The Impact of Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma: A Comprehensive Systematic Review and Meta-Analysis

Nowak, Łukasz; Krajewski, Wojciech; Chorbińska, Joanna; Kiełb, Paweł; Sut, Michał; Moschini, Marco; Teoh, Jeremy Yuen‐Chun; Mori, Keiichiro; Giudice, Francesco Del; Laukhtina, Ekaterina; Lonati, Chiara; Kaliszewski, Krzysztof; Małkiewicz, Bartosz; Szydełko, Tomasz

doi:10.3390/jcm10184197

Cited by 26 publications

(37 citation statements)

References 41 publications

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“…The study collectives were too different for this. The application of various techniques, such as the use of a ureteral sheath as protection against recurrence in the urinary bladder, also showed no improvement (35). The extent to which cryobiopsy can circumvent this phenomenon is not yet clear.…”

Section: Discussionmentioning

confidence: 99%

Improving the Quality of Human Upper Urinary Tract Specimens by Cryobiopsy

et al. 2022

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ObjectiveThe quality of histopathological specimens obtained from the upper urinary tract with conventional flexible ureterorenoscopic biopsy needs to be improved. We investigated the feasibility and biopsy quality of specimens obtained by cryobiopsy, compared with standard ureterorenoscopic biopsy techniques in a human ex vivo model.Materials and MethodsHuman ureters obtained from nephrectomy specimens (N=12) were dissected and canulated with an ureteral access sheath. Ureterorenoscopic biopsies were randomly obtained from different sites of the renal pelvic caliceal system using different types of instruments. The performance of two newly developed flexible cryoprobes with outer diameters of 1.1 mm (CB11) and 0.9 mm (CB09) was compared with that of the biopsy forceps(FB) and Bigopsy®(BiG) and two different Dormia baskets N‐Gage (NG) and Zero‐Tip (ZT). We assessed the feasibility of the various biopsy techniques based on the number of biopsy attempts needed to obtain macroscopically discernible biopsies. The specimens were examined histopathologically for size, biopsy quality, presence of various artifact types, and representativeness.ResultsBiopsies taken with the cryoprobes showed a higher biopsy quality than biopsies taken with the comparative instruments. The CB11 provided significantly larger biopsies than forceps biopsies and also than biopsies with ZT. The CB09 was able to collect larger samples when compared with the FB and BiG biopsy forceps. There were no significant differences in artifact area, except for the CB11 cryoprobe compared with the NG. To clarify the results a subdivision of larger or smaller than 20% artifact area was performed. A significant difference was found between CB11 and the forceps biopsies, as well as between CB11 and NG and ZT in favor of the cryoprobe. The representation of the histopathological sample was also determined. Biopsies taken with CB11 were more representative compared with forceps biopsies BiG and FB and basket biopsies NG and ZT.ConclusionsIn a standardized comparative ex vivo setting, larger biopsies were obtained by using the cryobiopsy technique with the CB11 probe. Qualitatively, cryobiopsy specimens were overlaid by fewer artifacts and a higher biopsy quality was achieved in histopathologic examination compared with standard instrumentation. Further stepwise development will transfer the promising cryobiopsy technique into the clinical setting.

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Section: Discussionmentioning

confidence: 99%

Improving the Quality of Human Upper Urinary Tract Specimens by Cryobiopsy

et al. 2022

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“…In a single study included in the present systematic review, patients who underwent URS and delayed RNU had similar CSS and RFS compared to the patients who underwent RNU without previous URS [ 11 ]. Nonetheless, the results of a recent meta-analysis including 16 retrospective series confirmed that URS with biopsy followed by RNU could be associated with significantly worse intravesical RFS (but not with CSS, OS, and metastasis-free-survival), compared to RNU alone [ 16 ]. These findings could be explained by increased risk of tumor seeding during endoscopic biopsy or the manipulation of the ureteroscope.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Surgical Waiting Time on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma Undergoing Radical Nephroureterectomy: A Systematic Review

Nowak

Krajewski

Łaszkiewicz

et al. 2022

JCM

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Radical nephroureterectomy (RNU) with bladder cuff excision is a standard of care in patients with high-risk upper tract urothelial carcinoma (UTUC). Although several recommendations and guidelines on the delayed treatment of urologic cancers exist, the evidence on UTUC is scarce and ambiguous. The present systematic review aimed to summarize the available evidence on the survival outcomes after deferred RNU in patients with UTUC. A systematic literature search of the three electronic databases (PubMed, Embase, and Cochrane Library) was conducted until 30 April 2022. Studies were found eligible if they reported the oncological outcomes of patients treated with deferred RNU compared to the control group, including those patients treated with RNU without delay. Primary endpoints were cancer-specific survival (CSS), overall survival (OS), and recurrence-free survival (RFS). In total, we identified seven eligible studies enrolling 5639 patients. Significant heterogeneity in the definition of “deferred RNU” was found across the included studies. Three out of five studies reporting CSS showed that deferring RNU was associated with worse CSS. Furthermore, three out of four studies reporting OS found a negative impact of delay in RNU on OS. One out of three studies reporting RFS found a negative influence of delayed RNU on RFS. While most studies reported a 3 month interval as a significant threshold for RNU delay, some subgroup analyses showed that a safe delay for RNU was less than 1 month in patients with ureteral tumors (UT) or less than 2 months in patients with hydronephrosis. In conclusion, long surgical waiting time for RNU (especially more than 3 months after UTUC diagnosis) could be considered as an important risk factor having a negative impact on oncological outcomes in patients with UTUC; however, the results of the particular studies are still inconsistent. The safe delay for RNU might be shorter in specific subsets of high-risk patients, such as those with UT and/or hydronephrosis at the time of diagnosis. High-quality additional studies are required to establish evidence for valid recommendations.

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“…Previous studies, including meta-analyses, have claimed increased intravesical recurrences after diagnostic URS before RNU [ 2 , 5 , 6 , 7 , 12 , 13 , 14 , 15 ], as is well-known in the urological community. However, although the potential for adverse oncological effects of URS on disease progression has attracted attention and has been hotly debated [ 9 ], cumulative studies have not demonstrated any significant association [ 2 , 5 , 7 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. However, these studies did not perform detailed subgroup analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Despite its diagnostic utility, URS is known to increase intravesical recurrence after RNU [ 2 , 5 , 6 ]. Although previous meta-analyses demonstrated no adverse prognostic impact of URS prior to RNU on survival or progression [ 2 , 7 ], some studies have raised concerns about lymphovascular dissemination of tumor cells via increased intra-ureteropelvic pressure during URS [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Adverse Prognostic Impact of Diagnostic Ureterorenoscopy in a Subset of Patients with High-Risk Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy

Yonese

Ito

Waseda

et al. 2022

Cancers

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Background: We hypothesized that diagnostic ureterorenoscopy (URS) may adversely affect prognosis in a subset of patients with high-risk upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). Methods: The present retrospective study included 143 patients with UTUC treated between 2010 and 2021 at two tertiary care hospitals, of whom 79 received URS prior to RNU. Subgroups were stratified by clinicopathological variables relevant to prognosis. The primary endpoint was to evaluate the prognostic impact of URS on overall survival (OS) and progression-free survival (PFS) after RNU. Results: During follow-up (median 54 months for survivors), 32 cases of all-cause mortality and 40 cases of progression were recorded. No significant difference was found in OS or PFS between patients with and without URS. Subgroup analysis demonstrated that URS was significantly associated with worse OS (p < 0.001) and PFS (p = 0.008) in 29 patients with non-papillary and ≥pT3 UTUC. Importantly, URS did not have any adverse effects on prognosis in 62 patients with papillary and ≤pT2 UTUC (p = 0.005). Conclusions: URS may adversely affect prognosis of UTUC patients, specifically non-papillary and ≥pT3 disease. URS may better be avoided in patients with high-risk UTUC features unless URS is necessary to diagnose UTUC. This study also corroborates the oncological safety of URS in those with low-risk UTUC.

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The Impact of Diagnostic Ureteroscopy Prior to Radical Nephroureterectomy on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma: A Comprehensive Systematic Review and Meta-Analysis

Cited by 26 publications

References 41 publications

Improving the Quality of Human Upper Urinary Tract Specimens by Cryobiopsy

Improving the Quality of Human Upper Urinary Tract Specimens by Cryobiopsy

The Impact of Surgical Waiting Time on Oncological Outcomes in Patients with Upper Tract Urothelial Carcinoma Undergoing Radical Nephroureterectomy: A Systematic Review

Adverse Prognostic Impact of Diagnostic Ureterorenoscopy in a Subset of Patients with High-Risk Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy

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