Predictive Factors of Intravesical Recurrence after Ureteroscopy in Upper Urinary Tract Urothelial Carcinoma Followed by Radical Nephroureterectomy

Sittiporn  Srinualnad; Atichet  Sawangchareon; Kantima  Jongjitaree; Kittipong  Phinthusophon; Tawatchai  Taweemonkongsap; Sunai  Leewansangtong; Chaiyong  Nualyong; Karn  Liangkobkit; Ekkarin  Chotikawanich

doi:10.33192/smj.v75i3.261149

Authors

Sittiporn Srinualnad Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Atichet Sawangchareon Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Kantima Jongjitaree Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Kittipong Phinthusophon Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Tawatchai Taweemonkongsap Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Sunai Leewansangtong Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Chaiyong Nualyong Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Karn Liangkobkit Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Ekkarin Chotikawanich Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.33192/smj.v75i3.261149

Keywords:

Upper tract urothelial carcinoma, intravesical recurrent, bladder cancer, ureteroscopy, biopsy

Abstract

Objective: To investigate the risk factors of developing intravesical recurrence (IVR) in patients with upper urinary tract urothelial carcinoma (UTUC) who underwent ureterorenoscopy (URS) before radical nephroureterectomy with bladder cuff excision (RNU).

Materials and Methods: This retrospective study collected data from the medical records of patients diagnosed with UTUC between January 2012 and December 2019. All the patients underwent ureteroscopy before radical surgery. Patients previously diagnosed with bladder cancer were excluded. A total of 63 patients were included in the study. Tumour factors, such as multiplicity, location, size, histologic grade, pathologic T-stage, and lymphovascular invasion status, were evaluated. The type of endoscopic procedure and time interval between URS and RNU were analysed to determine the factors affecting IVR.

Results: The associated factors with IVR included multifocal tumours (HR = 4.8(1.9–11.9)), large size tumours greater than or equal to 4 cm (HR = 3.3(1.5–7.0)), and time interval greater than or equal to 5 weeks between URS and RNU (HR = 2.6(1.2–5.5)). Factors including tumour location (kidney or ureter), size, grading, T-stage, and lymphovascular invasion as well as the type of endoscopic procedure were not at high risk for IVR.

Conclusion: The predictive factors of IVR for UTUC patients who underwent URS before RNU included a multiplicity of primary tumours and a tumour size greater than or equal to 4 cm, while a time interval between URS and RNU greater than or equal to 5 weeks increased the risk of IVR.

References

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

Raman JD, Messer J, Sielatycki JA, Hollenbeak CS. Incidence and survival of patients with carcinoma of the ureter and renal pelvis in the USA, 1973-2005. BJU Int. 2011;107(7):1059-64.

Ristau BT, Tomaszewski JJ, Ost MC. Upper tract urothelial carcinoma: current treatment and outcomes. Urology. 2012;79(4):749-56.

Roupret M, Babjuk M, Comperat E, Zigeuner R, Sylvester R, Burger M, et al. European guidelines on upper tract urothelial carcinomas: 2013 update. Eur Urol. 2013;63(6):1059-71.

Margulis V, Shariat SF, Matin SF, Kamat AM, Zigeuner R, Kikuchi E, et al. Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer. 2009;115(6):1224-33.

Kang CH, Yu TJ, Hsieh HH, Yang JW, Shu K, Huang CC, et al. The development of bladder tumors and contralateral upper urinary tract tumors after primary transitional cell carcinoma of the upper urinary tract. Cancer. 2003;98(8):1620-6.

Maneesuwansin S, Suk-ouichai C, Ramart P, Jitpraphai S, Phinthusophon K, Chotikawanich E, et al. Administration of Renin-Angiotensin System Inhibitor Affects Tumor Recurrence and Progression in Non-Muscle Invasive Bladder Cancer Patients. Siriraj Medical Journal. 2019;71(1):31-7.

Nualyong C, Woranisarakul V, Tantranont N, Chotikawanich E, Shrestha S, Taweemonkongsap T. Metastatic Malignant Melanoma of the Urinary Bladder: A Case Report and Review of Literature. Siriraj Medical Journal. 2018;70(3):254-9.

Azémar MD, Comperat E, Richard F, Cussenot O, Rouprêt M. Bladder recurrence after surgery for upper urinary tract urothelial cell carcinoma: frequency, risk factors, and surveillance. Urol Oncol. 2011;29(2):130-6.

Wu WJ, Ke HL, Yang YH, Li CC, Chou YH, Huang CH. Should patients with primary upper urinary tract cancer receive prophylactic intravesical chemotherapy after nephroureterectomy? J Urol. 2010;183(1):56-61.

O'Brien T, Ray E, Singh R, Coker B, Beard R, British Association of Urological Surgeons Section of O. 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. 2011;60(4):703-10.

Boonyapalanant C, Woranisarakul V, Jitpraphai S, Chotikawanich E, Taweemonkongsap T, Kc HB, et al. The Efficacy of Inside-Out Transversus Abdominis Plane Block vs Local Infiltration before Wound Closure in Pain Management after Kidney Transplantation: A Double-blind, Randomized Trial. Siriraj Medical Journal. 2022;74(4):233-8.

Blute ML, Segura JW, Patterson DE, Benson RC, Jr., Zincke H. Impact of endourology on diagnosis and management of upper urinary tract urothelial cancer. J Urol. 1989;141(6):1298-301.

Favaretto RL, Shariat SF, Savage C, Godoy G, Chade DC, Kaag M, et al. Combining imaging and ureteroscopy variables in a preoperative multivariable model for prediction of muscle-invasive and non-organ confined disease in patients with upper tract urothelial carcinoma. BJU Int. 2012;109(1):77-82.

Rojas CP, Castle SM, Llanos CA, Santos Cortes JA, Bird V, Rodriguez S, et al. Low biopsy volume in ureteroscopy does not affect tumor biopsy grading in upper tract urothelial carcinoma. Urol Oncol. 2013;31(8):1696-700.

Chung Y, Lee DH, Lee M, Kim H, Lee S, Hong SK, et al. Impact of diagnostic ureteroscopy before radical nephroureterectomy on intravesical recurrence in patients with upper tract urothelial cancer. Investig Clin Urol. 2020;61(2):158-65.

Guo RQ, Hong P, Xiong GY, Zhang L, Fang D, Li XS, et al. Impact of ureteroscopy before radical nephroureterectomy for upper tract urothelial carcinomas on oncological outcomes: a meta-analysis. BJU Int. 2018;121(2):184-93.

Luo HL, Kang CH, Chen YT, Chuang YC, Lee WC, Cheng YT, et al. Diagnostic ureteroscopy independently correlates with intravesical recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma. Ann Surg Oncol. 2013;20(9):3121-6.

Marchioni M, Primiceri G, Cindolo L, Hampton LJ, Grob MB, Guruli G, 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.

Sankin A, Tin AL, Mano R, Chevinsky M, Jakubowski C, Sfakianos JP, et al. Impact of Ureteroscopy Before Nephroureterectomy for Upper Tract Urothelial Carcinoma on Oncologic Outcomes. Urology. 2016;94:148-53.

Sung HH, Jeon HG, Han DH, Jeong BC, Seo SI, Lee HM, et al. Diagnostic Ureterorenoscopy Is Associated with Increased Intravesical Recurrence following Radical Nephroureterectomy in Upper Tract Urothelial Carcinoma. PLoS One. 2015;10(11):e0139976.

Fang D, Li XS, Xiong GY, Yao L, He ZS, Zhou LQ. Prophylactic intravesical chemotherapy to prevent bladder tumors after nephroureterectomy for primary upper urinary tract urothelial carcinomas: a systematic review and meta-analysis. Urol Int. 2013;91(3):291-6.

Ito A, Shintaku I, Satoh M, Ioritani N, Aizawa M, Tochigi T, et 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):1422-7.

Potretzke AM, Knight BA, Vetter JM, Anderson BG, Hardi AC, Bhayani SB, et al. Diagnostic Utility of Selective Upper Tract Urinary Cytology: A Systematic Review and Meta-analysis of the Literature. Urology. 2016;96:35-43.

Hong S, Kwon T, You D, Jeong IG, Hong B, Hong JH, et al. Incidence of benign results after laparoscopic radical nephroureterectomy. Jsls. 2014;18(4).

Gurbuz C, Youssef RF, Shariat SF, Lotan Y, Wood CG, Sagalowsky AI, et al. The impact of previous ureteroscopic tumor ablation on oncologic outcomes after radical nephrouretectomy for upper urinary tract urothelial carcinoma. J Endourol. 2011;25(5):775-9.

Shibing Y, Liangren L, Qiang W, Hong L, Turun S, Junhao L, 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(6):902-10.

Lee JK, Kim KB, Park YH, Oh JJ, Lee S, Jeong CW, et al. Correlation Between the Timing of Diagnostic Ureteroscopy and Intravesical Recurrence in Upper Tract Urothelial Cancer. Clin Genitourin Cancer. 2016;14(1):e37-41.