The Impact of Tumor Location on Prognosis of Transitional Cell Carcinoma of the Upper Urinary Tract

Park, Sungchan; Hong, Bumsik; Kim, Choung‐Soo; Ahn, Hanjong

doi:10.1097/01.ju.0000107767.56680.f7

Cited by 161 publications

(112 citation statements)

References 15 publications

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“…11,20 Conversely, van der Poel et al demonstrated that patients who had tumors in the renal pelvis and proximal ureter were 2.5 times more likely to die of disease compared with patients who had tumors in the distal ureter, reconfirming the data even in multivariate analyses. 10 In our series, patients with pelvic or ureteral cancers had similar survival probabilities, which were higher than those for the patients who harbored concomitant pelvic and ureteral cancers, although the data were not significant on multivariate analysis.…”

Section: Discussionmentioning

confidence: 87%

Independent predictors of cancer‐specific survival in transitional cell carcinoma of the upper urinary tract

Novara

Marco

Gottardo

et al. 2007

Cancer

175

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Sulfonation degree determination of sulfonated polystyrene and the corresponding ionomers are performed by adiabatic bomb calorimeter. The theoretical calculations from the band energies for the combustion enthalpy values (calorific values) and the experimental values are compared, and a linear relation between the values is found. Sulfonation and neutralization processes are examined by elemental sulfur analysis and atomic absorption spectroscopy (AAS). It was obvious that increasing sulfonation degree yields a decrease in the combustion enthalpy values, as it is expected from the theoretical calculations. In addition, metal ion incorporation to the structure deviates the experimental combustion enthalpy values especially for the ionomers which have higher sulfonation degrees. This is due to the formation of a higher degree aggregation. © Wiley Periodicals, Inc. J Appl Polym Sci 100: 4684–4688, 2006

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Section: Discussionmentioning

confidence: 87%

Independent predictors of cancer‐specific survival in transitional cell carcinoma of the upper urinary tract

Novara

Marco

Gottardo

et al. 2007

Cancer

175

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“…2,8,11,12,[14][15][16][17][18][20][21][22][23][24][25]29,[32][33][34] Thus, the identification of independent prognostic variables is an essential step to predict disease evolution, thus aiding surveillance strategies, and also to identify patient subgroups that might benefit from adjuvant cancer therapy. Our study is by far the largest systematic investigation of the impact of pT classification, tumor grade, as well as vascular invasion in patients with both pelvic and ureteral UCs with respect to metastasis-free survival.…”

Section: Discussionmentioning

confidence: 99%

pT classification, grade, and vascular invasion as prognostic indicators in urothelial carcinoma of the upper urinary tract

et al. 2006

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Clinicopathologic features predictive of patient outcome in upper urinary tract urothelial carcinoma are not well defined. The aim of this study was to assess the role of pT classification, tumor grade, and vascular invasion in predicting metastasis-free survival. A total of 190 consecutive invasive upper urinary tract urothelial cancers operated between 01/1984 and 12/2004 were re-evaluated with respect to pT classification, tumor grade (according to the three-tiered WHO 1973 and the recent two-tiered grading system following the WHO/ISUP consensus classification), as well as presence of lymph and/or blood vessel invasion. Prognostic impact was analyzed using the Kaplan-Meier method and the Log-Rank test. For multivariate testing, a Cox's proportional hazards regression model was used. pT1 was present in 81 (43%), pT2 in 29 (15%), pT3 in 73 (38%), and pT4 in seven (4%) cases. There were 12 (6%) G1, 96 (51%) G2, and 82 (43%) G3 tumors or 84 (44%) low-grade and 106 (56%) high-grade tumors according to the two-tiered system. The presence of vascular invasion in 72/190 (38%) tumors was associated with high pT classification (Po0.001) and high tumor grade (Po0.001). Disease progression occurred in 39% of patients, with 5-and 10-year metastasis-free survival rates of 56 and 45%, respectively. On univariate analysis, all investigated parameters showed prognostic significance. The negative influence of vascular invasion on patient outcome was strikingly strong in high pT classification and high-grade cancers. On multivariate analysis, pT classification (Po0.001) and vascular invasion (Po0.001) proved to be independent prognostic factors, whereas tumor grade according to the two-tiered system missed statistical significance (P ¼ 0.06). In conclusion, pT classification and vascular invasion are independent prognostic factors with respect to metastasis-free survival and should be used to guide adjuvant therapy strategies in affected patients. Presence (or absence) of vascular invasion should be commented upon separately in the pathology report. Modern Pathology (2006Pathology ( ) 19, 272-279. doi:10.1038 Keywords: urothelial carcinoma; upper urinary tract; tumor classification; tumor grade; vascular invasion; prognosis A significant proportion of patients with upper urinary tract urothelial carcinoma (UC) eventually die of the disease due to unrecognized and untreated nodal or distant metastasis present at the time of surgery, indicating the importance of adequate adjuvant therapy strategies for patients at high risk of failure. Initial tumor stage and tumor grade have been documented as major prognostic factors. 1-25 However, validity of most studies is limited due to inclusion of noninvasive (pTa) cancer cases and/or small sample size. Thus, to the best of our knowledge, there are only two systematic studies involving more than 100 invasive cancer cases including both univariate and multivariate statistical analyses with respect to recurrence-free and disease-specific survival. 12,24 Moreover, the assessment of tumor gr...

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“…7 Our patient's UC was pathologically high grade and a pT3 lesion, with involvement of renal sinus fat via invasion through muscle. A renal pelvic location has improved survival in UC versus a ureteral primary, 8,9 though Holmang and Johansson 10 have suggested only 25% survival in high-grade pT3 upper tract UC. The UC was likely the more ominous primary lesion in this patient.…”

Section: Leveridge Et Almentioning

confidence: 99%

Synchronous ipsilateral renal cell carcinoma and urothelial carcinoma of the renal pelvis

Leveridge

Isotalo

Boag

et al. 2013

CUAJ

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Renal cell carcinoma (RCC) and urothelial carcinoma of the upper urinary tract are not uncommon urological malignancies. Their simultaneous occurrence in a patient is, however, extraordinarily rare. We report the case of a patient who underwent laparoscopic nephrectomy for suspected RCC. Preoperative imaging was suspicious for renal pelvic involvement, which was confirmed upon bivalving the fresh specimen at the time of surgery, with the discovery of a separate urothelium-based lesion. We discuss this rare occurrence and our management approach. RésuméIndividuellement, l'hypernéphrome et le carcinome urothélial des voies urinaires supérieures ne sont pas des tumeurs urologiques rares. Leur survenue simultanée chez un même patient est cependant extrêmement rare. La reconnaissance préopératoire ou intraopératoire est cruciale afin que soit effectuée la résection urétérale requise. Nous décrivons un cas d'hypernéphrome et de carcinome urothélial simultanés et homolatéraux.Can Urol Assoc J 2009;3(1): Subsequent investigations included urine cytology, which was atypical but not diagnostic for malignancy, normal cystoscopy and normal blood work, including liver studies and calcium. A computed tomography (CT) scan confirmed the presence of a 5.5-cm solid mass on the anterior aspect of the upper pole of the right kidney (Fig. 1). Renal vein, lymph nodes and contralateral kidney were normal. Delayed views of the collecting system were suspicious for protrusion or extension of the mass into the renal pelvis (Fig. 2). The working diagnosis based on imaging studies was RCC with invasion into the collecting system.The patient was eager for definitive management of her renal mass, and so was scheduled for laparoscopic right radical nephrectomy, which was performed uneventfully. Titanium clips were placed on the distal ureter in close approximation before cutting, and there was no spillage of urine. The operating surgeon accompanied the gross specimen to the pathology department and requested that it be bivalved immediately, based on the atypical cytology and the suggestion of possible renal pelvic extension of the mass.Upon opening the kidney, it was clear that there were 2 geographically and morphologically distinct masses in the kidney: a 5.5-cm mass corresponding clearly to the radiographic lesion, and a 2.5-cm papillary mass in the superior aspect of the renal pelvis (Fig. 3). Intraoperative frozen section of the papillary mass confirmed a UC of the renal pelvis. The surgical team was alerted, and the patient's Pfannenstiel incision was extended to allow a right ureterectomy to be performed.Final pathology confirmed the presence of 2 distinct malignancies. A cortical RCC of primarily clear cell histology was present, with Fuhrman nuclear grade 3 of 4, and no invasion of the renal capsule (Fig. 4). There was, however, microscopic invasion of a medium-sized renal vein. The second tumour was a high-grade UC with invasion through the muscularis propria of the renal pelvis and extension into renal sinus fat (Fig. 5). ...

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The Impact of Tumor Location on Prognosis of Transitional Cell Carcinoma of the Upper Urinary Tract

Cited by 161 publications

References 15 publications

Independent predictors of cancer‐specific survival in transitional cell carcinoma of the upper urinary tract

Independent predictors of cancer‐specific survival in transitional cell carcinoma of the upper urinary tract

pT classification, grade, and vascular invasion as prognostic indicators in urothelial carcinoma of the upper urinary tract

Synchronous ipsilateral renal cell carcinoma and urothelial carcinoma of the renal pelvis

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