unnecessary ureteroscopy’, we have previously reported our outcomes in streamlining this decision making via a dedicated UTUC meeting within the context of the wider specialist bladder cancer multi‐disciplinary team (MDT) meeting [4]. With this approach, we have demonstrated a reduction in both the number of diagnostic ureteroscopies prior to RNU and the average time from referral to definitive surgery, all with no detriment to oncological outcomes.…”

mentioning

confidence: 99%

“…[1] demonstrate the median time to RNU from diagnosis was significantly shortened (49 vs 78 days, P < 0.001). In our series, we found RNU was performed 21 days earlier if ureteroscopy was not undertaken [4].…”

mentioning

confidence: 99%

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Do all patients require ureteroscopy prior to nephroureterectomy?

2022

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confidence: 61%

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confidence: 99%

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Do all patients require ureteroscopy prior to nephroureterectomy?

2022

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“…To the best of our knowledge, these results shed a new light on local staging of UTUC, and, once replicated in larger studies, they could support a relevant change in diagnostic workup and treatment planning of UTUC. In fact, biopsy and urinary cytology, which are included in risk stratification, are often not diagnostic [21]. A precise MRI description of the muscle layer infiltration could be added to the factors distinguishing high-from low-risk patients, in addition to the generic and insufficient definition of "local invasion on CT" as defined in the European Association of Urology guidelines [7].…”

Section: Discussionmentioning

confidence: 99%

MRI for risk stratification of muscle invasion by upper tract urothelial carcinoma: a feasibility study

Messina,

Proietti,

Laschena

et al. 2024

Eur Radiol Exp

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Background Magnetic resonance imaging (MRI) is recommended in patients with upper tract urothelial carcinoma (UTUC) only when computed tomography (CT) is contraindicated. However, CT does not allow distinguishing ureter wall layers, making impossible to assess muscle invasion, a factor contributing to differentiate high- from low-risk UTUCs, which require different therapeutic approaches. We investigated the feasibility of MRI assessment of UTUC muscle invasion. Methods From June 2022 to March 2023, we prospectively enrolled patients suspected of UTUC, i.e., with positive urinary tract ultrasound and/or ureteroscopy, or positive urinary cytology and/or hematuria but negative cystoscopy and bladder ultrasound at two Italian centers. They underwent CT followed by MRI (≤ 24 h apart), independently reported by two experienced radiologists, blinded from histopathology results. After imaging confirmation, they all underwent nephroureterectomy and histopathology analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the receiver operating characteristic curve (AUC) were calculated. Results Thirty-nine lesions were detected in 30 patients on both CT and MRI. Muscle-invasive UTUC prevalence was 81% (21/26) among patients with MRI suspicion and 8% (1/13) among those without MRI suspicion (p < 0.001). Considering the assessment of muscle-layer invasion, the more experienced reader achieved 95% sensitivity (95% confidence interval 82−100), 71% specificity (47−88), 81% PPV (63−93), 92% NPV (70−100), 85% accuracy (67−96), and 0.84 AUC (0.70−0.98). Inter-reader agreement was substantial (κ = 0.73). Conclusions MRI showed a promising diagnostic performance for the assessment of UTUC risk of muscle invasion. Relevance statement Resulting feasible both in technical and clinical terms, MRI could be helpful for upper tract urothelial carcinomas pre-operative risk stratification, to allow a personalized patients’ management. These results play in favor of promoting preoperative MRI for UTUC, as already proven for bladder cancer. Key points • Muscle invasion is a crucial information for tailored treatments of upper tract urothelial carcinomas. • CT does not distinguish ureter wall layers, making muscle invasion risk assessment not feasible. • MRI was shown to reliably diagnose muscle-layer invasion by upper tract urothelial carcinomas (sensitivity 95%, specificity 71%). Graphical Abstract

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“…Urothelial carcinoma (UC) is the most common malignancy of the urinary tract. However, upper tract (renal pelvis and ureter) tumors account for only 5% to 10% of all UCs, and almost 60% of upper tract UCs (UTUCs) are invasive at diagnosis (1,2). Currently available prognostic tools that utilize clinical and pathological parameters are limited for UTUC.…”

Section: Introductionmentioning

confidence: 99%

FOXO3A Expression in Upper Tract Urothelial Carcinoma

et al. 2021

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BackgroundEpidemiological studies have reported various results regarding whether FOXO3A is related to various carcinomas. However, the prognostic significance of FOXO3A in upper tract urothelial carcinoma (UTUC) remains unclear. The purpose of this study was to validate the correlation between FOXO3A expression and oncological outcomes in UTUC.MethodsThe expression levels of FOXO3A in 107 UTUC patients were examined by immunohistochemistry (IHC). We examined the prognostic role of FOXO3A by using the Cox proportional hazard model.ResultsThe results indicated that FOXO3A expression was notably decreased in UTUC tissue compared with control tissue. Decreased expression of FOXO3A was also related to advanced pathologic stage (P = 0.026), lymph node metastasis (P = 0.040), lymphovascular invasion (P < 0.001), and adjuvant therapy (P = 0.048). In addition, UTUC patients with low FOXO3A expression had a significantly shorter survival time, including both overall survival (OS) [hazard ratio (HR) 2.382, P = 0.004] and recurrence-free survival (RFS) (HR 2.385, P = 0.004), than those with high expression. Multivariate analyses showed that FOXO3A was a significant predictor for OS (HR 2.145, P = 0.014) and RFS (HR 2.227, P = 0.010) in UTUC patients.ConclusionOur results indicate that FOXO3A may be involved in the recurrence of UTUC and that it has certain clinical value in the therapeutic targeting and prognostic evaluation of UTUC.

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Improving management of upper tract urothelial carcinoma

Cited by 8 publications

References 7 publications

Do all patients require ureteroscopy prior to nephroureterectomy?

Do all patients require ureteroscopy prior to nephroureterectomy?

MRI for risk stratification of muscle invasion by upper tract urothelial carcinoma: a feasibility study

FOXO3A Expression in Upper Tract Urothelial Carcinoma

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