Management of patients with upper urinary tract transitional cell carcinoma

Abstract

Multiple therapeutic options are available for the management of patients with upper urinary tract transitional cell carcinoma (TCC). Radical nephroureterectomy with an ipsilateral bladder cuff is the gold-standard therapy for upper-tract cancers. However, less invasive alternatives have a role in the treatment of this disease. Endoscopic management of upper-tract TCC is a reasonable strategy for patients with anatomic or functional solitary kidneys, bilateral upper-tract TCC, baseline renal insufficiency, and significant comorbid diseases. Select patients with a normal contralateral kidney who have small, low-grade lesions might also be candidates for endoscopic ablation. Distal ureterectomy is an option for patients with high-grade, invasive, or bulky tumors of the distal ureter not amenable to endoscopic management. In appropriately selected patients, outcomes following distal ureterectomy are similar to that of radical nephroureterectomy. Bladder cancer is a common occurrence following the management of upper-tract TCC. Currently, there are no variables that consistently predict which patients will develop intravesical recurrences. As such, surveillance with cystoscopy and cytology following surgical management of upper-tract TCC is essential. Extrapolating from data on bladder TCC, both regional lymphadenectomy and neoadjuvant chemotherapy regimens are likely to be beneficial for patients with upper-tract TCC, particularly in the setting of bulky disease.

Effect of preoperative chemotherapy on survival of patients with upper urinary tract urothelial carcinoma clinically involving regional lymph nodes

“…Recent retrospective studies have shown that post-chemotherapy surgery after a good response in BC patients with cN+, but no other metastases, might contribute to long-term disease-free survival. 1 However, no definitive therapeutic recommendation in upper urinary tract urothelial carcinoma (UTUC) patients with cN+ has existed because of the rarity of the disease.…”

Prognostic impact of the expression of ALDH1 and SOX2 in urothelial cancer of the upper urinary tract

“…1 Radical nephroureterectomy with excision of an ipsilateral bladder cuff is the standard therapy for patients with a normal contralateral kidney. 2 Upper urinary tract urothelial cell carcinomas that invade the muscle wall usually have a very poor prognosis, even if radical nephroureterectomy is performed appropriately. 1 The 5-year specific survival is o50% for pT2/ pT3 and o10% for pT4.…”

Highly predictive survival nomogram after upper urinary tract urothelial carcinoma

“…[1][2][3][4][5] The pathological T and N categories and pathologically defined tumor grade are powerful indicators of prognosis. [6][7][8][9][10][11] However, to date, the ability of the combined input from pathological stage, grade, and other tumor and patient characteristics has never been examined with respect to prediction of cancer-specific mortality after nephroureterectomy.…”