Factores pronósticos de recurrencia y mortalidad en pacientes con tumor de urotelio superior tratados con cirugía / Prognostic Factors of Recurrence and Mortality in Patients with Upper Urothelial Tumor Treated with Surgery

Objetivos: Identificación de factores pronósticos de recurrencia y mortalidad cáncer-específica en pacientes con tumor de urotelio superior tratados con cirugía. Materiales y métodos: Análisis retrospectivo de pacientes con tumor de urotelio superior operados entre 1999 y 2011 en nuestro centro (139 pacientes). Se recogieron variables demográficas, clínicas, diagnósticas y patológicas, así como el tratamiento realizado, complicaciones y evolución. Análisis descriptivo mediante la prueba de chi cuadrado (X2 ) para variables categóricas y el test ANOVA (Analysis of Variance) para variables continuas. Análisis univariante y multivariante mediante modelo de riesgos proporcionales de Cox. La significación estadística se consideró con un valor de p<0,05. Todos los cálculos fueron realizados con el paquete estadístico IBM® SPSS® Statistics v-21. Resultados: En el análisis multivariante se identificaron como factores predictores independientes de recurrencia el crecimiento sólido tumoral (cociente de riesgo [hazard ratio, HR]=4,02; p<0,001) y el alto grado citológico (G3) (HR=3,42; p=0,01). La presencia de tumor vesical previo o concomitante (HR=1,84; p=0,07) presentó una tendencia a la significación. Se identificaron como factores predictores independientes de mortalidad cáncer-específica la presencia de tumor vesical previo o concomitante (HR=2,23; p=0,02), el crecimiento sólido tumoral (HR=2,73; p=0,008), la presencia de hidronefrosis (HR=2,46; p=0,02) y el estadío patológico avanzado pT3-pT4 (HR=2,74; p=0,01). Conclusiones: En nuestra serie, la existencia de tumor vesical previo o sincrónico, el crecimiento tumoral sólido y el alto grado citológico se comportaron como factores pronósticos de recurrencia. La hidronefrosis, el tumor vesical previo o sincrónico, el estadío pT3-4 y el crecimiento tumoral sólido se comportaron como factores pronósticos de mortalidad cáncer-específica. (AU)

Objectives: Identification of prognostic factors for recurrence and cancer-specific mortality in patients with upper urothelial tumor treated with surgery. Materials and methods: Retrospective analysis of patients with upper urothelial tumor operated between 1999 and 2011 in our center (139 patients). Demographic, clinical, diagnostic and pathological variables were collected, as well as the treatment performed, complications and evolution. Descriptive analysis using the chi-square test (X2 ) for categorical variables and the ANOVA (Analysis of Variance) test for continuous variables. Univariate and multivariate analysis using the Cox proportional hazards model. Statistical significance was considered with a value of p<0.05. All calculations were made with the statistical package IBM® SPSS® Statistics v-21. Results: In the multivariate analysis, solid tumor growth (hazard ratio, HR=4.02, p<0.001) and high cytological grade (G3) (HR=3, were identified as independent predictors of recurrence. 42, p=0.01). The presence of a previous or concomitant bladder tumor (HR=1.84, p= 0.07) presented a tendency towards significance. The presence of a previous or concomitant bladder tumor (HR=2.23, p=0.02), the solid tumor growth (HR=2.73, p=0.008), the presence of hydronephrosis (HR =2.46, p=0.02) and the advanced pathological stage pT3-pT4 (HR=2.74, p=0.01). Conclusions: In our series, the existence of previous or synchronic bladder tumor, solid tumor growth and high cytological grade behaved as prognostic factors of recurrence. Hydronephrosis, previous or synchronous bladder tumor, stage pT3-4 and solid tumor growth behaved as prognostic factors for cancer-specific mortality.(AU)

Clinicopathologic analysis of non-muscle invasive urothelial bladder tumor in young and old patients / 中华泌尿外科杂志

Objective To investigate the clinical feature,pathologic characteristics and prognosis of non-muscle invasive urothelial bladder tumor in young and old patients.Methods From January 2000 to March 2011,the clinicial data of 48 young patients (age ≤ 40 years) with non-muscle invasive urothelial bladder tumor and 50 patients randomly selected with non-muscle invasive urothelial tumor (age ≥ 60 years) were analyzed and compared retrospectively.There were 38 male and 10 female with a median age of 35.4 years (range,18 to 40).There were 34 male and 16 female with a median age of 68.5 years (range,68.5 to 87).All patients had postoperative intravesical instillation for one year.Young patients presented with gross hematuria mostly,which were similmar with old patients.Solitary tumor were 45 cases and 40 cases,and the multiple tumors were 3 cases and 10 cases in the young and old groups,respectively.Of the young group,40 patients were treated by transurethral resection of bladder tumor,and 8 patients by partial cystectomy.Of the old group,35 patients were treated by transurethral resection of bladder tumor,and 15 patients by partial cystectomy.Results According to 2004 WHO classification of papillary urothelial tumor,lower grade tumor were more frequentto occur in young group than in old group.There was significant difference in incidence of PUNLMP between young group and old group (16/48,33.3％ and 8/50,16.0％,P ＜ 0.05).There was significant difference in incidence of high grade bladder cancer between young group and old group (7/48,14.6％ and 17/50,34.0％,P ＜0.05).The incidence of PTa tumor was 70.8％ and 44.0％ in the young and old groups,respectively (P ＜ 0.05).Median follow up was 34 months (range,6 to 132) in young group and 35 months (range,6 to 130) in old group,respectively.Five-year recurrence rate was 36.7％ and 64.3％ respectively (P ＜ 0.05).Conclusions Non-muscle invasive urothelial bladder tumor in young patients had a better prognosis than those in the old group,with lower grade and stage at diagnosisand lower recurrence rate.

Development of urothelial tumors following renal transplantation of 11 cases report / 中国综合临床

Objective To analyze the incidence and clinical features of urothelial tumors in renal allograft recipients.Methods A retrospective analysis of 1042 patients received renal allografts who had taken immunosuppression for at least six months between 2006 and 2011 in The First Centre Hospital of Tianjin was performed.Results Eleven cases of uroepithelial tumors were diagnosed in the 1042 cases of renal transplantation ( 1.06％ ),of whom 9 cases were noticed by hematuria ( 81.8 ％ ),2 cases ( 18.2％ ) by medical examination.Six patients were diagnosed with multifocal urothelial carcinomas.Surgery was performed on all the patients with renal tumors and followed by chemotherapy or radiotherapy.Conclusion Malignancies in urinary tract after renal transplantation should be bore in mind.Early diagnosis is very important.The treatment options include reducing immunosuppressive agents and removing tumor lesions completely.

Risk Factors for Subsequent Bladder Tumor in Upper Tract Urothelial Tumor / 대한비뇨기과학회지

PURPOSE: To determine the clinical and pathological risk factors for subsequent bladder tumor in patients with primary upper tract urothelial tumor, we retrospectively analyzed patients with upper tract urothelial tumor, focusing on the clinicopathological features of subsequent bladder tumor. MATERIALS AND METHODS: Risk factors, disease free rate and survival were assessed with clinicopathological features in 56 patients with upper tract urothelial tumor operated between 1989 and 1998. We excluded the patients with lymph node metastasis or distant metastasis, those with a short period of follow-up, and those having a previous history of bladder tumor. Risk factors such as sex, age, location of tumor, size of tumor, number of tumor, synchronous bladder tumor, preoperative urine cytology, stage, grade, operation method, and adjuvant chemotherapy were investigated. RESULTS: Initial subsequent bladder tumor was found in 36 patients (53.6%) during follow-up period of 44 months (range 13 to 111). Among several clinicopathological factors examined, only urine cytology was significantly correlated with the incidence of subsequent bladder tumor (p<0.05). Sex, age, location of tumor, size of tumor, number of tumor, synchronous bladder tumor, stage, grade, operation method, or adjuvant chemotherapy did not affect subsequent bladder tumor recurrence. There was no significant difference in survival rates between the patients with and without subsequent bladder tumor. CONCLUSIONS: Of the clinical and pathological risk factors for subsequent bladder tumor in patients with primary upper tract urothelial tumor, only preoperative urine cytology was significantly correlated with subsequent bladder tumor.

A clinical analysis of the upper urinary tract transitional cell carcinoma and associated bladder tumor / 대한비뇨기과학회지

Urothelial tumor is characterized by a tendency of multicentricity. We analyzed retrospectively 43 cases of the upper urinary tract transitional cell carcinoma from June 1980 to May 1990. Of these cases. 16 (37.2%) cases involved the transitional cell carcinoma of the bladder (synchronous 6. metachronous 10). Of the metachronous group, the interval between treatment of the upper urinary tract lesion and the diagnosis of initial bladder tumor was within 1 year in 7 cases (70%) To compare the synchronous group to the metachronous group, the primary site of the upper urinary tract tumor was pelvis (1:4), ureter (2:2), pelvis + ureter (3:4). By histologic diagnosis, high grade (III, IV) and high stage (PT2-PT4) lesions of the upper urinary tract were 3:5 and 5:8. The 3 year cumulative survival rate of the upper urinary tract tumor without a history of bladder tumor, with the synchronous group and with the metachronous group was 59%, 50% and 62% respectively. There was no significant value (P>0.05) among them. Therefore it was considered that longer follow-ups and a larger series of patients were required.

M-VAC(Methotrexate, Vinblastine, Doxorubicin and Cisplatin) for Advanced Urothelial Tumors / 대한비뇨기과학회지

Patients with advanced urothelial tumors that relapse or persist following conventional therapy have poor prognosis. Management of the patients with recurrent local or disseminated urothelial tumors presents a difficult clinical problems. In 1985 Sternberg et al reported 71% of significant tumor regression and 50% of complete clinical remission with M-VAC (methotrexate, vinblastine, doxorubicin and Cisplatin) combination chemotherapy for treatment of advanced urothelial transitional cell carcinomas. Herein, we have experienced 13 cases of M-VAC combination chemotherapy in advanced urothelial tumors. Complete and partial remission was in achieved 46.2 per cent of the patients clinically, while 15.4 percent had a minor response and 38.4 per cent had progression with median survivals of 11.5, 8.5 and 7.4 months. Toxicity was significant. 15.4 per cent of the patients having experienced nadir sepsis, 30.8 per cent mucositis and 7.6 per cent cardiac toxicity. Median cycle length varied from 31.6 to 41.7 days for the first and 5th cycle respectively. This regimen has been efficacious in selected patients with advanced urothelial tumors.

A Clinical Observation on Urothelial Tumor of the Upper Urinary Tract / 대한비뇨기과학회지

urothelial tumors of the upper urinary tract are relatively uncommon, mostly malignant. 25 patients with urothelial tumor of upper urinary tract seen at St. Mary`s hospital from Jan. 1975 to Dec. 1986 are reviewed retrospectively. The average age was 57.3 years, approximately half of them being more than 60 years old. Gross Hematuria was the most prevalent sign and cytologic examination of the urine has proved not to be diagnostic. The most common findings of excretory urography and retrograde urography were non- visualization of the kidney and filling defect. CT can help to evaluate the extent of disease by determining the invasion or metastasis to surrounding tissues or retroperitoneal node. All 25 patients were surgically explored, 23 patients underwent nephroureterectomy and 6 of them was also done lymphadenectomy, distal ureterectomy with ureteral reimplantation was done in 1 patient and simple nephrectomy was done under the misdiagnosis of renal tuberculosis in 1 patient. There were close relations between histological grade and pathologic grade. Of the 25 patients, stage A and grade II were the most common, each of them were 11 and 16 cases. The over-all 2 year survival rate of 13 patients followed up was seventy percent.

Urothelial Tumors of the Upper Urinary Tract, 15 Cases / 대한비뇨기과학회지

Urothelial tumors of the upper urinary tract are rare, serious diseases that are increasing in frequency. Because of similar embryologic and histologic, pathologic appearance, symptomatology of these tumors are considered as a single entity. We experienced 15 patients with urothelial tumors of the upper urinary tract, who were admitted to our Dept. of Urology during 8 years period from Jan. 1978 to Jan, 1986. The most common symptom was gross hematuria. The most common finding on excretory urogram was a non-visualization of the kidney. Treatment included nephroureterctomy with excision of bladder cuff, nephrectomy and partial ureterectomy, nephroureterectomy and total cystectomy with ileal conduit or Kock continent ileal reservoir. We report 15 cases of urothelial tumors with some review of literatures.

Urothelial Tumors / 대한비뇨기과학회지

During the period of 10.6 years from January, 1974 to June, 1984, clinical observations were made en 28 patients with multiple urothelial tumors involving 2 or more sites among renal pelvis, ureter, bladder and urethra. Out of 28 patients 1 multiple urothelial tumors, 7 had renal pelvis and ureteral tumor, 12 had upper urinary tract and bladder tumor, and 9 had bladder and urethral tumor. The results were as follows 1. 7 patients c renal pelvis and concomitant ureter tumor mostly had higher grade and higher stage tumors. 2. 12 patients c upper urinary tract and concomitant or subsequent development of bladder tumor usually had higher grade and higher stage tumors. 3. Patients having bladder tumor c urethral tumor showed multiple bladder tumors in 8 out of 9 cases, bladder neck lesion were in 7 of 9 cases. The location of urethral tumors showed 2 cases at anterior urethra and 8 cases at posterior urethra. The shape of urethral tumors showed papillary type in 3 cases and non-papillary type in 5 cases.

Urothelial Tumors of the Upper Urinary Tract / 대한비뇨기과학회지

Urothelial tumors of the renal pelvis and ureter are rare. Because of similar histologic appearance, symptomatology and epidemiology both tumors are considered as a single entity. We herein analyze retrospectively 55 patients with urothelial tumors of upper urinary tract who were admitted to Dept. of Urology, Seoul National University Hospital during 15 year period from June, 1970 to June. 1984. Most patients were in 6th and 7th decades. The predominant symptom was hematuria (83 %). The most common finding on I. V. P. was a filling defect (45%), as well as R. G. P.(78 %). The antegrade pyelography and CT scan were beneficial in differential diagnosis of nonopaque filling defect and in differentiating urothelial tumor from renal parenchymal tumor. Concomitant tumors were found in 25% of patients on initial presentation. Various surgical interventions were performed in 45 patients and palliative managements in 10 patients. Major proportion of patients were in stage A. or D. There was close correlation between cellular Grade and tumor Stage. Only 28 patients in 55 were followed properly. 17 patients in 28(61 %) survived more than 2 years. The bladder tumor recurred in 7 in 20 patients with stage A, B or C. Average survival of 8 patients with distant metastasis was 8.6 months. The incidence of bladder tumor in 2 year survived patients was 41%. The recurrence of Ureteral stump were found in 3 of 13 patients(23%).