Sage Journals: Discover world-class research

Abstract

Background and aims

Urinary bladder recurrences (UBRs) after radical nephroureterectomy (RNUx) are a known challenge in patients with upper-tract urothelial cancers (UTUCs). We aim to assess factors associated with UBR and clonal-relatedness with resected UTUC.

Methods

Patients who underwent RNUx for UTUC between 1998 and 2015 in five institutions were identified. Clonal relatedness between primary UTUC and subsequent UBR in a sub-cohort was assessed using next-generation sequencing. A Kaplan–Meier curve was used to assess differences in UBR between two groups (with or without ureteroscopic biopsy).

Results

Of 267 patients with complete records, 73 (27.3%) had UBR during follow-up. The five-year UBR-free survival in all patients was 64.7%. The five-year UBR-free-survival was inferior in patients who underwent URS biopsy compared with patients who did not undergo ureteroscopic biopsy (49.9% vs 76.4%, p < 0.001). History of bladder tumour (HR, 95% CI; 2.94, 1.73–5.00, p < 0.001), ureteroscopic biopsy (HR, 95% CI; 2.21, 1.38–3.53, p = 0.001) and preoperative urine cytology ≥C3 (HR, 95% CI; 2.06, 1.24–3.40, p = 0.005) were independently associated with UBR. Patients with ureteroscopic biopsy (n = 3/5) showed identical mutational changes for common genes (TP53 and FGFR3) between primary UTUC and subsequent UBR.

Conclusions

Ureteroscopic biopsy of UTUC is a significant risk factor for UBR. Qualitative clonality assessment showed identical mutational signatures between primary UTUC and UBR.

Keywords

Urothelial cancer ureteroscopy genetics

Get full access to this article

View all access options for this article.

References

Raman

Messer

Sielatycki

, et al. Incidence and survival of patients with carcinoma of the ureter and renal pelvis in the USA, 1973–2005. BJU Int [Internet]. 2011; 107: 1059–1064 (accessed 25 October 2020).

Siegel

Miller

Jemal

. Cancer statistics, 2017. CA Cancer J Clin [Internet]. 2017; 67: 7–30 (accessed 25 October 2020).

Rouprêt

Babjuk

Burger

, et al. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2020 Update [Internet]. Eur Urol. 2021 Jan; 79: 62–79.

Yuan

Chen

Liu

, et al. Risk factors for intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma: a meta-analysis1These authors equally dedicated to this article. Urol Oncol Semin Orig Investig 2014; 32: 989–1002.

Seisen

Granger

Colin

, et al. A systematic review and meta-analysis of clinicopathologic factors linked to intravesical recurrence after radical nephroureterectomy to treat upper tract urothelial carcinoma [Internet]. Eur Urol. 2015; 67: 1122–1133. Elsevier, http://www.europeanurology.com/article/S0302283814012184/fulltext (accessed 25 October 2020).

Hwang

Sathianathen

Jung

, et al. Single-dose intravesical chemotherapy after nephroureterectomy for upper tract urothelial carcinoma [Internet]. Cochrane Database Syst Rev. 2019 May 18; 5.

Huang

Low

de Vere White

. Case reports: nephrostomy tract tumor seeding following percutaneous manipulation of a ureteral carcinoma. J Urol [Internet]. 1995; 153: 1041–1042 (accessed 25 October 2020).

Lundstedt

Stridbeck

Andersson

, et al. Tumor seeding occurring after fine-needle biopsy of abdominal malignancies. Acta Radiol [Internet]. 1991; 32: 518–520 (accessed 25 October 2020).

Shyamala

Girish

Murgod

. Risk of tumor cell seeding through biopsy and aspiration cytology. J Int Soc Prev Community Dent [Internet] 2014; 4: 5. /pmc/articles/PMC4015162/?report=abstract (accessed 25 October 2020).

10.

Yoo

You

Song

, et al.

Risk of intravesical recurrence after ureteroscopic biopsy for upper tract urothelial carcinoma: does the location matter?

J Endourol [Internet] 2017; 31: 259–265. https://pubmed.ncbi.nlm.nih.gov/27785917/ (accessed 25 October 2020).

11.

Sung

Jeon

Han

, et al. Diagnostic ureterorenoscopy is associated with increased intravesical recurrence following radical nephroureterectomy in upper tract Urothelial Carcinoma. PLoS One [Internet] 2015 Nov 10; 10.

12.

Lee

Kim

Park

, et al. Correlation between the timing of diagnostic ureteroscopy and intravesical recurrence in upper tract urothelial cancer. Clin Genitourin Cancer [Internet] 2016; 14: e37–e41. http://www.clinical-genitourinary-cancer.com/article/S1558767315001810/fulltext (accessed 25 October 2020).

13.

Luo

Kang

Chen

, et al. Diagnostic ureteroscopy independently correlates with intravesical recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma. Ann Surg Oncol [Internet] 2013; 20: 3121–3126. https://pubmed.ncbi.nlm.nih.gov/23661184/ (accessed 25 October 2020).

14.

Ishikawa

Abe

Shinohara

, et al. Impact of diagnostic ureteroscopy on intravesical recurrence and survival in patients with urothelial carcinoma of the upper urinary tract. J Urol [Internet] 2010; 184: 883–887. https://pubmed.ncbi.nlm.nih.gov/20643446/ (accessed 25 October 2020).

15.

Chung

Lee

, et al. Impact of diagnostic ureteroscopy before radical nephroureterectomy on intravesical recurrence in patients with upper tract urothelial cancer. Investig Clin Urol [Internet] 2020; 61: 158–165. /pmc/articles/PMC7052419/?report=abstract (accessed 25 October 2020).

16.

Necchi

Madison

Pal

, et al. Comprehensive Genomic Profiling of Upper-tract and Bladder Urothelial Carcinoma. Eur Urol Focus. 2021 Nov; 7: 1339–1346.

17.

Doeveren

Nakauma-Gonzalez

Mason

, et al. The clonal relation of primary upper urinary tract urothelial carcinoma and paired urothelial carcinoma of the bladder. Int J Cancer [Internet]. 2020; ijc.33327. https://onlinelibrary.wiley.com/doi/10.1002/ijc.33327 (accessed 25 October 2020).

18.

Audenet

Isharwal

Cha

, et al. Clonal relatedness and mutational differences between upper tract and bladder urothelial carcinoma. Clin Cancer Res [Internet] 2019; 25: 967–976. https://pubmed.ncbi.nlm.nih.gov/30352907/ (accessed 25 October 2020).

19.

Straub

Strittmatter

Karl

, et al. Ureterorenoscopic biopsy and urinary cytology according to the 2004 WHO classification underestimate tumor grading in upper urinary tract urothelial carcinoma. Urol Oncol Semin Orig Investig [Internet] 2013; 31: 1166–1170. https://linkinghub.elsevier.com/retrieve/pii/S1078143911004893 (accessed 25 October 2020).

20.

Baard

De Bruin

Zondervan

, et al. Diagnostic dilemmas in patients with upper tract urothelial carcinoma [Internet]. Nature Reviews Urology. Nature Publishing Group; 2017; 14: 181–191. www.nature.com/nrurol (accessed 25 October 2020).

21.

Murahashi

Abe

Shinohara

, et al. Diagnostic outcome of ureteroscopy in urothelial carcinoma of the upper urinary tract: incidence of later cancer detection and its risk factors after the first examination. BMC Urol [Internet] 2015; 15: 92–92. https://europepmc.org/articles/PMC4558756 (accessed 25 October 2020).

22.

Gallioli

Boissier

Territo

, et al. Adjuvant single-dose upper urinary tract instillation of mitomycin C after therapeutic ureteroscopy for upper tract urothelial carcinoma: a single-centre prospective non-randomized trial. J Endourol [Internet] 2020; 34: 573–580. https://pubmed.ncbi.nlm.nih.gov/32164441/ (accessed 25 October 2020).

23.

Somani

Moseley

Eljamel

, et al. Photodynamic diagnosis (PDD) for upper urinary tract transitional cell carcinoma (UT-TCC): evolution of a new technique. Photodiagn Photodyn Ther 2010; 7: 39–43.

24.

Ng Chieng Hin

Hettiarachchilage

Gravestock

, et al. Role of ureteroscopy in treatment of upper tract urothelial carcinoma. Curr Urol Rep 2021; 22. https://doi.org/10.1007/s11934-021-01065-7.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.73 MB