Üst üriner trakt ürotelyal tümörlerinde radikal nefroüretrektomi sonrası intravezikal nüks için risk faktörleri: retrospektif tek merkezli çalışma
Amaç: Üst üriner sistem karsinomu (UTUC) nedeniyle radikal nefroüreterektomi (RNU) uygulanan hasta serimizde mesane kanserinin metakron nüksünü öngören faktörleri inceledik.Gereç ve Yöntemler: Merkezimizde Eylül 2009 ile Mart 2020 tarihleri arasında UTUC kaynaklı RNU olan hastalar çalışmaya dahil edildi. Hastalar intravezikal nüks (IVR) olan ve olmayan olarak sınıflandırıldı ve nüksü öngören faktörler değerlendirildi.Bulgular: Çalışmaya toplam 50 hasta dahil edildi. Toplam 50 hastanın 19›unda (%38) IVR gelişmiştir ve ortalama takip süresi 39,5 ± 25,3 aydır. Demografik özellikler, başvuru hemoglobini, glomerüler filtrasyon hızı ve hidronefroz derecesi, preoperatif üreterorenoskopi ve sitoloji pozitiflik öyküsü açısından iki grup arasında anlamlı fark yoktu (p>0.05). IVR (+) grubunda anlamlı olarak daha fazla mesane kanseri öyküsü vardı (sırasıyla %35,5’e karşı %52,6, p=0.019). Üreter tümörü olan hasta sayısı IVR (-) grubunda 10 (%32,3) iken IVR (+) grubunda 9 (%47,4) idi ve anlamlı olarak daha yüksekti (p=0,04). Tüm hasta grubunda 28 (%56) T2-T4 patolojisi olan hasta vardı ve oran IVR (+) grubunda anlamlı olarak daha fazlaydı (sırasıyla %63,2 ve %51,6, p=0.038).Sonuç: Daha önce mesane kanseri öyküsü olan hastalarda, özellikle üreteral ve yüksek patolojik T evreli UTUC’larda mesane kanserinin metakron nüksü için dikkatli olunmalıdır.
Risk factors for intravesical recurrence after radical nephrourethrectomy in upper urinary tract urothelial tumors: retrospective single-center study
Objective: We examined factors predicting metachronous recurrence of bladder cancer in our series of patients who underwent radical nephroureterectomy (RNU) for upper system urothelial carcinoma (UTUC).Material and Methods: Patients with UTUC-induced RNU in our center from September 2009 to March 2020 were included in the study. Patients were classified as having and not having an intravesical recurrence (IVR), and the factors predicting recurrence were evaluated.Results: A total of 50 patients were included in the study. IVR was developed in 19 (38%) of 50 patients, with a mean follow-up of 39.5 ± 25.3 months. There was no significant difference between the two groups in demographic characteristics, admission hemoglobin, glomerular filtration rate, and degree of hydronephrosis in preoperative ureterorenoscopy and cytology positivity history (p>0.05). The IVR (+) group had significantly more previous history of bladder cancer (35.5% vs. 52.6%, p=0.019, respectively). While the number of patients with ureteral tumors was 10 (32.3%) in the IVR (-) group, it was 9 (47.4%) in the IVR (+) group, and it was significantly higher. There are 28 (56%) patients with T2-T4 pathology in the entire patient group, and the rate is significantly greater in the IVR (+) group (63.2% vs. 51.6%, p=0.038, respectively).Conclusion: Caution should be exercised for metachronous bladder cancer recurrence in patients with a previous history of bladder cancer, especially in ureteral and high pathological T-stage UTUCs.
___
- Jung KW, Won YJ, Oh CM et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2014. Cancer Res Treat. 2017; 49(2):292-305. DOI:10.4143/crt.2017.118.
- Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017; 67:7-30. DOI:10.3322/caac.21387.
- Soria F, Shariat SF, Lerner SP, et al. Epidemiology, diagnosis, preoperative evaluation and prognostic assessment of upper-tract urothelial carcinoma (UTUC). World J Urol. 2017; 35(3):379-387. DOI:10.1007/s00345-016-1928-x.
- Xylinas E, Rink M, Cha EK, et al. Upper Tract Urothelial Carcinoma Collaboration. Impact of distal ureter management on oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma. Eur Urol. 2014; 65(1):210-217. DOI:10.1016/j.eururo.2012.04.052.
- Alothman KI, Mehmood S, Alzahrani HM, et al. Surgical and oncological outcome after laparoscopic versus open nephroureterectomy for non-metastatic, upper-tract urothelial carcinoma. A single-center experience. Saudi Med J. 2020; 41(1):25-33. DOI:10.15537/smj.2020.1.24780.
- Ku JH, Choi WS, Kwak C, et al. Bladder cancer after nephroureterectomy in patients with urothelial carcinoma of the upper urinary tract. Urol Oncol. 2011; 29(4):383-387. DOI:10.1016/j.urolonc.2009.04.007.
- Yamashita R, Watanabe R, Ito I, et al. Risk factors for intravesical recurrence after nephroureterectomy in patients with upper urinary tract urothelial carcinoma. Int Urol Nephrol. 2017; 49(3):425-430. DOI:10.1007/s11255-017-1510-5.
- Seisen T, Granger B, Colin P, at al. A systematic review and meta-analysis of clinicopathologic factors linked to intravesical recurrence after radical nephroureterectomy to treat upper tract urothelial carcinoma. Eur Urol. 2015; 67:1122-1133. DOI:10.1016/j.eururo.2014.11.035.
- Habuchi T, Takahashi R, Yamada H, et al. Metachronous multifocal development of urothelial cancers by intraluminal seeding. Lancet. 1993; 342:1087–1088. DOI:10.1016/0140-6736(93)92066-3.
- Jones TD, Wang M, Eble JN, et al. Molecular evidence supporting field effect in urothelial carcinogenesis. Clin Cancer Res. 2005; 11(18):6512–6519. DOI:10.1158/1078-0432.CCR-05-0891.
- O’Brien T, Ray E, Singh R, et al. British Association of Urological Surgeons Section of Oncology. Prevention of bladder tumors 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. 2011; 60(4):703–710. DOI:10.1016/j.eururo.2011.05.064.
- Ito A, Shintaku I, Satoh M, at al. Prospective randomized phase II trial of a single early intravesical instillation of pirarubicin (THP) in the prevention of bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma: the THP Monotherapy Study Group Trial. J Clin Oncol. 2013; 31(11):1422–1427. DOI:10.1200/JCO.2012.45.2128.
- Rouprêt M, Babjuk M, Compérat E, et al. European guidelines on upper tract urothelial carcinomas: 2017 update. Eur Urol. 2018; 73(1):111-122. DOI:10.1016/j.eururo.2017.07.036.
- Zigeuner RE, Hutterer G, Chromecki T, et al. Bladder tumor development after urothelial carcinoma of the upper urinary tract is related to primary tumor location. BJU Int. 2006; 98(6):1181–1186. DOI:10.1111/j.1464-410X.2006.06519.x.
- Ishioka J, Saito K, Kijima T, et al. Risk stratification for bladder recurrence of upper urinary tract urothelial carcinoma after radical nephroureterectomy. BJU Int. 2015; 115(5):705-712. DOI:10.1111/bju.12707.
- Marchioni M, Giulia P, Luca C, et al. Impact of diagnostic ureteroscopy on intravesical recurrence in patients undergoing radical nephroureterectomy for upper tract urothelial cancer: a systematic review and meta-analysis. BJU Int. 2017; 120(3):313–9. DOI:10.1111/bju.13935.
- Wang Q, Zhang T, Wu J, et al. Prognosis and risk factors of patients with upper urinary tract urothelial carcinoma and postoperative recurrence of bladder cancer in central China. BMC Urol. 2019; 19(1):24. DOI:10.1186/s12894-019-0457-5.
- Gou RQ, Hang P, Xiong GY, et al. Impact of ureteroscopy before radical nephroureterectomy for upper tract urothelial carcinomas on oncological outcomes: a meta-analysis. BJU Int. 2018; 121(2):184-193. DOI:10.1111/bju.14053.
- Capitanio U, Shariat SF, Isbarn H, et al. Comparison of oncologic outcomes for open and laparoscopic nephroureterectomy: a multi-institutional analysis of 1249 cases. Eur Urol. 2009; 56(1):1-9 DOI:10.1016/j.eururo.2009.03.072.
- Kim TH, Hong B, Seo HK, et al. The Comparison of Oncologic Outcomes between Open and Laparoscopic Radical Nephroureterectomy for the Treatment of Upper Tract Urothelial Carcinoma: A Korean Multicenter Collaborative Study. Cancer Res Treat. 2019; 51(1):240-251. DOI:10.4143/crt.2017.417.
- Kim HS, Ku JH, Jeong CW, et al. Laparoscopic radical nephroureterectomy is associated with worse survival outcomes than open radical nephroureterectomy in patients with locally advanced upper tract urothelial carcinoma. World J Urol. 2016; 34:859-869. DOI:10.1007/s00345-015-1712-3.
- Zhang S, Luo Y, Wang C, et al. Long-term oncologic outcomes of laparoscopic nephroureterectomy versus open nephroureterectomy for upper tract urothelial carcinoma: a systematic review and meta-analysis. Peer J. 2016; 4:e2063. DOI:10.7717/peerj.2063.
- Xylinas E, Kluth L, Passoni N, et al. Prediction of intravesical recurrence after radical nephroureterectomy: development of a clinical decision-making tool. European Urology. 2014; 65(3):650-658. DOI:10.1016/j.eururo.2013.09.003.
- Knoedler JJ and Raman JD. Advances in the management of upper tract urothelial carcinoma: improved endoscopic management through better diagnostics. Ther Adv Urol. 2018; 10:421-429. DOI:10.1177/1756287218805334.