Prognostic Value of Tumor Size in Patients with Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-analysis

Ma, Runzhuo; Liu, Zenan; Cheng, Yinchu; Zhou, Pengxiang; Pan, Yuting; Bi, Hai; Tao, Liyuan; Yang, Bin; Zhu, Xuehua; He, Jide; He, Wei; Wang, Guoliang; Huang, Yi; Ma, Lulin; Lu, Jian

doi:10.1016/j.euros.2022.06.001

Cited by 5 publications

(2 citation statements)

References 54 publications

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“…7,15,16 As shown in Figure 3, PFS and OS of UTUC without RPI were not significantly different from those of BC, suggesting poor prognosis of this condition. Although primary tumor size has been reported to be a prognostic factor in localized UTUC, 17 our data suggest that it is a prognostic factor in advanced UTUC.…”

Section: Discussioncontrasting

confidence: 63%

The poor antitumor effect of pembrolizumab in advanced upper urothelial carcinoma with renal parenchymal invasion

et al. 2023

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ObjectivesWe investigated poor prognosticators in advanced or unresectable urothelial carcinoma, focusing on renal parenchymal invasion (RPI).MethodsThis study included 48 bladder cancer (BC) and 67 upper tract urothelial carcinoma (UTUC) patients treated with pembrolizumab from December 2017 to September 2022 at Kobe University Hospital. Medical records were retrospectively reviewed for clinical characteristics, objective response rate (ORR), progression‐free survival (PFS), and overall survival (OS). Multivariate analyses were performed using the Cox proportional hazard regression model to identify parameters associated with either PFS or OS.ResultsOf 67 UTUC patients, 23 had RPI and 41 patients did not, while 3 cases could not be evaluated. Patients with RPI were predominantly elderly and had liver metastases. ORR for patients with RPI was 8.7%, while it was 19.5% for those without RPI. PFS was significantly shorter for patients with RPI compared with those without RPI. Patients with RPI had significantly shorter OS than those without RPI. On multivariate analysis, performance status (PS) ≥ 2, neutrophil‐lymphocyte ratio (NLR) ≥ 3, C‐reactive protein ≥0.3 mg/dL and RPI were independent prognostic factors for PFS. PS ≥ 2, NLR ≥ 3, visceral metastasis and RPI were independent prognostic factors for OS. UTUC patient OS was significantly shorter than BC patient OS, while no significant difference in PFS or OS was observed between BC patients and UTUC patients without RPI.ConclusionsRPI was a poor prognostic factor in advanced urothelial carcinoma treated with pembrolizumab, possibly resulting in a poorer prognosis for UTUC compared with BC.

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Section: Discussioncontrasting

confidence: 63%

The poor antitumor effect of pembrolizumab in advanced upper urothelial carcinoma with renal parenchymal invasion

et al. 2023

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“…Moreover, extensive tumor necrosis (>10% of tumor area) has been reported to be associated with metastasis-and cancer-related deaths. Lastly, patients with larger tumor sizes are more likely to involve both the ureter and the renal pelvis, making open RNU necessary, and putting the patient at risk of poorer surgical outcomes [87][88][89].…”

Section: Tumor Presentation Location Multifocality and Sizementioning

confidence: 99%

Upper Tract Urothelial Carcinoma (UTUC) Diagnosis and Risk Stratification: A Comprehensive Review

Bitaraf,

Ghafoori Yazdi,

Amini

2023

Cancers

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Diagnosis and risk stratification are cornerstones of therapeutic decisions in the management of patients with upper tract urothelial carcinoma (UTUC). Diagnostic modalities provide data that can be integrated, to provide nomograms and stratification tools to predict survival and adverse outcomes. This study reviews cytology, ureterorenoscopy and the novel tools and techniques used with it (including photodynamic diagnosis, narrow-band imaging, optical coherence tomography, and confocal laser endomicroscopy), and biopsy. Imaging modalities and novel biomarkers are discussed in another article. Patient- and tumor-related prognostic factors, their association with survival indices, and their roles in different scores and predictive tools are discussed. Patient-related factors include age, sex, ethnicity, tobacco consumption, surgical delay, sarcopenia, nutritional status, and several blood-based markers. Tumor-related prognosticators comprise stage, grade, presentation, location, multifocality, size, lymphovascular invasion, surgical margins, lymph node status, mutational landscape, architecture, histologic variants, and tumor-stroma ratio. The accuracy and validation of pre-operative predictive tools, which incorporate various prognosticators to predict the risk of muscle-invasive or non-organ confined disease, and help to decide on the surgery type (radical nephroureterectomy, or kidney-sparing procedures) are also investigated. Post-operative nomograms, which help decide on adjuvant chemotherapy and plan follow-up are explored. Finally, a revision of the current stratification of UTUC patients is endorsed.

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The importance of second-look ureteroscopy implementation in the conservative management of upper tract urothelial carcinoma

Gallioli,

Basile,

Territo

et al. 2023

World J Urol

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Prognostic Value of Tumor Size in Patients with Upper Tract Urothelial Carcinoma: A Systematic Review and Meta-analysis

Cited by 5 publications

References 54 publications

The poor antitumor effect of pembrolizumab in advanced upper urothelial carcinoma with renal parenchymal invasion

The poor antitumor effect of pembrolizumab in advanced upper urothelial carcinoma with renal parenchymal invasion

Upper Tract Urothelial Carcinoma (UTUC) Diagnosis and Risk Stratification: A Comprehensive Review

The importance of second-look ureteroscopy implementation in the conservative management of upper tract urothelial carcinoma

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