Adjuvant Treatments for Advanced Stage, Non-metastatic Upper Tract Urothelial Carcinoma: A Multicenter Study.

PURPOSE: We assessed the efficacy of adjuvant treatments in patients with peripelvic/periureteral fat-infiltrating (pT3b), nonmetastatic upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy. METHODS AND MATERIALS: The multicenter data of 222 patients with pT3bN0-x disease treated with radical nephroureterectomy were analyzed. The effects of adjuvant radiation therapy and chemotherapy on local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and cancer-specific survival (CSS) were evaluated. RESULTS: Adjuvant radiation therapy and chemotherapy were given to 39 (17.6%) and 74 patients (33.3%), respectively. Seventeen patients (7.7%) received concomitant adjuvant radiation therapy and chemotherapy. The median follow-up duration was 34.4 months. After adjusting for age, sex, tumor location, multifocality, tumor grade, presence of lymphovascular invasion, surgical margin, execution of node dissection, and other types of concomitant adjuvant treatment (radiation therapy or chemotherapy) through propensity-scored matching, adjuvant radiation therapy significantly reduced the local recurrence (5-year LRFS, 83.9 vs 54.2%; P = .001), distant metastasis (5-year DMFS, 72.1 vs 48.1%; P = .032), and cancer-specific death (5-year CSS, 76.4% vs 55.5%; P = .038) in pT3b UTUC. However, in the same condition, adjuvant chemotherapy did not reduce the local recurrence (5-year LRFS, 69.0% vs 66.2%; P = .786), distant metastasis (5-year DMFS, 65.3% vs 61.1%; P = .436), and cancer-specific death (5-year CSS, 67.9% vs. 67.9%; P = .458) in pT3b UTUC. CONCLUSIONS: Our study suggests that adjuvant radiation therapy may be beneficial in patients with T3bN0-x UTUC; however, prospective clinical trials are needed to clarify this issue.

Reassessment of prognostic heterogeneity of pT3 renal pelvic urothelial carcinoma: analysis in terms of proposed pT3 subclassification systems.

PURPOSE: We determined whether the 3 pT3 subclassification systems reported by the Asan, Cornell and Nagoya groups provide an accurate estimation of patient prognosis. We also determined which subclassification is most predictive of the heterogeneous oncological outcomes of pT3 renal pelvic urothelial carcinoma. MATERIALS AND METHODS: Using a Korea-Japan multi-institutional, retrospective database 250 pT3 renal pelvic urothelial carcinomas treated with radical nephroureterectomy were assigned to the 3 pT3 subcategories by tumor location and depth of parenchymal invasion after pathological reevaluation. Recurrence-free and cancer specific survival was assessed according to the 3 pT3 subclassifications. Predictive accuracy for survival in 4 models (baseline and each of the 3 pT3 subclassifications) was quantified and predictive accuracy increments for each model were compared. RESULTS: In the baseline multivariate Cox regression model nodal metastasis and high grade were significant for survival. On multivariate analysis including the pT3 subclassifications the 3 subclassifications remained significantly associated with survival rates. Of the 3 pT3 subclassification systems the Cornell subclassification had the highest predictive accuracy for discriminating the heterogeneous prognosis of pT3 renal pelvic urothelial carcinoma, followed by the Nagoya subclassification. Compared with the baseline model adding the Cornell subclassification significantly increased predictive accuracy for recurrence-free survival from 0.687 to 0.742 (p = 0.029) and for cancer specific survival from 0.713 to 0.758 (p = 0.047). CONCLUSIONS: The criteria of microscopic vs macroscopic parenchymal invasion and/or peripelvic fat invasion provide the most accurate differential classification of the prognostic heterogeneity of pT3 renal pelvic urothelial carcinoma. Further studies should be performed to determine the need to modify the current pT3 renal pelvic urothelial carcinoma staging system.

Characteristics of calculus fragmentation with Er:YAG laser light emitted by an infrared hollow optical fiber with various sealing caps.

We have experimentally quantified calculus fragmentation by Er:YAG laser light. Er:YAG laser light was delivered to an underwater target through a sealed hollow optical fiber. Fragmentation efficiency was obtained for an alumina ball used as a calculus model when sealing caps with various focusing effects were used. Three types of human calculus were analyzed, and their absorption properties at the wavelength of Er:YAG laser light were obtained. The relationships among the absorption properties, calculus constituents, and fragmentation efficiency are discussed.

[Active chemotherapy with gemcitabine, carboplatin and docetaxel for three patients with MVAC-resistant liver metastasis of urothelial carcinoma].

We report three cases with methotrexate-vinblastin-adriamycin-cisplatin (MVAC) resistant multiple liver metastases of urothelial carcinoma that responded to combination chemotherapy consisting of gemcitabine plus carboplatin (GC) with additional docetaxel (GCD) as salvage chemotherapy. Case 1: A 55-year-old man underwent left nephroureterectomy for ureteral cancer (TCC, G3, pT3pN1M0). Three courses of GC followed by three courses of GCD were given via intra-hepatic arterial infusion for multiple liver metastases, which appeared after adjuvant high-dose MVAC therapy. Complete response was obtained and maintained for 11 months. Case 2: A 46-year-old man underwent radical cystectomy for locally advanced bladder cancer (TCC G3 + adenocarcinoma. pT3pN0M0). Two courses of GC followed by 2 courses of GCD systemic therapies were performed for multiple liver metastases, which appeared after adjuvant high-dose MVAC therapy. Partial response was obtained and maintained for six months. Case 3: A 66-year-old man received three courses of MVAC for multiple metastases of the bladder cancer (TCC, G3, > pT2), which resulted in disease progression. Eight courses of GC followed by six courses of GCD were administrated via intra-hepatic arterial infusion. Partial response was obtained and maintained for 12 months. Although the response duration was still short, GC and GCD may be promising salvage chemotherapeutic regimens for the patients with MVAC-resistant liver metastases of urothelial carcinoma.

[Two cases of encrusted cystitis].

Encrusted cystitis is a type of severe cystitis, which progresses chronically and is characterized by excessively alkaline urine and calcifications within the bladder wall. We report two cases of encrusted cystitis. Both cases were high aged and had severe anemia with chronic cystitis. They complained of gross hematuria, voiding frequency and pain upon urination. Urine pH was 8-9, and urine cytology was negative. Urine culture contained Corynebacterium Group D2. Abdominal computed tomography and transurethral resection revealed wall bladder wall calcification and inflammatory change. We diagnosed it as encrusted cystitis. The patients underwent excision of plaques of calcified encrustation, adapted antibiotic therapy and acidification of urine. It is essential to diagnose encrusted cystitis early and to provide adequate treatment promptly.

Erbium:YAG laser lithotripsy by use of a flexible hollow waveguide with an end-scaling cap.

An Er:YAG laser light delivery system composed of a polymer-coated silver hollow waveguide and a quartz sealing cap has been developed for calculus fragmentation. Sealing caps with various distal-end geometries were fabricated, and the focusing effects of these caps for Er:YAG laser light were measured both in air and in water. Owing to the high power capability of the quartz a beam of sealing caps, Er:YAG laser light with an output energy of 200 mJ and a repetition rate of 10 Hz was successfully transmitted in saline solution by use of the system. Calculus fragmentation experiments conducted in vitro showed that the delivery system is suitable for medical applications in lithotripsy. We also found that the cap with a focusing effect is more effective in cutting calculi. The deterioration of the sealing caps after calculus fragmentation is also discussed.

[Translation and adaptation of the UCLA prostate cancer index for use in Japan].

PURPOSE: To translate the UCLA Prostate Cancer Index (UCLA PCI), which is designed to measure Quality of Life (QOL) of patients with prostate cancer, and to adapt it as needed for use in Japan. METHODS: We translated the original English version into a preliminary Japanese version in a multi-stage procedure according to established guidelines. Then, we tested the preliminary Japanese version on 6 patients with prostate cancer, and we revised the Japanese version based on the findings of the pilot test. RESULTS: The back-translation of the preliminary Japanese version was reviewed by its original developer, and some wordings were revised. In the pilot testing, the average time required to complete the questionnaire was 5.5 minutes. Four of the 20 items frequently had missing data (> 15%). This is believed to have been due to inappropriate wording of the response choices, which were revised accordingly. CONCLUSION: We conducted translation and cross-cultural adaptation of the Japanese version of UCLA PCI. Pilot testing proved to be useful in refining items and response choices.