Intravesical Recurrence after Surgical Management of Urothelial Carcinoma of the Upper Urinary Tract

Hirano, Daisaku; Okada, Yasuhiro; Nagane, Yusuke; Satoh, Katsuhiko; Mochida, Joji; Yamanaka, Yataro; Hirakata, Hideki; Yamaguchi, Kenya; Kawata, Naoko; Takahashi, Satoru; Henmi, Akihiro

doi:10.1159/000338644

Cited by 27 publications

(20 citation statements)

References 45 publications

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“…In fact, a previous history of bladder cancer is present in 10–20% of patients with UTUC, and 8.5–13% of patients with UTUC have synchronous bladder cancer according to previous reports . Even in patients with no history of bladder cancer, the onset (recurrence) of bladder cancer is common after surgical treatment of UTUC, occurring in 15–50% of cases mostly within 2 years after surgery . Therefore, screening of the entire urinary tract is necessary when UTUC or bladder cancer is diagnosed.…”

Section: Epidemiologymentioning

confidence: 99%

Evidenced‐based clinical practice guideline for upper tract urothelial carcinoma (summary – Japanese Urological Association, 2014 edition)

Oya

Kikuchi

2014

Int J of Urology

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Upper tract urothelial carcinoma is more rare than bladder cancer, although they are both categorized as urothelial carcinoma. Because of the low incidence, little clinical evidence is available regarding the treatment of the former. However, recently such evidence has slowly begun to accumulate. The guideline presented herein was compiled for the purpose of ensuring proper diagnosis and treatment by physicians involved in the treatment of upper tract urothelial carcinoma. We carefully selected 16 clinical questions essential for daily clinical practice and grouped them into four major categories: epidemiology, diagnosis, surgery and systemic chemotherapy/other matters. Related literature was searched using PubMed and Japan Medical Abstracts Society databases for articles published between 1987 and 2013. If the judgment was made on the basis of insufficient or inadequate evidence, the grade of recommendation was determined on the basis of committee discussions and resultant consensus statements. Here, we present a short English version of the original guideline, and overview its key clinical issues.

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Section: Epidemiologymentioning

confidence: 99%

Evidenced‐based clinical practice guideline for upper tract urothelial carcinoma (summary – Japanese Urological Association, 2014 edition)

Oya

Kikuchi

2014

Int J of Urology

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“…Kang et al [9] and Hirano et al [10] reported that tumor multiplicity was the only independent risk factor for bladder recurrence in a multivariate analysis. Matsui et al [6], Terakawa et al [7], and Hisataki et al [12] also reported that tumor multiplicity was one of the independent risk factors for bladder recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…Risk factors such as tumor configuration [8], tumor multiplicity [6,7,9,10], tumor stage [6,7,11,12], tumor grade [5,13], tumor location [5,14,15], patient gender [8,16,17], postoperative adjuvant systemic chemotherapy [16,18], and preoperative voided urine cytology [15,19] have been proposed, but the results remain controversial and no reliable conclusions could be drawn to aid surveillance strategies. Therefore, a clear knowledge of potential predictive factors for bladder recurrence in UUT-UC would allow better prognostic evaluation and aid surveillance strategies.…”

Section: Introductionmentioning

confidence: 99%

Predictive Factors for Bladder Recurrence after Radical Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

Cho¹,

Kim²,

Ahn³

et al. 2013

Urol Int

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Introduction: To identify predictive factors for developing subsequent bladder urothelial carcinoma (UC) in patients undergoing radical nephroureterectomy for the treatment of upper urinary tract UC (UUT-UC). Materials and Methods: We retrospectively reviewed the medical records of 78 patients with clinically localized UUT-UC who had undergone operation at our institution between June 1994 and December 2009. Univariate and multivariate analyses were carried out to determine the predictive factors. Results: Out of a total of 78 patients, 14 (17.9%) developed bladder UC after radical nephroureterectomy at a median interval of 10 months (range: 3-46). Of these 14 patients, 11 (78.6%) experienced bladder recurrence within the first 2 years of follow-up. All 14 patients (100%) had non-muscle-invasive bladder UC and 10 patients (71.4%) had high-grade tumors. The univariate analysis identified preoperative voided urine cytology, tumor configuration, and adjuvant systemic chemotherapy as significant predictive factors for bladder recurrence, whereas the multivariate analysis indicated that only preoperative voided urine cytology was an independent predictive factor. Conclusions: Positive preoperative voided urine cytology is an independent predictor for bladder recurrence after radical nephroureterectomy for UUT-UC. Therefore, closer surveillance of the bladder is necessary, especially in patients with positive preoperative urine cytology.

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“…Complete ureterectomy with removal of bladder cuff, previously resected endoscopically, should be considered the treatment of choice, similarly to TCC of the lower ureter [1]. Follow-up with cystoscopy should adhere to the same principles as for upper tract tumours post nephroureterectomy, as tumour multifocality has been shown to be a positive predictor for intravesical recurrence, especially during the first 2 years after treatment [20]. …”

Section: Discussionmentioning

confidence: 99%

Transitional Cell Carcinoma of the Ureteric Stump: A Systematic Review of the Literature

Bourdoumis¹,

Syed²,

Soosay

et al. 2013

Urol Int

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Objective: To present a review of the literature using evidence-based criteria for diagnosis and treatment of malignant growths in the ureteric remnant following nephrectomy for non-malignant disease. Methods: A database search using the key search words was performed, producing a total of 16 articles published between 1952 and 2009. The Oxford Centre for Evidence-Based Medicine classification was used. Statistical significance was tested by Pearson correlation. Demographic data, reason for nephrectomy, symptoms, time to diagnosis since initial nephrectomy, imaging modality and treatment option chosen, as well as histology and overall survival were reviewed. Results: Analysis was possible for 33 out of 63 cases reported in the literature. There was a male predominance (82%). Visible, painless haematuria was the presenting symptom in 72% of cases. Open ureterectomy was performed in the majority of patients (85%), while none had laparoscopic surgery. Transitional cell carcinoma was found in 66% of cases. Mean follow-up was 2.7 years. Metastases were detected in 36% and correlated significantly with cancer-specific mortality (95% CI: p < 0.001). Tumour stage, grade and cell type did not correlate significantly with mortality. Conclusion: Gross, painless haematuria is a feature highly suggestive of neoplastic change. Diagnosis often involves multimodality imaging and endoscopy. Complete ureterectomy with removal of bladder cuff, previously resected endoscopically, is the treatment of choice. Metastases at diagnosis and follow-up carry a worse prognosis.

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Intravesical Recurrence after Surgical Management of Urothelial Carcinoma of the Upper Urinary Tract

Cited by 27 publications

References 45 publications

Evidenced‐based clinical practice guideline for upper tract urothelial carcinoma (summary – Japanese Urological Association, 2014 edition)

Evidenced‐based clinical practice guideline for upper tract urothelial carcinoma (summary – Japanese Urological Association, 2014 edition)

Predictive Factors for Bladder Recurrence after Radical Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

Transitional Cell Carcinoma of the Ureteric Stump: A Systematic Review of the Literature

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