Prediction of Intravesical Recurrence After Radical Nephroureterectomy: Development of a Clinical Decision-making Tool

Xylinas, Évanguelos; Kluth, Luis A.; Passoni, Niccolò; Trinh, Quoc Dien; Rieken, Malte; Lee, Richard K.; Fajković, Harun; Novara, Giacomo; Margulis, Vitaly; Raman, Jay D.; Lotan, Yair; Rouprêt, Morgan; Aziz, Atiqullah; Fritsche, Hans Martin; Weizer, Alon Z.; Martínez-Salamanca, Juan Ignacio; Matsumoto, Kazumasa; Seitz, Christian; Remzi, Mesut; Walton, Thomas J.; Karakiewicz, Pierre I.; Montorsi, Francesco; Zerbib, Marc; Scherr, Douglas S.; Shariat, Shahrokh F.

doi:10.1016/j.eururo.2013.09.003

Cited by 141 publications

(124 citation statements)

References 26 publications

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“…This finding is consistent with those of a previous report (4). Multifocality and high tumour grade were candidate predictors of intravesical recurrence in the current study.…”

Section: Discussionsupporting

confidence: 83%

Tumour multifocality and grade predict intravesical recurrence after nephroureterectomy in patients with upper urinary tract urothelial carcinoma without a history of bladder cancer

Narukawa

Hara

Arai³

et al. 2015

Japanese Journal of Clinical Oncology

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Objective: Patients with upper urinary tract urothelial carcinoma (UUT-UC) without a history of bladder cancer have a different natural history of intravesical recurrence after nephroureterectomy compared with those with a history of bladder cancer. The aim of this study was to identify predictive factors for post-operative intravesical recurrence in patients with non-metastatic upper urinary tract-localized urothelial carcinoma without a history of bladder cancer and who were not taking medication during the perioperative period. Methods: This retrospective study included 133 patients who were treated between 1995 and 2012. Univariate and multivariate analyses were used to evaluate the clinical and pathological factors associated with the cumulative incidence of bladder cancer. Results: Of the 133 patients, 51 (38.3%) developed intravesical recurrence during a median follow-up of 71 months (range, 0.8-210.8). In the multivariate analysis, multifocality (P = 0.03) and high tumour grade (P = 0.007) were significantly associated with the cumulative incidence of bladder cancer. We constructed a prediction classification model on the basis of the total number of risk factors. The 2-year cumulative incidence rates were 5.6, 34.8 and 50.0% in individuals with no, one and two risk factors, respectively. There was a significant difference between patients with no risk factors and those with two risk factors (P = 0.01). Conclusions: Although this retrospective study had several limitations, tumour multifocality and tumour grade were found to be potential risk factors for intravesical recurrence in our cases.

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“…This finding is consistent with those of a previous report (4). Multifocality and high tumour grade were candidate predictors of intravesical recurrence in the current study.…”

Section: Discussionsupporting

confidence: 83%

Tumour multifocality and grade predict intravesical recurrence after nephroureterectomy in patients with upper urinary tract urothelial carcinoma without a history of bladder cancer

Narukawa

Hara

Arai³

et al. 2015

Japanese Journal of Clinical Oncology

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“…In 2014, Xylinas et al (8) developed nomograms for predicting intravesical recurrence, which could improve the clinical decision-making process with regard to cystoscopic surveillance schedules and postoperative intravesical instillations of mitomycin-C after RNU. However, incorporating biologically significant biomarkers into those nomograms may allow us to counsel patients more accurately (9).…”

Section: Introductionmentioning

confidence: 99%

Low-level Ki-67 expression as an independent predictor of bladder tumour recurrence in patients with primary upper tract urothelial carcinoma after radical nephroureterectomy

Liu

Zhang

et al. 2015

Jpn. J. Clin. Oncol.

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Objective: To evaluate the association of molecular markers and conventional clinicopathological factors with bladder tumour recurrence in patients with primary upper tract urothelial carcinoma after radical nephroureterectomy. Methods: The expressions of Ki-67 and P53 were measured by immunohistochemical staining prospectively in 115 consecutive patients with primary upper tract urothelial carcinoma from March 2004 to February 2014. The Cox proportional hazards regression model was used to identify independent predictors. The association between Ki-67 expression and clinicopathological variables was assessed by the χ 2 test.Results: Intravesical recurrence occurred in 13 out of 115 (11.3%) patients with a mean follow-up of 54.2 months (range: 7-130). Low-level Ki-67 expression (P = 0.010), older age (>65, P = 0.040) and lower ureter tumour (P = 0.001) were independent predictors of bladder tumour recurrence in Cox regression analysis. Ki-67 expression was elevated with the progression of tumour grade (P = 0.004) but not with stage (P = 0.186). Ki-67 overexpression was also significantly higher in aggressive pathological types (P = 0.008), but only shows an inclination towards poor oncologic outcomes in the cancer-specific survival rate (P = 0.107) and the overall survival rate (P = 0.063).Conclusions: Low-level Ki-67 expression was an independent predictor for bladder tumour recurrence, while Ki-67 overexpression was associated with adverse clinicopathological parameters and poor prognosis in patients with primary upper tract urothelial carcinoma after radical nephroureterectomy.

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“…We propose new surveillance guidelines based on a large multi-institutional series of 1029 patients treated with RNU for UTUC. Predictors for recurrence observed in our dataset are in keeping with other series 3,4,6 .…”

Section: Surveillance Recommendationmentioning

confidence: 61%

“…Post-operative recurrences after RNU are common and can occur at different sites: bladder (30%), locoregional (20%), distant (10-20%) and contralateral upper tract (2-6%). [4][5][6][7][8] Due to the rarity of UTUC, evidence regarding post-operative surveillance is lacking. Recently, nomograms predicting intravesical, loco-regional, and distant metastatic recurrence based on clinico-pathologic variables have been developed using large retrospective multiinstitutional data 3,4,6 .…”

Section: Introductionmentioning

confidence: 99%

Surveillance guidelines based on recurrence patterns for upper tract urothelial carcinoma

Locke

Hamidizadeh

Kassouf

et al. 2018

CUAJ

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Introduction: Upper tract urothelial carcinoma (UTUC) accounts for 5% of all urothelial tumours. Due to its rarity, evidence regarding postoperative surveillance is lacking. The objective of this study was to develop a post-radical nephroureterectomy (RNU) surveillance protocol based on recurrence patterns in a large multi-institutional cohort of patients. Methods: Retrospective clinical and pathological data were collected from 1029 patients undergoing RNU over a 15-year period (1994-2009) at 10 Canadian academic institutions. A multivariable model was used to identify prognostic clinicopathological factors, which were then used to define risk categories. Risk-based surveillance guidelines were proposed based on actual recurrence patterns. Results: Overall, 555 (49.9%) patients developed recurrence, including 289 (25.9%) in the urothelium and 266 (23.9%) with loco-regional and distant recurrences. Based on multivariable analysis, three risk groups were identified: 1) low-risk patients with pTa-T1, pN0 disease and no adverse histological features (high tumour grade, lymphovascular invasion [LVI], tumour multifocality); 2) intermediate-risk patients with pTa-T1, pN0 disease with one or more of the adverse histological features; and 3) high-risk patients with a ≥pT2 tumour and/or nodal involvement. Low-, intermediate-, and high-risk patients were free of urothelial recurrence at three years in 72%, 66%, and 63%, respectively, and free of regional/distant recurrence in 93%, 87%, and 62%, respectively. The risks of loco-regional and distant recurrences (p<0.0001) and time to death (p<0.0001) were significantly different between the low-, intermediate-, and highrisk patients.

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Prediction of Intravesical Recurrence After Radical Nephroureterectomy: Development of a Clinical Decision-making Tool

Cited by 141 publications

References 26 publications

Tumour multifocality and grade predict intravesical recurrence after nephroureterectomy in patients with upper urinary tract urothelial carcinoma without a history of bladder cancer

Tumour multifocality and grade predict intravesical recurrence after nephroureterectomy in patients with upper urinary tract urothelial carcinoma without a history of bladder cancer

Low-level Ki-67 expression as an independent predictor of bladder tumour recurrence in patients with primary upper tract urothelial carcinoma after radical nephroureterectomy

Surveillance guidelines based on recurrence patterns for upper tract urothelial carcinoma

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