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Journal of Cancer Research and Clinical Oncology

Published in:

01-03-2014 | Original Paper

Risk factors and treatment outcomes of new contralateral upper urinary urothelial carcinoma after nephroureterectomy: the experiences of a large Chinese center

Authors: Dong Fang, Lei Zhang, Xuesong Li, Gengyan Xiong, Xiaopeng Chen, Wenke Han, Zhisong He, Liqun Zhou

Published in: Journal of Cancer Research and Clinical Oncology | Issue 3/2014

Abstract

Objective

To explore the risk factors and treatment outcomes of contralateral new upper tract urothelial carcinoma (UTUC) after nephroureterectomy in a large single-center cohort of UTUC patients.

Methods

A retrospective analysis of the clinicopathological data of 509 consecutive patients treated by nephroureterectomy from 2000 to 2010 at a high-volume center in China was conducted.

Results

Thirty-five patients (6.9 %) were found to develop contralateral UTUC. Gross hematuria was a common symptom, and aristolochic acid (AA) containing Chinese herbs was identified as an underlying cause. In multivariate analysis, renal transplant recipients (HR = 16.507) and preoperative renal insufficiency (HR = 2.523) were independent risk factors. No correlation was found in the clinical and pathological characteristics of primary and subsequent contralateral UTUC. A second round of nephroureterectomy should be performed on renal transplant patients, whereas patients who are older, exhibit relatively better renal function, and have tumors that are single, located in the ureter and small size could be treated with nephron-sparing surgery. No survival difference was detected between the two treatment groups, and developing contralateral UTUC was not associated with worse survival.

Conclusion

Contralateral UTUC is comparatively rare, and gross hematuria is a common symptom. Renal transplant history and renal insufficiency are independent risk factors, and prophylactic contralateral nephroureterectomy is considered for uremic UTUC patients with proper renal replacement treatment or renal transplant recipients. These features are likely related to the mechanisms of multifocality of UTUC, and the potential correlation with AA remains to be elucidated. Tumor characteristics and renal function are informative for the decisions concerning surgical options for contralateral UTUC.

Bloom NA, Vidone RA, Lytton B (1970) Primary carcinoma of the ureter: a report of 102 new cases. J Urol 103(5):590–598PubMed

Charbit L, Gendreau MC, Mee S, Cukier J (1991) Tumors of the upper urinary tract: 10 years of experience. J Urol 146(5):1243–1246PubMed

Chen CH, Dickman KG, Huang CY, Moriya M, Shun CT, Tai HC, Huang KH, Wang SM, Lee YJ, Grollman AP, Pu YS (2013) Aristolochic acid-induced upper tract urothelial carcinoma in Taiwan: clinical characteristics and outcomes. Int J Cancer 133(1):14–20PubMedCrossRef

Colin P, Ouzzane A, Pignot G, Ravier E, Crouzet S, Ariane MM, Audouin M, Neuzillet Y, Albouy B, Hurel S, Saint F, Guillotreau J, Guy L, Bigot P, De La Taille A, Arroua F, Marchand C, Matte A, Fais PO, Roupret M (2012) Comparison of oncological outcomes after segmental ureterectomy or radical nephroureterectomy in urothelial carcinomas of the upper urinary tract: results from a large French multicentre study. BJU Int 110(8):1134–1141PubMedCrossRef

Cosyns JP, Jadoul M, Squifflet JP, Wese FX, van Ypersele de Strihou C (1999) Urothelial lesions in Chinese-herb nephropathy. Am J Kidney Dis 33(6):1011–1017PubMedCrossRef

Cummings KB (1980) Nephroureterectomy: rationale in the management of transitional cell carcinoma of the upper urinary tract. Urol Clin N Am 7(3):569–578

Gadzinski AJ, Roberts WW, Faerber GJ, Wolf JS Jr (2010) Long-term outcomes of nephroureterectomy versus endoscopic management for upper tract urothelial carcinoma. J Urol 183(6):2148–2153PubMedCrossRef

Habuchi T, Takahashi R, Yamada H, Kakehi Y, Sugiyama T, Yoshida O (1993) Metachronous multifocal development of urothelial cancers by intraluminal seeding. Lancet 342(8879):1087–1088PubMedCrossRef

Hafner C, Knuechel R, Zanardo L, Dietmaier W, Blaszyk H, Cheville J, Hofstaedter F, Hartmann A (2001) Evidence for oligoclonality and tumor spread by intraluminal seeding in multifocal urothelial carcinomas of the upper and lower urinary tract. Oncogene 20(35):4910–4915PubMedCrossRef

Holmang S, Johansson SL (2006) Bilateral metachronous ureteral and renal pelvic carcinomas: incidence, clinical presentation, histopathology, treatment and outcome. J Urol 175(1):69–72 (discussion 72–63)PubMedCrossRef

Hou HJ, Xiao J, Tian Y (2013) Contralateral nephroureterectomy for renal transplant recipients with unilateral upper urinary tract transitional cell carcinoma: a report of 12 cases. Transplant Proc 45(6):2203–2206PubMedCrossRef

Kang CH, Yu TJ, Hsieh HH, Yang JW, Shu K, Huang CC, Chiang PH, Shiue YL (2003) The development of bladder tumors and contralateral upper urinary tract tumors after primary transitional cell carcinoma of the upper urinary tract. Cancer 98(8):1620–1626PubMedCrossRef

Li CC, Chang TH, Wu WJ, Ke HL, Huang SP, Tsai PC, Chang SJ, Shen JT, Chou YH, Huang CH (2008a) Significant predictive factors for prognosis of primary upper urinary tract cancer after radical nephroureterectomy in Taiwanese patients. Eur Urol 54(5):1127–1134PubMedCrossRef

Li XB, Xing NZ, Wang Y, Hu XP, Yin H, Zhang XD (2008b) Transitional cell carcinoma in renal transplant recipients: a single center experience. Int J Urol 15(1):53–57PubMedCrossRef

Li HZ, Xia M, Han Y, Xu XG, Zhang YS (2009) De novo urothelial carcinoma in kidney transplantation patients with end-stage aristolochic acid nephropathy in China. Urol Int 83(2):200–205PubMedCrossRef

Li WM, Shen JT, Li CC, Ke HL, Wei YC, Wu WJ, Chou YH, Huang CH (2010) Oncologic outcomes following three different approaches to the distal ureter and bladder cuff in nephroureterectomy for primary upper urinary tract urothelial carcinoma. Eur Urol 57(6):963–969PubMedCrossRef

Liao CH, Chueh SC, Lai MK, Chen J (2004) Transitional cell carcinoma in renal transplant recipients. Transplant Proc 36(7):2152–2153PubMedCrossRef

Ma YC, Zuo L, Chen JH, Luo Q, Yu XQ, Li Y, Xu JS, Huang SM, Wang LN, Huang W, Wang M, Xu GB, Wang HY (2006) Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol 17(10):2937–2944PubMedCrossRef

Millan-Rodriguez F, Chechile-Toniolo G, Salvador-Bayarri J, Huguet-Perez J, Vicente-Rodriguez J (2000) Upper urinary tract tumors after primary superficial bladder tumors: prognostic factors and risk groups. J Urol 164(4):1183–1187PubMedCrossRef

Miyake H, Hara I, Kamidono S, Eto H (2004) Multifocal transitional cell carcinoma of the bladder and upper urinary tract: molecular screening of clonal origin by characterizing CD44 alternative splicing patterns. J Urol 172(3):1127–1129PubMedCrossRef

Mufti GR, Gove JR, Badenoch DF, Fowler CG, Tiptaft RC, England HR, Paris AM, Singh M, Hall MH, Blandy JP (1989) Transitional cell carcinoma of the renal pelvis and ureter. Br J Urol 63(2):135–140PubMedCrossRef

Nakazawa R, Miyano S, Sasaki H, Kudo H, Kimura K, Chikaraishi T (2011) Synchronous bilateral urothelial cancer in a kidney recipient. Int J Urol 18(12):847–850PubMedCrossRef

Nortier JL, Martinez MC, Schmeiser HH, Arlt VM, Bieler CA, Petein M, Depierreux MF, De Pauw L, Abramowicz D, Vereerstraeten P, Vanherweghem JL (2000) Urothelial carcinoma associated with the use of a Chinese herb (Aristolochia fangchi). N Engl J Med 342(23):1686–1692PubMedCrossRef

Novara G, De Marco V, Dalpiaz O, Galfano A, Bouygues V, Gardiman M, Martignoni G, Patard JJ, Artibani W, Ficarra V (2009) Independent predictors of contralateral metachronous upper urinary tract transitional cell carcinoma after nephroureterectomy: multi-institutional dataset from three European centers. Int J Urol 16(2):187–191PubMedCrossRef

Roupret M, Babjuk M, Comperat E, Zigeuner R, Sylvester R, Burger M, Cowan N, Bohle A, Van Rhijn BW, Kaasinen E, Palou J, Shariat SF (2013) European guidelines on upper tract urothelial carcinomas: 2013 update. Eur Urol 63(6):1059–1071PubMedCrossRef

Stewart JH, Vajdic CM, van Leeuwen MT, Amin J, Webster AC, Chapman JR, McDonald SP, Grulich AE, McCredie MR (2009) The pattern of excess cancer in dialysis and transplantation. Nephrol Dial Transplant 24(10):3225–3231PubMedCrossRef

Wu MJ, Lian JD, Yang CR, Cheng CH, Chen CH, Lee WC, Shu KH, Tang MJ (2004) High cumulative incidence of urinary tract transitional cell carcinoma after kidney transplantation in Taiwan. Am J Kidney Dis 43(6):1091–1097PubMedCrossRef

Wu CF, Chang PL, Chen CS, Chuang CK, Weng HH, Pang ST (2006) The outcome of patients on dialysis with upper urinary tract transitional cell carcinoma. J Urol 176(2):477–481PubMedCrossRef

Xiong G, Chen X, Li X, Fang D, Zhang L, Yang L, Zhang L, Yao L, He Z, Zhou L (2013) Prevalence and factors associated with baseline chronic kidney disease in China: a 10-year study of 785 upper urinary tract urothelial carcinoma patients. J Formos Med Assoc. doi: 10.1016/j.jfma.2013.04.001. [Epub ahead of print]

Title: Risk factors and treatment outcomes of new contralateral upper urinary urothelial carcinoma after nephroureterectomy: the experiences of a large Chinese center
Authors: Dong Fang
Lei Zhang
Xuesong Li
Gengyan Xiong
Xiaopeng Chen
Wenke Han
Zhisong He
Liqun Zhou
Publication date: 01-03-2014
Publisher: Springer Berlin Heidelberg
Published in: Journal of Cancer Research and Clinical Oncology / Issue 3/2014
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-014-1585-7

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Abstract

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Conclusion

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