Abstract
Aim: This study aimed to evaluate the effect of tumor location based on clinicopathologic features on cancer-specific survival (CSS) of patients who were treated surgically for locally/locally advanced upper tract urothelial carcinoma (UTUC).
Materials and Methods: A single-center series of 145 patients with UTUC who underwent radical nephroureterectomy between May 2010 and August 2019 were included in the study. Patients were stratified based on the location of the tumor as renal pelvis and ureter located tumor. Clinicopathologic characteristics and oncological outcomes were compared according to tumor location and CSS rates after surgery were graphically explored using Kaplan–Meier curves.
Results: At a mean follow-up time of 41.8 (4-124) months after surgery, 65 patients (44.8%) died from UTUC. Kaplan-Meier curves showed that tumor location was not associated with CSS in the analysis performed according to tumor stage, grade, and size. In the analysis that was conducted without regard to tumor location, worse CSS was found for patients with pT3 disease versus those with ≤pT2 and with high-grade tumors versus those with low-grade (p=0.025 and p=0.011, respectively).
Conclusion: Tumor location was not associated with CSS in any of the analyses. Regardless of tumor location, patients with pT3 disease and high-grade tumors, have a worse prognosis. Further studies on prognostic factors are needed to evaluate the advantages of these factors in the management of patients with UTUC.
Keywords
Cancer-specific survival Nephroureterectomy Renal Pelvis Upper tract urothelial carcinoma Ureter
References
- Rouprêt M, Babjuk M, Compérat E, et al.: European Association of Urology Guidelines on Upper Urinary Tract Urothelial Cell Carcinoma: 2015 Update. Eur Urol. 2015, 68:868-79.
- Ristau BT, Tomaszewski JJ, Ost MC: Upper tract urothelial carcinoma: current treatment and outcomes. Urology. 2012, 79:749-56.
- Lughezzani G, Burger M, Margulis V, et al.: Prognostic factors in upper urinary tract urothelial carcinomas: a comprehensive review of the current literature. Eur Urol. 2012, 62:100-14.
- Milojevic B, Djokic M, Sipetic-Grujicic S, et al.: Upper urinary tract transitional cell carcinoma: location is not correlated with prognosis. BJU Int. 2012, 109:1037-42.
- Joshi SS, Quast LL, Chang SS, Patel SG: Effects of tumor size and location on survival in upper tract urothelial carcinoma after nephroureterectomy. Indian J Urol. 2018, 34:68-73.
- Espiritu PN, Sverrisson EF, Sexton WJ, Pow-Sang JM, Poch MA, Dhillon J, Spiess PE: Effect of tumor size on recurrence-free survival of upper tract urothelial carcinoma following surgical resection. Urol Oncol. 2014, 32:619-24.
- Simone G, Papalia R, Loreto A, Leonardo C, Sentinelli S, Gallucci M: Independent prognostic value of tumour diameter and tumour necrosis in upper urinary tract urothelial carcinoma. BJU Int. 2009, 103:1052-7.
- Brierley J, Gospodarowicz Mk, Wittekind C: TNM classification of malignant tumours. Oxford UK: Blackwell publishing Ltd, 2017.
- Cha EK, Shariat SF, Kormaksson M, et al.: Predicting clinical outcomes after radical nephroureterectomy for upper tract urothelial carcinoma. Eur Urol. 2012, 61:818-25.
- Rouprêt M, Hupertan V, Seisen T, et al. French National Database on Upper Tract Tumors; Upper Tract Urothelial Carcinoma Collaboration. Prediction of cancer specific survival after radical nephroureterectomy for upper tract urothelial carcinoma: development of an optimized postoperative nomogram using decision curve analysis. J Urol. 2013, 189:1662-9.
- Ku JH, Moon KC, Jung JH, Jeong SH, Kwak C, Kim HH: External validation of an online nomogram in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma. Br J Cancer. 2013, 3:1130-6.
- Seisen T, Colin P, Hupertan V, et al. Postoperative nomogram to predict cancer-specific survival after radical nephroureterectomy in patients with localised and/or locally advanced upper tract urothelial carcinoma without metastasis. BJU Int. 2014, 114:733-40.
- Yates DR, Hupertan V, Colin P, et al; French collaborative national database on UUT-UC. Cancer-specific survival after radical nephroureterectomy for upper urinary tract urothelial carcinoma: proposal and multi-institutional validation of a post-operative nomogram. Br J Cancer. 2012, 13:1083-8.
- Rouprêt M, Babjuk M, Burger M, et al. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2020 Update. Eur Urol. 2021, 79(1):62-79.
- Wu Y, Dong Q, Liu L, Han P, Wei Q: The impact of tumor location and multifocality on prognosis for patients with upper tract urothelial carcinoma: a meta-analysis. Sci Rep. 2014, 15:6361.
- Lwin AA, Hsu CH, Chipollini J. Urothelial Carcinoma of the Renal Pelvis and Ureter: Does Location Make a Difference? Clin Genitourin Cancer: 2020, 18:45-9.
- Park J, Ha SH, Min GE, et al.: The protective role of renal parenchyma as a barrier to local tumor spread of upper tract transitional cell carcinoma and its impact on patient survival. J Urol. 2009, 182:894-9.
- van der Poel HG, Antonini N, van Tinteren H, Horenblas S: Upper urinary tract cancer: location is correlated with prognosis. Eur Urol. 2005, 48:438-44.
- Mbeutcha A, Rouprêt M, Kamat AM, Ket al. Prognostic factors and predictive tools for upper tract urothelial carcinoma: a systematic review. World J Urol. 2017, 35:337-53.
- Petrelli F, Yasser Hussein MI, Vavassori I, Barni S: Prognostic Factors of Overall Survival in Upper Urinary Tract Carcinoma: A Systematic Review and Meta-analysis. Urology. 2017, 100:9-15.
- Li WM, Li CC, Ke HL, Wu WJ, Huang CN, Huang CH: The prognostic predictors of primary ureteral transitional cell carcinoma after radical nephroureterectomy. J Urol. 2009, 182:451-8.
- Bolenz C, Fernández MI, Trojan L, et al.: Lymphovascular invasion and pathologic tumor stage are significant outcome predictors for patients with upper tract urothelial carcinoma. Urology. 2008, 72:364-9.
- Foerster B, Abufaraj M, Mari A, et al.: The Performance of Tumor Size as Risk Stratification Parameter in Upper Tract Urothelial Carcinoma (UTUC). Clin Genitourin Cancer. 2021, 19:272-1.
- Shibing Y, Liangren L, Qiang W, et al.: Impact of tumour size on prognosis of upper urinary tract urothelial carcinoma after radical nephroureterectomy: a multi-institutional analysis of 795 cases. BJU Int. 2016, 118:902-10.
- Milenkovic-Petronic D, Milojevic B, Djokic M, Sipetic-Grujicic S, Milojevic IG, Bumbasirevic U, Dzamic Z: The impact of tumor size on outcomes in patients with upper urinary tract urothelial carcinoma. Int Urol Nephrol. 2014, 46:563-9.
- Rink M, Soave A, Dahlem R, et al.: Impact of Perioperative Allogenic Blood Transfusion on Survival After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma. Clin Genitourin Cancer. 2016, 14:96-104.
- Kim HS, Jeong CW, Kwak C, Kim HH, Ku JH: Can body mass index predict survival outcomes in patients treated with radical nephroureterectomy for upper-tract urothelial carcinoma?. Int Urol Nephrol. 2015, 47:1311-20.
- Mason RJ, Kassouf W, Bell DG, et al.: The contemporary role of lymph node dissection during nephroureterectomy in the management of upper urinary tract urothelial carcinoma: the Canadian experience. Urology. 2012, 79:840-5.
Abstract
Amaç: Bu çalışma, lokal/lokal ileri üst sistem ürotelyal karsinomu nedeniyle cerrahi olarak tedavi edilen hastaların klinikopatolojik özelliklere dayalı tümör yerleşiminin kansere özgü sağkalım üzerindeki etkisini değerlendirmeyi amaçlamıştır.
Gereç ve Yöntem: Çalışmamıza, Mayıs 2010 ile Ağustos 2019 arasında üst üriner sistem ürotelyal karsinomu nedeniyle radikal nefroüreterektomi yapılan 145 hasta dâhil edildi. Hastalar tümörün yerleşimine göre renal pelvis ve üreter yerleşimli tümör olarak sınıflandırıldı. Klinikopatolojik özellikler ve onkolojik sonuçlar, tümör yerleşimine göre karşılaştırıldı ve ameliyat sonrası kanser spesifik sağ kalım oranları Kaplan-Meier eğrileri kullanılarak grafiksel olarak karşılaştırıldı.
Bulgular: Radikal nefrorüreterektomi ameliyatından sonra ortalama 41,8 (4-124) aylık takip süresinde 65 hasta (%44,8) üst üriner sistem ürotelyal karsinom tümörü nedeniyle öldü. Kaplan-Meier eğrileri, tümör evresi, derecesi ve boyutuna göre yapılan analizde tümör lokasyonunun kanser spesifik sağkalım ile ilişkili olmadığını gösterdi. Tümör yerleşimine bakılmaksızın yapılan analizde, pT3 hastalığı olanlarda ≤pT2 olanlara ve yüksek dereceli tümörü olanlarda da düşük dereceli olanlara göre daha kötü kanser spesifik sağkalım değerleri bulundu (sırasıyla p=0.025 ve p=0.011).
Sonuç: Tümör yerleşimi, yapılan analizlerin hiçbirinde kanser spesifik sağkalım ile ilişkilendirilmedi. Tümörün yerleşiminden bağımsız olarak, pT3 hastalığı ve yüksek dereceli tümörleri olan hastalar daha kötü bir prognoza sahip olduğu görüldü. Üst üriner sistem ürotelyal karsinomlu hastaların yönetiminde bu faktörlerin avantajlarını değerlendirmek için prognostik faktörler hakkında daha fazla çalışmaya ihtiyaç vardır.
References
- Rouprêt M, Babjuk M, Compérat E, et al.: European Association of Urology Guidelines on Upper Urinary Tract Urothelial Cell Carcinoma: 2015 Update. Eur Urol. 2015, 68:868-79.
- Ristau BT, Tomaszewski JJ, Ost MC: Upper tract urothelial carcinoma: current treatment and outcomes. Urology. 2012, 79:749-56.
- Lughezzani G, Burger M, Margulis V, et al.: Prognostic factors in upper urinary tract urothelial carcinomas: a comprehensive review of the current literature. Eur Urol. 2012, 62:100-14.
- Milojevic B, Djokic M, Sipetic-Grujicic S, et al.: Upper urinary tract transitional cell carcinoma: location is not correlated with prognosis. BJU Int. 2012, 109:1037-42.
- Joshi SS, Quast LL, Chang SS, Patel SG: Effects of tumor size and location on survival in upper tract urothelial carcinoma after nephroureterectomy. Indian J Urol. 2018, 34:68-73.
- Espiritu PN, Sverrisson EF, Sexton WJ, Pow-Sang JM, Poch MA, Dhillon J, Spiess PE: Effect of tumor size on recurrence-free survival of upper tract urothelial carcinoma following surgical resection. Urol Oncol. 2014, 32:619-24.
- Simone G, Papalia R, Loreto A, Leonardo C, Sentinelli S, Gallucci M: Independent prognostic value of tumour diameter and tumour necrosis in upper urinary tract urothelial carcinoma. BJU Int. 2009, 103:1052-7.
- Brierley J, Gospodarowicz Mk, Wittekind C: TNM classification of malignant tumours. Oxford UK: Blackwell publishing Ltd, 2017.
- Cha EK, Shariat SF, Kormaksson M, et al.: Predicting clinical outcomes after radical nephroureterectomy for upper tract urothelial carcinoma. Eur Urol. 2012, 61:818-25.
- Rouprêt M, Hupertan V, Seisen T, et al. French National Database on Upper Tract Tumors; Upper Tract Urothelial Carcinoma Collaboration. Prediction of cancer specific survival after radical nephroureterectomy for upper tract urothelial carcinoma: development of an optimized postoperative nomogram using decision curve analysis. J Urol. 2013, 189:1662-9.
- Ku JH, Moon KC, Jung JH, Jeong SH, Kwak C, Kim HH: External validation of an online nomogram in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma. Br J Cancer. 2013, 3:1130-6.
- Seisen T, Colin P, Hupertan V, et al. Postoperative nomogram to predict cancer-specific survival after radical nephroureterectomy in patients with localised and/or locally advanced upper tract urothelial carcinoma without metastasis. BJU Int. 2014, 114:733-40.
- Yates DR, Hupertan V, Colin P, et al; French collaborative national database on UUT-UC. Cancer-specific survival after radical nephroureterectomy for upper urinary tract urothelial carcinoma: proposal and multi-institutional validation of a post-operative nomogram. Br J Cancer. 2012, 13:1083-8.
- Rouprêt M, Babjuk M, Burger M, et al. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2020 Update. Eur Urol. 2021, 79(1):62-79.
- Wu Y, Dong Q, Liu L, Han P, Wei Q: The impact of tumor location and multifocality on prognosis for patients with upper tract urothelial carcinoma: a meta-analysis. Sci Rep. 2014, 15:6361.
- Lwin AA, Hsu CH, Chipollini J. Urothelial Carcinoma of the Renal Pelvis and Ureter: Does Location Make a Difference? Clin Genitourin Cancer: 2020, 18:45-9.
- Park J, Ha SH, Min GE, et al.: The protective role of renal parenchyma as a barrier to local tumor spread of upper tract transitional cell carcinoma and its impact on patient survival. J Urol. 2009, 182:894-9.
- van der Poel HG, Antonini N, van Tinteren H, Horenblas S: Upper urinary tract cancer: location is correlated with prognosis. Eur Urol. 2005, 48:438-44.
- Mbeutcha A, Rouprêt M, Kamat AM, Ket al. Prognostic factors and predictive tools for upper tract urothelial carcinoma: a systematic review. World J Urol. 2017, 35:337-53.
- Petrelli F, Yasser Hussein MI, Vavassori I, Barni S: Prognostic Factors of Overall Survival in Upper Urinary Tract Carcinoma: A Systematic Review and Meta-analysis. Urology. 2017, 100:9-15.
- Li WM, Li CC, Ke HL, Wu WJ, Huang CN, Huang CH: The prognostic predictors of primary ureteral transitional cell carcinoma after radical nephroureterectomy. J Urol. 2009, 182:451-8.
- Bolenz C, Fernández MI, Trojan L, et al.: Lymphovascular invasion and pathologic tumor stage are significant outcome predictors for patients with upper tract urothelial carcinoma. Urology. 2008, 72:364-9.
- Foerster B, Abufaraj M, Mari A, et al.: The Performance of Tumor Size as Risk Stratification Parameter in Upper Tract Urothelial Carcinoma (UTUC). Clin Genitourin Cancer. 2021, 19:272-1.
- Shibing Y, Liangren L, Qiang W, et al.: Impact of tumour size on prognosis of upper urinary tract urothelial carcinoma after radical nephroureterectomy: a multi-institutional analysis of 795 cases. BJU Int. 2016, 118:902-10.
- Milenkovic-Petronic D, Milojevic B, Djokic M, Sipetic-Grujicic S, Milojevic IG, Bumbasirevic U, Dzamic Z: The impact of tumor size on outcomes in patients with upper urinary tract urothelial carcinoma. Int Urol Nephrol. 2014, 46:563-9.
- Rink M, Soave A, Dahlem R, et al.: Impact of Perioperative Allogenic Blood Transfusion on Survival After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma. Clin Genitourin Cancer. 2016, 14:96-104.
- Kim HS, Jeong CW, Kwak C, Kim HH, Ku JH: Can body mass index predict survival outcomes in patients treated with radical nephroureterectomy for upper-tract urothelial carcinoma?. Int Urol Nephrol. 2015, 47:1311-20.
- Mason RJ, Kassouf W, Bell DG, et al.: The contemporary role of lymph node dissection during nephroureterectomy in the management of upper urinary tract urothelial carcinoma: the Canadian experience. Urology. 2012, 79:840-5.
Details
| Primary Language | English |
|---|---|
| Subjects | Urology |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | September 18, 2023 |
| Submission Date | October 23, 2022 |
| Published in Issue | Year 2023Volume: 62 Issue: 3 |
