The importance of second-look ureteroscopy implementation in the conservative management of upper tract urothelial carcinoma.
Conservative management
Second-look ureteroscopy
UTUC
Journal
World journal of urology
ISSN: 1433-8726
Titre abrégé: World J Urol
Pays: Germany
ID NLM: 8307716
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
received:
07
05
2023
accepted:
11
08
2023
medline:
23
10
2023
pubmed:
5
9
2023
entrez:
5
9
2023
Statut:
ppublish
Résumé
The purpose of the study was to evaluate the effect of second-look ureteroscopy (SU) in the endoscopic operative work-up of patients with upper tract urothelial carcinoma (UTUC). Patients with UTUC who underwent SU between 2016 and 2021 were included. Cancer detection rate (CDR) at SU was defined as endoscopic visualization of tumor. The effect of SU on recurrence-free survival (RFS), radical nephroureterectomy-free survival (RNU-FS), bladder cancer-free survival (BC-FS), and cancer-specific survival (CSS) was estimated using the Kaplan-Meier method. Multivariate logistic regression analysis (MLR) assessed predictors of negative SU. Finally, we evaluated the effect of SU timing on oncological outcomes, classifying SUs as "early" (≤ 8 weeks) and "late" (> 8 weeks). Overall, 85 patients underwent SU. The CDR at SU was 44.7%. After a median follow-up was 35 (IQR: 15-56) months, patients with positive SU had a higher rate of UTUC recurrence (47.4% vs 19.1%, p = 0.01) and were more frequently radically treated (34.2% vs 8.5%, p = 0.007). Patients with high-grade disease (hazard ratio [HR]: 3.14, 95% CI 1.18-8.31; p = 0.02) had a higher risk of UTUC recurrence, while high-grade tumor (HR: 3.87, 95%CI 1.08-13.77; p = 0.04) and positive SU (HR: 4.56, 95%CI 1.05-22.81; p = 0.04) were both predictors of RNU. Low-grade tumors [odds ratio (OR): 5.26, 95%CI 1.81-17.07, p = 0.003] and tumor dimension < 20 mm (OR: 5.69, 95%CI 1.48-28.31, p = 0.01) were predictors of negative SU. Finally, no significant difference emerged regarding UTUC recurrence, RNU, BC-FS, and CSM between early vs. late SUs (all p > 0.05). SU may help in identifying patients with UTUC experiencing an early recurrence after conservative treatment. Patients with low-grade and small tumors are those in which SU could be safely postponed after 8 weeks.
Identifiants
pubmed: 37668716
doi: 10.1007/s00345-023-04577-8
pii: 10.1007/s00345-023-04577-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2743-2749Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Rouprêt M, Babjuk M, Burger M, Capoun O, Cohen D, Compérat EM et al (2021) European association of urology guidelines on upper urinary tract urothelial carcinoma: 2020 update. Eur Urol 79:62–79. https://doi.org/10.1016/J.EURURO.2020.05.042
doi: 10.1016/J.EURURO.2020.05.042
pubmed: 32593530
Collà Ruvolo C, Nocera L, Stolzenbach LF, Wenzel M, Cucchiara V, Tian Z et al (2021) Incidence and survival rates of contemporary patients with invasive upper tract urothelial carcinoma. Eur Urol Oncol 4:792–801. https://doi.org/10.1016/J.EUO.2020.11.005
doi: 10.1016/J.EUO.2020.11.005
pubmed: 33293235
Rouprêt M, Seisen T, Birtle AJ, Capoun O, Compérat EM, Dominguez-Escrig JL et al (2023) European Association of urology guidelines on upper urinary tract urothelial carcinoma: 2023 update. Eur Urol. https://doi.org/10.1016/J.EURURO.2023.03.013
doi: 10.1016/J.EURURO.2023.03.013
pubmed: 37775360
Cutress ML, Stewart GD, Tudor ECG, Egong EA, Wells-Cole S, Phipps S et al (2013) Endoscopic versus laparoscopic management of noninvasive upper tract urothelial carcinoma: 20-year single center experience. J Urol 189:2054–2061. https://doi.org/10.1016/J.JURO.2012.12.006
doi: 10.1016/J.JURO.2012.12.006
pubmed: 23228378
Mohapatra A, Strope SA, Liu N, Winer A, Benfante NE, Coleman JA et al (2020) Importance of long-term follow-up after endoscopic management for upper tract urothelial carcinoma and factors leading to surgical management. Int Urol Nephrol 52:1465–1469. https://doi.org/10.1007/S11255-020-02439-5
doi: 10.1007/S11255-020-02439-5
pubmed: 32157621
pmcid: 7572076
Hasan MN, Rouprêt M, Keeley F, Cracco C, Jones R, Straub M et al (2019) Consultation on UTUC, Stockholm 2018 aspects of risk stratification: long-term results and follow-up. World J Urol 37:2289–2296. https://doi.org/10.1007/S00345-019-02739-1
doi: 10.1007/S00345-019-02739-1
pubmed: 30944969
pmcid: 6825637
Seisen T, Peyronnet B, Dominguez-Escrig JL, Bruins HM, Yuan CY, Babjuk M et al (2016) Oncologic outcomes of kidney-sparing surgery versus radical nephroureterectomy for upper tract urothelial carcinoma: a systematic review by the EAU non-muscle invasive bladder cancer guidelines panel. Eur Urol 70:1052–1068. https://doi.org/10.1016/J.EURURO.2016.07.014
doi: 10.1016/J.EURURO.2016.07.014
pubmed: 27477528
Sanguedolce F, Fontana M, Turco M, Territo A, Lucena JB, Cortez JC et al (2021) Endoscopic management of upper urinary tract urothelial carcinoma: oncologic outcomes and prognostic factors in a contemporary cohort. J Endourol 35:1593–1600. https://doi.org/10.1089/END.2021.0133
doi: 10.1089/END.2021.0133
pubmed: 33971725
Ploussard G, Xylinas E, Lotan Y, Novara G, Margulis V, Rouprêt M et al (2015) Conditional survival after radical nephroureterectomy for upper tract carcinoma. Eur Urol 67:803–812. https://doi.org/10.1016/J.EURURO.2014.08.003
doi: 10.1016/J.EURURO.2014.08.003
pubmed: 25145551
Martini A, Lonati C, Nocera L, Fallara G, Raggi D, Herout R et al (2022) Oncologic surveillance after radical nephroureterectomy for high-risk upper tract urothelial carcinoma. Eur Urol Oncol 5:451–459. https://doi.org/10.1016/J.EUO.2022.04.003
doi: 10.1016/J.EUO.2022.04.003
pubmed: 35504834
Villa L, Cloutier J, Letendre J, Ploumidis A, Salonia A, Cornu JN et al (2016) Early repeated ureteroscopy within 6–8 weeks after a primary endoscopic treatment in patients with upper tract urothelial cell carcinoma: preliminary findings. World J Urol 34:1201–1206. https://doi.org/10.1007/S00345-015-1753-7
doi: 10.1007/S00345-015-1753-7
pubmed: 26699629
Babjuk M, Burger M, Capoun O, Cohen D, Compérat EM, Dominguez Escrig JL et al (2022) European Association of urology guidelines on non-muscle-invasive bladder cancer (Ta, T1, and carcinoma in situ). Eur Urol 81:75–94. https://doi.org/10.1016/J.EURURO.2021.08.010
doi: 10.1016/J.EURURO.2021.08.010
pubmed: 34511303
Assel M, Sjoberg D, Elders A, Wang X, Huo D, Botchway A et al (2019) Guidelines for reporting of statistics for clinical research in urology. Eur Urol 75:358–367. https://doi.org/10.1016/J.EURURO.2018.12.014
doi: 10.1016/J.EURURO.2018.12.014
pubmed: 30580902
Ma R, Liu Z, Cheng Y, Zhou P, Pan Y, Bi H et al (2022) Prognostic value of tumor size in patients with upper tract urothelial carcinoma: a systematic review and meta-analysis. Eur Urol Open Sci 42:19–29. https://doi.org/10.1016/J.EUROS.2022.06.001
doi: 10.1016/J.EUROS.2022.06.001
pubmed: 35783990
pmcid: 9244730
Yafi FA, Novara G, Shariat SF, Gupta A, Matsumoto K, Walton TJ et al (2012) Impact of tumour location versus multifocality in patients with upper tract urothelial carcinoma treated with nephroureterectomy and bladder cuff excision: a homogeneous series without perioperative chemotherapy. BJU Int. https://doi.org/10.1111/J.1464-410X.2011.10792.X
doi: 10.1111/J.1464-410X.2011.10792.X
pubmed: 22500588
Lughezzani G, Burger M, Margulis V, Matin SF, Novara G, Roupret M et al (2012) Prognostic factors in upper urinary tract urothelial carcinomas: a comprehensive review of the current literature. Eur Urol 62:100–114. https://doi.org/10.1016/J.EURURO.2012.02.030
doi: 10.1016/J.EURURO.2012.02.030
pubmed: 22381168
Baboudjian M, Territo A, Gallioli A, Verri P, Aumatell J, Izquierdo P et al (2023) Long-term oncologic outcomes of endoscopic management of high-risk upper tract urothelial carcinoma: the Fundació Puigvert’s experience. J Endourol. https://doi.org/10.1089/END.2023.0092
doi: 10.1089/END.2023.0092
pubmed: 37310884
Breda A, Territo A, Sanguedolce F, Basile G, Subiela JD, Reyes HV et al (2019) Comparison of biopsy devices in upper tract urothelial carcinoma. World J Urol 37:1899–1905. https://doi.org/10.1007/S00345-018-2586-Y
doi: 10.1007/S00345-018-2586-Y
pubmed: 30560298
Territo A, Gallioli A, Diana P, Boissier R, Fontana M, Gaya JM et al (2022) DNA methylation urine biomarkers test in the diagnosis of upper tract urothelial carcinoma: results from a single-center prospective clinical trial. J Urol 208:570–579. https://doi.org/10.1097/JU.0000000000002748
doi: 10.1097/JU.0000000000002748
pubmed: 35549312
Gallioli A, Territo A, Mercadé A, Fontana M, Boissier R, Gaya JM et al (2021) The impact of ureteroscopy following computerized tomography urography in the management of upper tract urothelial carcinoma. J Urol 205:392–399. https://doi.org/10.1097/JU.0000000000001370
doi: 10.1097/JU.0000000000001370
pubmed: 32935620
Subiela JD, Territo A, Mercadé A, Balañà J, Aumatell J, Calderon J et al (2020) Diagnostic accuracy of ureteroscopic biopsy in predicting stage and grade at final pathology in upper tract urothelial carcinoma: systematic review and meta-analysis. Eur J Surg Oncol 46:1989–1997. https://doi.org/10.1016/J.EJSO.2020.06.024
doi: 10.1016/J.EJSO.2020.06.024
pubmed: 32674841