Top

World Journal of Urology

Published in:

01-02-2013 | Topic paper

Results and outcomes after endoscopic treatment of upper urinary tract carcinoma: the Austrian experience

Authors: Harun Fajkovic, Tobias Klatte, Udo Nagele, Michael Dunzinger, Richard Zigeuner, Wilhelm Hübner, Mesut Remzi

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

Abstract

Introduction

Through evolution in technology, endoscopic treatment has gained popularity for the treatment of upper tract urothelial carcinoma (ENDO-UTUC).

Methods

A total of 20 patients with ENDO-UTUC were compared to 178 treated by radical nephroureterectomy (RNU) for a pTa-1 UTUC, and a systematic review was performed.

Results

Mean age for ENDO-UTUC was 71.9 ± 16.0 years, and tumor features were favorable (90 % papillary, 14 low grade, 11 pTa). All ENDO-UTUC were performed ureteroscopically. Mean follow-up was 20.4 ± 30 months. The 5-year overall survival (OS) rate was 45 %. Local (LR) and bladder recurrence (BR) was 25 and 15 %. Time to definitive treatment was longer, ASA higher, LR rates higher, OS lower for ENDO-UTUC (all p < 0.001), but no difference was recorded for BR (p = 0.056) and cancer-specific survival (CSS) (p = 0.364). Postoperative kidney function (KF) was better in the ENDO-UTUC (p = 0.048), though preoperative KF showed no difference. The maximal level of evidence was 3b, patients were highly selected, numbers of patients were low, and ASA scores high. OS was rather low and CSS high. LR rate was high (61 %) and BR rate moderate (39 %) for ureteroscopic and 36 and 28 %, respectively, for percutaneous approach.

Conclusions

LR for ENDO-UTUC is high. In high-grade UTUC, oncological outcome is worse. RNU is associated with a significant loss of KF, but LR is rare. ENDO-UTUC is reserved for selected cases if elective. In imperative cases, it has to be balanced between KF, morbidity of the procedure, risk of operation and tumor control. ENDO-UTUC is not necessarily underused in Austria, because of lack in evidence, but 41 % of all RNU were performed in pTa/pTis/pT1 lesions.

Munoz JJ, Ellison LM (2000) Upper tract urothelial neoplasms: incidence and survival during the last 2 decades. J Urol 164(5):1523–1525PubMedCrossRef

Rouprêt M, Zigeuner R, Palou J, Boehle A, Kaasinen E, Sylvester R, Babjuk M, Oosterlinck W (2011) European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update. Eur Urol 59(4):584–594PubMedCrossRef

Margulis V, Shariat SF, Matin SF, Kamat AM, Zigeuner R, Kikuchi E, Lotan Y, Weizer A, Raman JD, Wood CG, Collaboration UTUCCUTUC (2009) Outcomes of radical nephroureterectomy: a series from the upper tract urothelial carcinoma collaboration. Cancer 115(6):1224–1233PubMedCrossRef

Kaag MG, O’Malley RL, O’Malley P et al (2010) Changes in renal function following nephroureterectomy may affect the use of perioperative chemotherapy. Eur Urol 58(4):581–587PubMedCrossRef

Zhang QL, Rothenbacher D (2008) „Prevalence of chronic kidney disease in population-based studies: systematic review”. BMC public health 8:117PubMedCrossRef

USRDS (2010) United States Renal Data System 2010 Annual Data Report. Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD http://www.usrds.org/2010/pdf/v1_04.pdf

Cutress ML, Stewart GD, Wells-Cole S, Phipps S, Thomas BG, Tolley DA (2012) Long-term endoscopic management of upper tract urothelial carcinoma: 20-year single-centre experience. BJU Int. doi:10.1111/j.1464-410X.2012.11169.x

Grasso M, Fishman AI, Cohen J, Alexander B (2012) Ureteroscopic and extirpative treatment of upper urinary tract urothelial carcinoma: a 15-year comprehensive review of 160 consecutive patients. BJU Int doi. doi:10.1111/j.1464-410X.2012.11066.x

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

10.

Cornu JN, Rouprêt M, Carpentier X, Geavlete B, de Medina SG, Cussenot O, Traxer O (2010) Oncologic control obtained after exclusive flexible ureteroscopic management of upper urinary tract urothelial cell carcinoma. World J Urol 28(2):151–156PubMedCrossRef

11.

Pak RW, Moskowitz EJ, Bagley DH (2009) What is the cost of maintaining a kidney in upper-tract transitional-cell carcinoma? An objective analysis of cost and survival. J Endourol 23(3):341–346PubMedCrossRef

12.

Lucas SM, Svatek RS, Olgin G, Arriaga Y, Kabbani W, Sagalowsky AI, Lotan Y (2008) Conservative management in selected patients with upper tract urothelial carcinoma compares favourably with early radical surgery. BJU Int 102:172–176PubMedCrossRef

13.

Painter DJ, Denton K, Timoney AG, Keeley FX (2008) Ureteroscopic management of upper-tract urothelial cancer: an exciting nephron-sparing option or an unacceptable risk? J Endourol 22(6):1237–1239PubMedCrossRef

14.

Krambeck AE, Thompson RH, Lohse CM, Patterson DE, Segura JW, Zincke H, Elliott DS, Blute ML (2007) Endoscopic management of upper tract urothelial carcinoma in patients with a history of bladder urothelial carcinoma. J Urol 177(5):1721–1726PubMedCrossRef

15.

Reisiger K, Hruby G, Clayman and Landman RV, Landman J (2007) Office-based surveillance ureteroscopy after endoscopic treatment of transitional cell carcinoma: technique and clinical outcome. Urology 70:263–266PubMedCrossRef

16.

Rouprêt M, Hupertan V, Traxer O, Loison G, Chartier-Kastler E, Conort P, Bitker MO, Gattegno B, Richard F, Cussenot O (2006) Comparison of open nephroureterectomy and ureteroscopic and percutaneous management of upper urinary tract transitional cell carcinoma. Urology 67(6):1181–1187PubMedCrossRef

17.

Johnson GB, Fraiman M, Grasso M (2005) “Broadening experience with the retrograde endoscopic management of upper urinary tract urothelial malignancies. B JU Int 95(Suppl.2):110–113

18.

Iborra I, Solsona E, Casanova J, Ricós JV, Rubio J, Climent MA (2003) Conservative elective treatment of upper urinary tract tumors: a multivariate analysis of prognostic factors for recurrence and progression. J Urol 169(1):82–85PubMedCrossRef

19.

Matsuoka K, Lida S, Tomiyasu K, Inoue M, Noda S (2003) Transurethral endoscopic treatment of upper urinary tract tumors using a holmium: YAG laser. Lasers Surg Med 32:336–340PubMedCrossRef

20.

Daneshmand S, Quek ML, Huffman JL (2003) Endoscopic management of upper urinary tract transitional cell carcinoma:long-term experience. Cancer 98:55–60PubMedCrossRef

21.

Engelmyer EI, Belis JA (1996) Long-term ureteroscopic management of low-grade transitional cell carcinoma of the upper urinary tract. Tech Urol 2(2):113–116PubMed

22.

Gaboardi F, Bozzola A, Dotti E, Galli L (1994) Conservative treatment of upper urinary tract tumors with Nd: YAG laser. J Endourol 8:37–41PubMedCrossRef

23.

Andersen JR, Kristensen JK (1994) Ureteroscopic management of transitional cell tumors. Scand J Urol Nephrol 28:153–157PubMedCrossRef

24.

Schmeller NT, Hofstetter AG (1989) Laser treatment of ureteral tumors. J Urol 141(4):840–843PubMed

25.

Wolf SJ Jr (2009) Are we underutilizing minimally invasive approaches for upper tract urothelial carcinoma? Urol Oncol 27(1):75–80PubMedCrossRef

26.

Remzi M, Haitel A, Margulis V et al (2009) Tumour architecture is an independent predictor of outcomes after nephroureterectomy: a multi-institutional analysis of 1363 patients. BJU Int 103(3):307–311PubMedCrossRef

27.

Tavora F, Fajardo DA, Lee TK, Lotan T, Miller JS, Miyamoto H, Epstein JI (2009) Small endoscopic biopsies of the ureter and renal pelvis: pathologic pitfalls. Am J Surg Pathol 33(10):1540–1546PubMedCrossRef

28.

Roupret M, Traxer O, Tligui M et al (2007) Upper urinary tract transitional cell carcinoma: recurrence rate after percutaneous endoscopic resection. Eur Urol 51:709–714PubMedCrossRef

29.

Rink M, Fajkovic H, Cha EK, Gupta A, Karakiewicz PI, Chun FK, Lotan Y, Shariat SF (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):854–855PubMedCrossRef

30.

Rastinehad AR, Ost MC, Vanderbrink BA, Greenberg KL, El-Hakim A, Marcovich R, Badlani GH, Smith AD (2009) A 20-year experience with percutaneous resection of upper tract transitional carcinoma: is there an oncologic benefit with adjuvant bacillus Calmette Guérin therapy? Urology 73(1):27–31PubMedCrossRef

31.

Palou J, Caparrós J, Orsola A, Xavier B, Vicente J (1995) Transurethral resection of the intramural ureter as the first step of nephroureterectomy. J Urol 154(1):43–44PubMedCrossRef

32.

Goel MC, Mahendra V, Roberts JG (2003) Percutaneous management of renal pelvic urothelial tumors: long-term followup. J Urol 169(3):925–929; discussion 929–930

33.

Clark PE, Streem SB, Geisinger MA (1999) 13-year experience with percutaneous management of upper tract transitional cell carcinoma. J Urol 161(3):772–775; discussion 775–776

34.

Patel A, Soonawalla P, Shepherd SF, Dearnaley DP, Kellett MJ, Woodhouse CR (1996) Long-term outcome after percutaneous treatment of transitional cell carcinoma of the renal pelvis. J Urol 155:868–874PubMedCrossRef

35.

Plancke HR, Strijbos WE, Delaere KP (1995) Percutaneous endoscopic treatment of urothelial tumours of the renal pelvis. Br J Urol 75:736–739PubMedCrossRef

36.

Fuglsig S, Krarup T (1995) Percutaneous nephroscopic resection of renal pelvic tumors. Scand J Urol Nephrol 172:15–17

37.

Tasca A, Zattoni F, Garbeglio A, Villi G, Bassi P, Meneghini A (1992) Endourologic treatment of transitional cell carcinoma of the upper urinary tract. J Endourol 6:253–256CrossRef

38.

Raymundo EM, Lipkin ME, Bañez LB, Mancini JG, Zilberman DE, Preminger GM, Inman BA (2011) Third prize: the role of endoscopic nephron-sparing surgery in the management of upper tract urothelial carcinoma. J Endourol 25(3):377–384PubMedCrossRef

39.

Thompson RH, Krambeck AE, Lohse CM, Elliott DS, Patterson DE, Blute ML (2008) Elective endoscopic management of transitional cell carcinoma first diagnosed in the upper urinary tract. BJU Int 102(9):1107–1110PubMedCrossRef

40.

Suh RS, Faerber GJ, Wolf JS (2003) Predictive factors for applicability and success with endoscopic treatment of upper tract urothelial carcinoma. J Urol 170(6 Pt 1):2209–2216PubMedCrossRef

41.

Deligne E, Colombel M, Badet L, Taniere P, Rouviere O, Dubernard JM, Lezrek M, Gelet A, Martin X (2002) Conservative management of upper urinary tract tumors. Eur Urol 42(1):43–48PubMedCrossRef

42.

Martínez-Piñeiro JA, García Matres MJ, Martínez-Piñeiro L (1996) Endourological treatment of upper tract urothelial carcinomas: analysis of a series of 59 tumors. J Urol 156(2 Pt 1):377–385PubMed

43.

Bagley DH, Grasso M (2010) Ureteroscopic laser treatment of upper urinary tract neoplasms. World J Urol 28:143–149PubMedCrossRef

44.

Remzi M, Shariat S, Huebner W, Fajkovic H, Seitz C (2011) Upper urinary tract urothelial carcinoma: what have we learned in the last 4 years? Ther Adv Urol 3(2):69–80PubMedCrossRef

45.

Remzi M, Javadli E, Özsoy M (2010) Management of small renal masses: a review. World J Urol 28(3):275–281PubMedCrossRef

46.

Jeldres C, Lughezzani G, Sun M, Isbarn H, Shariat SF, Budäus L, Lattouf JB, Widmer H, Graefen M, Montorsi F, Perrotte P, Karakiewicz P (2010) Segmental ureterectomy can safely be performed in patients with transitional cell carcinoma of the ureter. J Urol 183(4):1324–1329PubMedCrossRef

47.

Chen GL, Bagley DH (2000) Ureteroscopic management of upper tract transitional cell carcinoma in patients with normal contralateral kidneys. J Urol 164:1173–1176PubMedCrossRef

48.

Brown GA, Matin SF, Busby JE et al (2007) Ability of clinical grade to predict final pathologic stage in upper urinary tract transitional cell carcinoma: implications for therapy. Urology. 70:252–256PubMedCrossRef

49.

Wang JK, Tollefson MK, Krambeck AE, Trost LW, Thompson RH (2012) High Rate of Pathologic Upgrading at Nephroureterectomy for upper tract urothelial carcinoma. Urology 79:615–619

50.

Cutress MLl, Stewart GD, Zakikhani P, Phipps S, Thomas BG, Tolley DA (2012) Ureteroscopic and percutaneous management of upper tract urothelial carcinoma (UTUC): systematic review. BJU Int. doi:10.1111/j.1464-410X.2012.11068.x

51.

Weizer AZ, Faerber GJ, Wolf JS Jr (2007) Progression of disease despite good endoscopic local control of upper tract urothelial carcinoma. Urology 70(3):469–472PubMedCrossRef

52.

Xylinas E, Rink M, Cha EK, Clozel T, Lee RK, Fajkovic H, Comploj E, Novara G, Margulis V, Raman JD et al (2012) Impact of distal ureter management on oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma. Eur Urol. doi:10.1016/j.eururo.2012.04.052

53.

O’Brien T, Ray E, Singh R, Coker B, Beard R (2011) Prevention of bladder tumours after nephroureterectomy for primary upper urinary tract urothelial carcinoma: a prospective, multicentre, randomised clinical trial of a single postoperative intravesical dose of mitomycin C (the ODMIT-C Trial). Eur Urol 60(4):703–710PubMedCrossRef

Title: Results and outcomes after endoscopic treatment of upper urinary tract carcinoma: the Austrian experience
Authors: Harun Fajkovic
Tobias Klatte
Udo Nagele
Michael Dunzinger
Richard Zigeuner
Wilhelm Hübner
Mesut Remzi
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/s00345-012-0948-4

At a glance: The STEP trials

Springer Medicine

Results and outcomes after endoscopic treatment of upper urinary tract carcinoma: the Austrian experience

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2013

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

Evaluation of bladder capacity in Korean children younger than 24 months: a nationwide multicenter study

Transperitoneal laparoscopic nephroureterectomy for native upper tract urothelial carcinoma in renal transplant recipients

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

Mapping the cytokine profile of painful bladder syndrome/interstitial cystitis in human bladder and urine specimens

Distinct patterns and behaviour of urothelial carcinoma with respect to anatomical location: how molecular biomarkers can augment clinico-pathological predictors in upper urinary tract tumours