Top

Published in:

01-02-2013 | Topic paper

Intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinomas: predictors and impact on subsequent oncological outcomes from a national multicenter study

Authors: Evanguelos Xylinas, Pierre Colin, François Audenet, Véronique Phe, Luc Cormier, Olivier Cussenot, Alain Houlgatte, Gilles Karsenty, Franck Bruyère, Thomas Polguer, Alain Ruffion, Antoine Valeri, François Rozet, Jean-Alexandre Long, Marc Zerbib, Morgan Rouprêt

Published in: World Journal of Urology | Issue 1/2013

Abstract

Objectives

To identify predictive factors and assess the impact on oncological outcomes of intravesical recurrence after radical nephroureterectomy (RNU) in upper tract urothelial carcinoma (UTUC).

Methods

Using a national multicentric retrospective dataset, we identified all patients with UTUC who underwent a RNU between 1995 and 2010 (n = 482). Intravesical recurrence was tested as a prognostic factor for survival through univariable and multivariable Cox regression analysis.

Results

Overall, intravesical recurrence occurred in 169 patients (35 %) with a median age of 69.2 years (IQR: 60–76) and after a median follow-up of 39.5 months (IQR: 25–60). Actuarial intravesical recurrence-free survival estimates at 2 and 5 years after RNU were 72 and 45 %, respectively. On univariable analyses, previous history of bladder tumor, tumor multifocality, laparoscopic approach, pathological T-stage, presence of concomitant CIS and lymphovascular invasion were all associated with intravesical recurrence. On multivariable analysis, previous history of bladder cancer, tumor multifocality and laparoscopic approach remained independent predictors of intravesical recurrence. Existence of intravesical recurrence was not correlated with worst oncological outcomes in terms of disease recurrence (p = 0.075) and cancer-specific mortality (p = 0.06).

Conclusions

In the current study, intravesical recurrence occurred in 35 % of patients with UTUC after RNU. Previous history of bladder cancer, tumor multifocality, concomitant CIS and laparoscopic approach were independent predictors of intravesical recurrence. These findings are in line with recent published data and should be considered carefully to provide a definitive surveillance protocol regarding management of urothelial carcinomas regardless of the location of urothelial carcinomas in the whole urinary tract.

Margulis V, Shariat SF, Matin SF et al (2009) Outcomes of radical nephroureterectomy: a series from the upper tract urothelial carcinoma collaboration. Cancer 115:1224–1233PubMedCrossRef

Rouprêt M, Zigeuner R, Palou J et al (2011) European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update. Eur Urol 59:584–594PubMedCrossRef

Raman JD, Ng CK, Boorjian SA, Vaughan ED Jr, Sosa RE, Scherr DS (2005) Bladder cancer after managing upper urinary tract transitional cell carcinoma: predictive factors and pathology. BJU Int 96:1031–1035PubMedCrossRef

Zigeuner RE, Hutterer G, Chromecki T, Rehak P, Langner C (2006) Bladder tumour development after urothelial carcinoma of the upper urinary tract is related to primary tumour location. BJU Int 98:1181–1186PubMedCrossRef

Novara G, De Marco V, Dalpiaz O et al (2008) Independent predictors of metachronous bladder transitional cell carcinoma (TCC) after nephroureterectomy for TCC of the upper urinary tract. BJU Int 101:1368–1374PubMedCrossRef

Mullerad M, Russo P, Golijanin D et al (2004) Bladder cancer as a prognostic factor for upper tract transitional cell carcinoma. J Urol 172:2177–2181PubMedCrossRef

Rabbani F, Perrotti M, Russo P, Herr HW (2001) Upper-tract tumors after an initial diagnosis of bladder cancer: argument for long-term surveillance. J Clin Oncol 19:94–100PubMed

Wheat JC, Weizer AZ, Wolf JS, et al (2012) Concomitant carcinoma in situ is a feature of aggressive disease in patients with organ confined urothelial carcinoma following radical nephroureterectomy. Urol Oncol 30(3):252–258

Pieras E, Frontera G, Ruiz X et al (2010) Concomitant carcinoma in situ and tumour size are prognostic factors for bladder recurrence after nephroureterectomy for upper tract transitional cell carcinoma. BJU Int 106:1319–1323PubMedCrossRef

10.

Otto W, Shariat SF, Fritsche HM et al (2011) Concomitant carcinoma in situ as an independent prognostic parameter for recurrence and survival in upper tract urothelial carcinoma: a multicenter analysis of 772 patients. World J Urol 29:487–494PubMedCrossRef

11.

Xylinas E, Rink M, Cha EK, et al (2012) Impact of distal ureter management on oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma. Eur Urol. http://dx.doi.org/10.1016/j.eururo.2012.04.052

12.

Greene FL, Balch CM, Fleming ID et al (2002) AJCC cancer staging handbook: TNM classification of malignant tumors, 6th edn. American Joint Committee on Cancer, Chicago, IL

13.

Epstein JI, Amin MB, Reuter VR, Mostofi FK (1998) The World Health Organization/International Society of Urological Pathology consensus classification of urothelial (transitional cell) neoplasms of the urinary bladder. Bladder Consensus Conference Committee. Am J Surg Pathol 22:1435–1448

14.

Ouzzane A, Colin P, Xylinas E et al (2011) Ureteral and multifocal tumours have worse prognosis than renal pelvic tumours in urothelial carcinoma of the upper urinary tract treated by nephroureterectomy. Eur Urol 60:1258–1265PubMedCrossRef

15.

Chromecki TF, Cha EK, Fajkovic H et al (2012) The impact of tumor multifocality on outcomes in patients treated with radical nephroureterectomy. Eur Urol 61:245–253PubMedCrossRef

16.

Novara G, Matsumoto K, Kassouf W et al (2010) Prognostic role of lymphovascular invasion in patients with urothelial carcinoma of the upper urinary tract: an international validation study. Eur Urol 57:1064–1071PubMedCrossRef

17.

Rink M, Fajkovic H, Cha EK, et al (2012) Death certificates are valid for the determination of cause of death in patients with upper and lower tract urothelial carcinoma. Eur Urol 61(4):854–855

18.

Volkmer BG, Schnoeller T, Kuefer R, Gust K, Finter F, Hautmann RE (2009) Upper urinary tract recurrence after radical cystectomy for bladder cancer—who is at risk? J Urol 182:2632–2637PubMedCrossRef

19.

Xylinas E, Rink M, Margulis V et al (2012) Multifocal carcinoma in situ of the upper tract is associated with high risk of bladder cancer recurrence. Eur Urol 61:1069–1070PubMedCrossRef

20.

Ariane MM, Colin P, Ouzzane A et al (2012) Assessment of oncologic control obtained after open versus laparoscopic nephroureterectomy for upper urinary tract urothelial carcinomas (UUT-UCs): results from a large French multicenter collaborative study. Ann Surg Oncol 19:301–308PubMedCrossRef

21.

Favaretto RL, Shariat SF, Chade DC et al (2010) Comparison between laparoscopic and open radical nephroureterectomy in a contemporary group of patients: are recurrence and disease-specific survival associated with surgical technique? Eur Urol 58:645–651PubMedCrossRef

22.

Capitanio U, Shariat SF, Isbarn H et al (2009) Comparison of oncologic outcomes for open and laparoscopic nephroureterectomy: a multi-institutional analysis of 1249 cases. Eur Urol 56:1–9PubMedCrossRef

23.

Walton TJ, Novara G, Matsumoto K et al (2011) Oncological outcomes after laparoscopic and open radical nephroureterectomy: results from an international cohort. BJU Int 108:406–412PubMedCrossRef

24.

O’Brien T, Ray E, Singh R, Coker B, Beard R, British Association of Urological Surgeons Section of Oncology (2011) Prevention of bladder tumours after nephroureterectomy for primary upper urinary tract urothelial carcinoma: a prospective, multicentre, randomized clinical trial of a single postoperative intravesical dose of mitomycin C (the ODMIT-C Trial). Eur Urol 60:703–710PubMedCrossRef

Title: Intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinomas: predictors and impact on subsequent oncological outcomes from a national multicenter study
Authors: Evanguelos Xylinas
Pierre Colin
François Audenet
Véronique Phe
Luc Cormier
Olivier Cussenot
Alain Houlgatte
Gilles Karsenty
Franck Bruyère
Thomas Polguer
Alain Ruffion
Antoine Valeri
François Rozet
Jean-Alexandre Long
Marc Zerbib
Morgan Rouprêt
Publication date: 01-02-2013
Publisher: Springer-Verlag
Published in: World Journal of Urology / Issue 1/2013
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-012-0957-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinomas: predictors and impact on subsequent oncological outcomes from a national multicenter study

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2013

Ureteral tumours showing a worse prognosis than renal pelvis tumours may be attributed to ureteral tumours more likely to have hydronephrosis and less likely to have haematuria

The oncologic impact of a delay between diagnosis and radical nephroureterectomy due to diagnostic ureteroscopy in upper urinary tract urothelial carcinomas: results from a large collaborative database

Genetic polymorphisms on 8q24.1 and 4p16.3 are not linked with urothelial carcinoma of the bladder in contrast to their association with aggressive upper urinary tract tumours

The method of bladder cuff excision during laparoscopic radical nephroureterectomy does not affect oncologic outcomes in upper tract urothelial carcinoma

A systematic review of the tools available for predicting survival and managing patients with urothelial carcinomas of the bladder and of the upper tract in a curative setting

Urothelial carcinomas of the upper urinary tract are now recognised as a true and distinct entity from bladder cancer and belong fully to the broad spectrum of onco-urologic neoplasms