The Significance of Functional Renal Obstruction in Predicting Pathologic Stage of Upper Tract Urothelial Carcinoma

Abstract

Background and Purpose: Assessing the severity of upper tract urothelial carcinoma (UTUC) has been difficult because of inadequate biopsy specimens. Additional predictive parameters of disease stage would be useful when deciding a treatment plan; it has been suggested that preoperative hydronephrosis can be a surrogate. We examined the relationship between preoperative ipsilateral renal obstruction identified by imaging with final pathologic stage after nephroureterectomy (NU) for UTUC. We then analyzed those patients with ipsilateral renal obstruction and examined if tumor location is associated with an advanced pathologic stage. Methods: Patients who underwent NU for UTUC between the years 2001 to 2013 were analyzed and relevant staging studies and pathology were reviewed. Criteria for ipsilateral renal obstruction were defined by the presence of a delayed nephrogram on CT scan, renal cortical atrophy with associated hydronephrosis on crosssectional imaging, and/or >10% split function discrepancy on nuclear renal scintigraphy with associated hydronephrosis. Results: Eighty-two patients met inclusion criteria; 26/82 (31.7%) had locally advanced disease (pT 3 /T 4 ), while 56/82 (63.4%) had organ-confined ( £ pT 2 ) disease. Of the patients with pT 3 /T 4 disease, 10/26 (38.5%) demonstrated radiographic evidence of functional obstruction of the ipsilateral renal unit; similarly, in patients with £ pT 2 disease, 21/56 (37.5%) demonstrated ipsilateral renal obstruction (P = 0.93). Of the patients with ipsilateral renal obstruction, in those patients with pT 3 /T 4 disease, 7/10 (70.0%) had ureteral tumor involvement while 9/21 (42.9%) patients with £ pT 2 disease had tumor in the ureter (P = 0.25). Conclusions: This study suggests that renal obstruction by radiographic analysis does not always predict advanced stage. In addition, there is a trend toward advanced stage when a patient has radiographic evidence of ipsilateral renal dysfunction and a ureteral tumor.

Changes in Renal Function After Nephroureterectomy for Upper Tract Urothelial Cancer in Elderly Patients

“…Hashimoto et al [9] reported that it is reasonable to speculate that the renal function of the diseased kidney is already impaired, and the decrease in eGFR after RNU is expected to be smaller in patients with HN. Moreover, Amirian et al [14] reported that in the ureter, locally advanced tumors theoretically penetrate the muscularis propria, potentially diminishing peristaltic activity, and thus causing obstruction, with HN being the result. In another study, the renal function of patients with UTUC with HN decreased only 5.5 mL/min/1.73 m 2 between the pre-and postoperative periods [8].…”

Role of nuclear medicine SPECTCT methods in the diagnosis of Urinary Tract Urothelial Cell Cancer

“…Поради тези причини е направен анализ на данните от проведено ретроспективно проучване за предоперативна диагноза на ипсилатералната бъбречна обструкция и хидронефроза, както и за определяне на разделната релативна бъбречна функция при уротелни тумори на горния уринарен тракт (23) Въз основа на получените резултати от проведените образни изследвания, могат да се направят следните обобщения и изводи:…”

“…Динамичната нефросцинтиграфия е от съществено значение за определяне на бъбречна функция на контралатералния бъбрек при следоперативното проследяване на болните с уротелните тумори на горния уринарен тракт (22,23), /Фигура 9, Фигура 10/ .…”