Is Renal Function at the Tumor Side a Prognostic Factor in Ureteral Transitional Cell Carcinoma?

Chung, Hsiao-Jen; Chen, K.-K.; Lin, Alex T.L.; Chang, Yen; Wu, Howard H.H.; Hsu, Ted H.; Chiu, A. W.; Chang, Luke S.

doi:10.1159/000283054

Cited by 13 publications

(3 citation statements)

References 6 publications

(15 reference statements)

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“…In addition, hydronephrosis also correlated with the T stage. 21,22 Presently, hydronephrosis and T stage did not correlate. Therefore, we investigated whether the anatomical location of urothelial carcinoma (renal pelvis vs. ureter) and degree of hydronephrosis has real prognostic value for UUTUC.…”

Section: Cuaj • April 2013 • Volume 7 Issues 3-4 E218mentioning

confidence: 76%

Preoperative hydronephrosis and diabetes mellitus predict poor prognosis in upper urinary tract urothelial carcinoma

Hwang

Jung

Nam

et al. 2013

CUAJ

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Introduction:We assess the impact of traditional prognostic factors, tumour location, degree of hydronephrosis and diabetes mellitus (DM) on the survival of patients treated for upper urinary tract urothelial carcinoma (UUTUC). Methods: From January 2004 to March 2010, we analyzed data from 114 patients with UUTUC who underwent nephroureterectomy with a bladder cuff excision. Median patient age was 71 years and median follow-up was 26.5 months. The influence of traditional prognostic factors, including DM, tumour stage, grade, location and degree of hydronephrosis, on recurrence-free survival (RFS) rates were analyzed using Kaplan-Meier analysis and Cox proportional hazards regression model. Results: Among 61 renal pelvis and 53 ureteral tumour cases, recurrence was identified in 71 cases (62.3%). Kaplan-Meier analysis showed that degree of hydronephrosis was associated with RFS (p = 0.001). DM and degree of hydronephrosis were independent factors for RFS in Cox proportional regression analysis (HR=1.8 CI: 1.01-3.55, p = 0.04), (HR=3.7, CI: 2.0-6.5, p = 0.001). All patients with ureteral tumour had no worse prognosis than those with renal pelvis tumour , but the pT2 patients with ureteral tumour had a worse prognosis than those with renal pelvis tumour with a median RFS of 9 months (range: 2.6-15.3 months) and 29 months (range: 8.0-13.2 months), respectively (p = 0.028). Conclusions: Tumour location is not a factor influencing RFS, except in the pT2 stage. However, severe hydronephrosis is associated with a higher recurrence in UUTUC. Also, DM is related to disease recurrence. Further prospective studies are needed to establish the prognostic significance of DM in large populations. IntroductionUpper urinary tract urothelial carcinoma (UUTUC), including renal pelvic and ureteral cancer, is relatively rare, constituting 5% of all urinary tract urothelial carcinoma cases. 1Urothelial carcinoma of the renal pelvis is 3 to 4 times more common than ureteral urothelial carcinoma. 2,3T stage, tumour grade and lymphovascular invasion are thought to be prognostic factors for UUTUC. [4][5][6][7] Of these factors, the most important is the pathologic T stage. Although computed tomography (CT) has been applied to determine the preoperative T stage in UUTUC, the accuracy of this prediction is poor, making it difficult to predict the prognosis of patients with UUTUC. 8 The impact of tumour localization on prognosis has been debated. 6,9,10 In some reports, ureteral urothelial carcinoma had a worse prognosis than renal pelvic urothelial carcinoma.10-12 Generally, ureteral urothelial carcinoma causes gradual ureteral obstruction, resulting in hydronephrosis. This continuous obstruction may cause higher hydronephrosis grade and impairment of renal function. Therefore, severe degree of hydronephrosis may be associated with late detection of UUTUC and late treatment.Diabetes mellitus (DM) is a chronic metabolic disease. Evidence indicates that DM is influential in the treatment outcomes of malignancies.13 Several studies ...

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Section: Cuaj • April 2013 • Volume 7 Issues 3-4 E218mentioning

confidence: 76%

Preoperative hydronephrosis and diabetes mellitus predict poor prognosis in upper urinary tract urothelial carcinoma

Hwang

Jung

Nam

et al. 2013

CUAJ

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“…As a result, UTUC might progress during the development of hydronephrosis (13). Second, several studies reported that patients with hydronephrosis had a more advanced tumor stage than those without hydronephrosis (13,14,28). In addition, ureteral tumors were reported to be more likely to present with hydronephrosis and to have a worse prognosis than renal pelvic tumors, which could be attributed to the thin layer of surrounding ureteral adventitia containing an extensive plexus of blood vessels and lymphatic channels, making tumor invasion and metastasis easier (29,30).…”

Section: Discussionmentioning

confidence: 99%

Preoperative hydronephrosis predicts adverse pathological features and postoperative survival in patients with high-grade upper tract urothelial carcinoma

et al. 2021

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Purpose: Epidemiological studies reported confl icting results about preoperative hydronephrosis in upper tract urothelial carcinoma (UTUC). This study aimed to investigate the association between preoperative hydronephrosis and pathologic features and oncologic outcomes in patients with UTUC treated by radical nephroureterectomy (RNU). Materials and Methods: This was a retrospective, single-center cohort study of 377 patients treated by RNU without perioperative chemotherapy between January 2001 and December 2014. Logistic regression, Cox regression, and survival analyses were performed. Results: Among the 226 patients with high-grade UTUC, 132 (58%) had preoperative hydronephrosis. Multivariable logistic regression revealed that hydronephrosis was independently associated with advanced pT stage (P=0.017) and lymph node or lymphovascular invasion (P=0.002). Median follow-up was 36 months (interquartile range: 20-48 months). The 3-and 5-year overall survival (OS) rates in patients with hydronephrosis were signifi cantly lower than in those without hydronephrosis (both P <0.001). The 3-and 5-year cancer-specifi c survival (CSS) rates in patients with hydronephrosis were signifi cantly lower than in those without hydronephrosis (both P=0.001). Hydronephrosis was independently associated with OS and CSS (P=0.001 and P=0.004, respectively). Among the 151 patients with low-grade UTUC, hydronephrosis was not associated with pathologic features and postoperative survival. Conclusions: Preoperative hydronephrosis was signifi cantly associated with adverse pathologic features and postoperative survival in patients with high-grade UTUC.

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“…13,14 In addition, delayed ipsilateral renal excretion in patients with ureteral tumors has been associated with decreased survival on univariate analysis. 15 We sought to confirm this relationship with our own, single-institutional UTUC population. Realizing that UTUC may have a different prognosis dependent on tumor location, we also sought to determine if the location of the primary tumor (renal pelvis/ calices vs ureter) changed this association.…”

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confidence: 93%

The Significance of Functional Renal Obstruction in Predicting Pathologic Stage of Upper Tract Urothelial Carcinoma

Amirian

Radadia

Narins

et al. 2014

Journal of Endourology

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Background and Purpose: Assessing the severity of upper tract urothelial carcinoma (UTUC) has been difficult because of inadequate biopsy specimens. Additional predictive parameters of disease stage would be useful when deciding a treatment plan; it has been suggested that preoperative hydronephrosis can be a surrogate. We examined the relationship between preoperative ipsilateral renal obstruction identified by imaging with final pathologic stage after nephroureterectomy (NU) for UTUC. We then analyzed those patients with ipsilateral renal obstruction and examined if tumor location is associated with an advanced pathologic stage. Methods: Patients who underwent NU for UTUC between the years 2001 to 2013 were analyzed and relevant staging studies and pathology were reviewed. Criteria for ipsilateral renal obstruction were defined by the presence of a delayed nephrogram on CT scan, renal cortical atrophy with associated hydronephrosis on crosssectional imaging, and/or >10% split function discrepancy on nuclear renal scintigraphy with associated hydronephrosis. Results: Eighty-two patients met inclusion criteria; 26/82 (31.7%) had locally advanced disease (pT 3 /T 4 ), while 56/82 (63.4%) had organ-confined ( £ pT 2 ) disease. Of the patients with pT 3 /T 4 disease, 10/26 (38.5%) demonstrated radiographic evidence of functional obstruction of the ipsilateral renal unit; similarly, in patients with £ pT 2 disease, 21/56 (37.5%) demonstrated ipsilateral renal obstruction (P = 0.93). Of the patients with ipsilateral renal obstruction, in those patients with pT 3 /T 4 disease, 7/10 (70.0%) had ureteral tumor involvement while 9/21 (42.9%) patients with £ pT 2 disease had tumor in the ureter (P = 0.25). Conclusions: This study suggests that renal obstruction by radiographic analysis does not always predict advanced stage. In addition, there is a trend toward advanced stage when a patient has radiographic evidence of ipsilateral renal dysfunction and a ureteral tumor.

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Is Renal Function at the Tumor Side a Prognostic Factor in Ureteral Transitional Cell Carcinoma?

Cited by 13 publications

References 6 publications

Preoperative hydronephrosis and diabetes mellitus predict poor prognosis in upper urinary tract urothelial carcinoma

Preoperative hydronephrosis and diabetes mellitus predict poor prognosis in upper urinary tract urothelial carcinoma

Preoperative hydronephrosis predicts adverse pathological features and postoperative survival in patients with high-grade upper tract urothelial carcinoma

The Significance of Functional Renal Obstruction in Predicting Pathologic Stage of Upper Tract Urothelial Carcinoma

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