Preoperative Hydronephrosis Grade Independently Predicts Worse Pathological Outcomes in Patients Undergoing Nephroureterectomy for Upper Tract Urothelial Carcinoma

Ito, Y.; Kikuchi, Eiji; Tanaka, Nobuyuki; Miyajima, Akira; Mikami, Shuji; Jinzaki, Masahiro; Oya, Mototsugu

doi:10.1016/j.juro.2010.12.035

Cited by 114 publications

(80 citation statements)

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“…The presence of ipsilateral HN in patients with bladder cancer is a predictive factor for poor pathological outcome and poor prognosis (18)(19)(20); however, at present, no consensus has been reached regarding the predictive role of the presence of HN in UTUC patients. Although HN has been reported to be associated with advanced disease (17,(21)(22)(23)(24), only two studies demonstrated a correlation between HN and poor prognosis based on small sample (17,25).…”

Section: Introductionmentioning

confidence: 99%

Predictive role of preoperative hydronephrosis on poor pathological outcomes and prognosis in upper tract urothelial carcinoma patients: Experience from a nationwide high-volume center in China

et al. 2015

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Abstract.To validate the predictive value of preoperative hydronephrosis (HN) with regard to clinicopathological outcome and prognosis in a large cohort of upper tract urothelial carcinoma (UTUC) patients, a retrospective analysis was conducted using the clinicopathological data of 520 consecutive patients treated between 2000 and 2010 at a nationwide high-volume center in China. Preoperative computed tomography or magnetic resonance imaging scans were evaluated for the presence of ipsilateral HN, and the associations between HN and pathological outcomes, patient survival and urinary tract recurrences were assessed. Ipsilateral HN was present in 271 patients (52.1%). Preoperative HN was associated with advanced age (P=0.007), sessile tumor architecture (P<0.001), ureteral location (P<0.001), higher tumor stage (P<0.001) and higher histological grade (P=0.002). Univariate and multivariate analyses revealed that poorer cancer-specific survival (CSS) and overall survival (OS) times were correlated with preoperative HN (P=0.004 and P=0.009, respectively). The 5-year CSS and OS rates for patients with HN were 86.9 and 86.2%, respectively, compared to 93.3 and 91.9% for patients without HN. For patients with muscle-invasive disease, HN remained a risk factor for poor CSS and OS (P=0.009 and P=0.012, respectively). No association was identified between HN and bladder recurrence (P=0.552) or the development of contralateral upper tract carcinoma (P= 0.164). The findings indicated that preoperative HN is prevalent in UTUC. The presence of preoperative HN predicted poorer pathological outcomes and was a significant risk factor affecting survival. The evaluation of HN may be informative for decisions concerning surgical options, and the presence of HN should raise the possibility of employing an aggressive treatment approach.

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Section: Introductionmentioning

confidence: 99%

Predictive role of preoperative hydronephrosis on poor pathological outcomes and prognosis in upper tract urothelial carcinoma patients: Experience from a nationwide high-volume center in China

et al. 2015

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“…Moreover, although 56 of 70 patients with UTC exhibited varied degrees of hydronephrosis, 26 of 71 patients with RPC had selected hydrocalyx or hydronephrosis. The presence of hydronephrosis is related to tumor invasiveness in UTC (18), thus eGFR might be an independent predictor for EUR in patients with UTC in our previous study (11). By contrast, partial RPC invasion of the renal parenchyma (pT3 disease) is likely to slightly decrease eGFR.…”

Section: Univariate Multivariate ------------------------------------mentioning

confidence: 78%

Preoperative risk factors for extraurothelial recurrence in N0M0 patients with renal pelvic cancer treated by radical nephroureterectomy

Ito

Asakuma

Kuroda

et al. 2016

Molecular and Clinical Oncology

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Abstract. The prediction of extraurothelial recurrence (EUR) before radical nephroureterectomy (RNU) is difficult for patients with upper tract urothelial carcinoma. If EUR can be predicted preoperatively, it may be possible to determine the need for neoadjuvant chemotherapy or the surgical strategy. Our previous study identified preoperative risk factors for EUR in ureteral cancer, while the present study identified preoperative risk factors for EUR in renal pelvic cancer (RPC). The preoperative factors were reviewed in 71 N0M0 patients with RPC treated by RNU between 1999 and 2013. Preoperative clinical background data, laboratory test results, including inflammatory indices, lactate dehydrogenase (LDH), and estimated glomerular filtration rate, and radiological findings were subjected to multivariate analyses to identify independent predictive factors for EUR. The 3-year EUR-free survival (EURFS) rate was 81.9%, and univariate analysis showed that clinical T (cT) stage ≥3, white blood cell counts ≥7600/µl, neutrophil counts ≥4,500/µl, neutrophil-to-lymphocyte ratio ≥2.0, and LDH ≥210 IU/l were significantly associated with EURFS. Additionally, a cT stage ≥3 (P= 0.0244) and LDH ≥210 IU/l (P= 0.0322) were independent predictors for EUR. When patients were stratified into three groups according to the number of risk factors, the 3-year EURFS rates were 94.5, 76.3, and 33.3% for the low-, intermediate-, and high-risk patient groups, respectively. In conclusion, cT stage ≥3 and LDH ≥210 IU/l were preoperative predictive factors of EUR in patients with RPC. High-risk patients may be candidates for neoadjuvant chemotherapy and low-risk patients may be candidates for RNU without lymph node dissection.

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“…The Society of Foetal Ultrasound irst described the grading system for hydronephrosis [38]. Similar description has also been applied to other imaging modalities like intravenous urography and CT [39].…”

Section: Features Of Upper Tract Obstructionmentioning

confidence: 99%

Non-contrast CT in the Evaluation of Urinary Tract Stone Obstruction and Haematuria

Ather¹,

Memon²,

Aziz³

et al. 2017

Computed Tomography - Advanced Applications

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Non-contrast computed tomography (CT) abdomen has emerged as a irst line investigation in suspected upper urinary tract obstruction. Underlying causes can usually be ascertained on computed tomography of kidneys, ureters and bladder (CT KUB). However, further investigations may be required to delineate/conirm underlying pathology like ureteropelvic junction obstruction (UPJ), diferentiation between obstruction and residual dilatation. Actual protocol of CT KUB for evaluation of stone disease and haematuria vary on institutional guidelines. CT KUB is not only extremely sensitive and speciic in the diagnosis of stone; it is now used in the pre-operative nomograms in predicting success of various endourological interventions like percutaneous nephrolithotomy (PCNL) and shock wave lithotripsy (SWL). Determination of stone density, stone volume, stone composition, skin to stone distance, presence of ureteral wall oedema, perinephric oedema are highly predictive of stone free rate. CT recognition of various anomalies, presence of retro-renal colon, horse-shoe kidney, malrotation, etc. can help in beter planning to avoid complications. One of the major limitations of CT is the radiation dose, besides cost and availability. Modiication in technique and technological innovation has resulted in signiicant dose reduction from 4.5 to about 1 mSv.

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Preoperative Hydronephrosis Grade Independently Predicts Worse Pathological Outcomes in Patients Undergoing Nephroureterectomy for Upper Tract Urothelial Carcinoma

Cited by 114 publications

References 20 publications

Predictive role of preoperative hydronephrosis on poor pathological outcomes and prognosis in upper tract urothelial carcinoma patients: Experience from a nationwide high-volume center in China

Predictive role of preoperative hydronephrosis on poor pathological outcomes and prognosis in upper tract urothelial carcinoma patients: Experience from a nationwide high-volume center in China

Preoperative risk factors for extraurothelial recurrence in N0M0 patients with renal pelvic cancer treated by radical nephroureterectomy

Non-contrast CT in the Evaluation of Urinary Tract Stone Obstruction and Haematuria

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