Abstract
Objective: The aim of this study was to investigate whether diagnostic ureteroscopy (URS) biopsy is unfavourable for bladder tumour recurrence in upper urinary tract urothelial carcinoma (UTUC). Materials and Methods: We performed a retrospective analysis of 195 patients diagnosed with UTUC, who were divided into a diagnostic URS group (URS+) and a nondiagnostic URS group (URS–) according to whether diagnostic ureteroscopic biopsy was performed. A Cox regression model was used to analyse the risk factors for intravesical recurrence (IVR)-free survival (IRFS) and overall survival (OS) in UTUC after radical nephroureterectomy (RNU). Kaplan-Meier analysis was used to estimate the influence of factors on the incidence of IVR and the cumulative survival rate of UTUC. Results: Patients with a maximum tumour diameter of less than 3.1 cm, low-stage tumours, and ureteral tumours were more likely to undergo diagnostic URS before radical surgery. Multivariate Cox regression analysis showed that tumour pathological stage and diagnostic ureteroscopic biopsy can be used as predictors of IVR after RNU (p = 0.019, 0.033). Kaplan-Meier survival analysis found that diagnostic ureteroscopic biopsy was a high-risk factor for IRFS (p = 0.034). Subcomponent analysis showed that pTa/Tis/T1, pT2, pT3/pT4 stage, and diagnostic ureteroscopic biopsy with pTa/Tis/T1 stage were unfavourable for IVR (p = 0.047). Conclusion: Diagnostic ureteroscopic biopsy before RNU should be carefully selected for patients with atypical preoperative UTUC. We believe that intravesical chemotherapy drug perfusion can be used after surgery to prevent IVR if biopsy is unavoidable, but this still requires further prospective studies.
References
1.
Soria
F
, Shariat
SF
, Lerner
SP
, Fritsche
HM
, Rink
M
, Kassouf
W
, Epidemiology, diagnosis, preoperative evaluation and prognostic assessment of upper-tract urothelial carcinoma (UTUC)
. World J Urol
. 2017
;35
(3
):379
–87
. .2.
Rouprêt
M
, Babjuk
M
, Burger
M
, Capoun
O
, Cohen
D
, Compérat
EM
, European Association of Urology Guidelines on upper urinary tract urothelial carcinoma: 2020 update
. Eur Urol
. 2020
;79
(1
):62
–79
.3.
Ljungberg
B
, Bensalah
K
, Canfield
S
, Dabestani
S
, Hofmann
F
, Hora
M
, EAU guidelines on renal cell carcinoma: 2014 update
. Eur Urol
. 2015
;67
(5
):913
–24
. .4.
Margulis
V
, Shariat
SF
, Matin
SF
, Kamat
AM
, Zigeuner
R
, Kikuchi
E
, Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration
. Cancer
. 2009
;115
(6
):1224
–33
. .5.
Xylinas
E
, Rink
M
, Margulis
V
, Karakiewicz
P
, Novara
G
, Shariat
SF
. Multifocal carcinoma in situ of the upper tract is associated with high risk of bladder cancer recurrence
. Eur Urol
. 2012
;61
(5
):1069
–70
. .6.
Guo
RQ
, Hong
P
, Xiong
GY
, Zhang
L
, Fang
D
, Li
XS
, Impact of ureteroscopy before radical nephroureterectomy for upper tract urothelial carcinomas on oncological outcomes: a meta-analysis
. B J U Int
. 2018
;121
(2
):184
–93
. .7.
Luo
HL
, Kang
CH
, Chen
YT
, Chuang
YC
, Lee
WC
, Cheng
YT
, Diagnostic ureteroscopy independently correlates with intravesical recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma
. Ann Surg Oncol
. 2013
;20
(9
):3121
–6
. .8.
Hou
G
, Zheng
Y
, Zhang
L
, Lai
D
, Wang
F
, Li
X
, Development and validation of a prognostic nomogram for patients with intravesical recurrence after radical nephroureterectomy for non-metastatic upper tract urothelial carcinoma
. World J Urol
. 2020
;38
(8
):1969
–75
. .9.
Lee
HY
, Yeh
HC
, Wu
WJ
, He
JS
, Huang
CN
, Ke
HL
, The diagnostic ureteroscopy before radical nephroureterectomy in upper urinary tract urothelial carcinoma is not associated with higher intravesical recurrence
. World J Surg Oncol
. 2018
;16
(1
):135
. .10.
Grasso
M
, McCue
P
, Bagley
DH
. Multiple urothelial recurrences of renal cell carcinoma after initial diagnostic ureteroscopy
. J Urol
. 1992
;147
(5
):1358
–60
. .11.
Andersen
JR
, Kristensen
JK
. Ureteroscopic management of transitional cell tumors
. Scand J Urol Nephrol
. 1994
;28
(2
):153
–7
. .12.
Peyronnet
B
, Seisen
T
, Dominguez-Escrig
JL
, Bruins
HM
, Yuan
CY
, Lam
T
, Oncological outcomes of laparoscopic nephroureterectomy versus open radical nephroureterectomy for upper tract urothelial carcinoma: an European Association of Urology guidelines systematic review
. Eur Urol Focus
. 2019
;5
(2
):205
–23
. .13.
Xylinas
E
, Kluth
L
, Passoni
N
, Trinh
QD
, Rieken
M
, Lee
RK
, Prediction of intravesical recurrence after radical nephroureterectomy: development of a clinical decision-making tool
. Eur Urol
. 2014
;65
(3
):650
–8
. .14.
Kim
KH
, You
D
, Jeong
IG
, Hong
JH
, Ahn
H
, Kim
CS
. Muscle-invasive bladder cancer developing after nephroureterectomy for upper urinary tract urothelial carcinoma
. Urol Oncol
. 2013
;31
(8
):1643
–9
. .15.
Janisch
F
, Shariat
SF
, Baltzer
P
, Fajkovic
H
, Kimura
S
, Iwata
T
, Diagnostic performance of multidetector computed tomographic (MDCTU) in upper tract urothelial carcinoma (UTUC): a systematic review and meta-analysis
. World J Urol
. 2020
;38
(5
):1165
–75
. .16.
Jinzaki
M
, Kikuchi
E
, Akita
H
, Sugiura
H
, Shinmoto
H
, Oya
M
. Role of computed tomography urography in the clinical evaluation of upper tract urothelial carcinoma
. Int J Urol
. 2016
;23
(4
):284
–98
. .17.
Nison
L
, Rouprêt
M
, Bozzini
G
, Ouzzane
A
, Audenet
F
, Pignot
G
, The oncologic impact of a delay between diagnosis and radical nephroureterectomy due to diagnostic ureteroscopy in upper urinary tract urothelial carcinomas: results from a large collaborative database
. World J Urol
. 2013
;31
(1
):69
–76
. .18.
Kohada
Y
, Hayashi
T
, Goto
K
, Kobatake
K
, Abdi
H
, Honda
Y
, Preoperative risk classification using neutrophil-lymphocyte ratio and hydronephrosis for upper tract urothelial carcinoma
. Jpn J Clin Oncol
. 2018
;48
(9
):841
–50
. .19.
Goel
A
, Paul
S
. Re: Tim O’Brien, Eleanor Ray, Rajinder Singh, Bola Coker, Ralph Beard, British Association of Urological Surgeons Section of Oncology. 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;60:703–10
. Eur Urol
. 2012
;61
(3
):e14
; author reply e15. .20.
Marchioni
M
, Primiceri
G
, Cindolo
L
, Hampton
LJ
, Grob
MB
, Guruli
G
, 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
. .21.
Rehman
J
, Monga
M
, Landman
J
, Lee
DI
, Felfela
T
, Conradie
MC
, Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths
. Urology
. 2003
;61
(4
):713
–8
. .22.
O’Brien
T
, Ray
E
, Singh
R
, Coker
B
, Beard
R
; British Association of Urological Surgeons Section of Oncology
. 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) [J]
. Eur Urol
. 2011
;60
(4
):703
–10
.23.
Ito
A
, Shintaku
I
, Satoh
M
, Ioritani
N
, Aizawa
M
, Tochigi
T
, 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]
. J Clin Oncol
. 2013
;31
(11
):1422
–7
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