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Oncological impact of different distal ureter managements during radical nephroureterectomy for primary upper urinary tract urothelial carcinoma

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World Journal of Clinical Cases 2020年第21期8卷 5104-5115页

作者： Shi-Cong Lai Peng-Jie Wu Jian-Yong Liu Samuel Seery Sheng-Jie Liu Xing-Bo Long Ming Liu Jian-Ye Wang Department of Urology Beijing HospitalNational Center of GerontologyInstitute of Geriatric MedicineChinese Academy of Medical SciencesBeijing 100730China Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences Beijing 100730China School of Humanities and Social Sciences Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China

BACKGROUND The current standard surgical treatment for non-metastatic upper urinary tract urothelial carcinoma(UTUC)is radical nephroureterectomy(RNU)with bladder cuff excision(BCE).Typically,BCE techniques are classified in one of the following three categories:An open technique described as intrasvesical incision of the bladder cuff,a transurethral incision of the bladder cuff(TUBC),and an extravesical incision of the bladder cuff(EVBC)*** though each of these management techniques are widely used,there is no consensus about which surgical intervention is superior,with the best oncologic *** To investigate the oncological outcomes of three BCE methods during RNU for primary UTUC *** We retrospectively analyzed the data of 248 primary UTUC patients,who underwent RNU with BCE between January 2004 to December *** were analyzed according to each BCE *** extracted included patient demographics,perioperative parameters,and oncological *** analyses were performed using chi-square and log-rank *** Cox proportional hazards regression model was utilized to identify independent predictors.P<0.05 was considered statistically *** Of the 248 participants,39.9%(n=99)underwent intrasvesical incision of the bladder cuff,38.7%(n=96)EVBC,and 21.4%(n=53)*** a median followup of 44.2 mo,bladder recurrence developed in 17.2%,12.5%,and 13.2%of the cases,***-specific deaths occurred in 11.1%,5.2%,and 7.5%of patients,***-Meier survival curves with a log-rank test highlighted no significant differences in intravesical recurrence-free survival,cancer-specific survival,and overall survival among these approaches with P values of 0.987,0.825,and 0.497,*** analysis showed that the lower ureter location appears to have inferior intravesical recurrence-free survival(P=0.042).However,cancer-specific survival and overall survival were independently influe

关键词： Bladder cuff excision Prognosis Upper urinary tract urothelial carcinoma radical nephroureterectomy Technique Survival

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Impact of surgical management of upper tract urothelial cancer in octogenarians: A population-based study

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CURRENT UROLOGY 2024年第3期18卷 225-231页

作者： Wang, Shu Phelan, Michael Siddiqui, Mohummad Minhaj Univ Maryland Dept Surg Div Urol Sch Med Baltimore MD USA Vet Affairs Maryland Healthcare Syst Baltimore MD USA

BackgroundUpper tract urothelial carcinoma (UTUC) is an aggressive disease with a high progression rate. The standardmanagement for this disease is nephroureterectomy. Nephron sparing nonradical surgery is an alternative therapeutic approach. In men with limited life expectancy, the potential harm of UTUC progression must be weighed against surgical morbidity and mortality, and thus, more conservative approaches may be selected. This study aims to investigate the comparative benefits of radical and conservative surgical management in patients older than 80 years with localized UTUC. Materials and methodsA search was conducted in the Surveillance, Epidemiology, and End Results database for patients older than 80 years who were diagnosed with localized (T1-2N0M0) cancer in the renal pelvis or ureter as the only malignancy from 2004 to 2015. Patients were divided into 3 therapeutic groups: no surgery, local intervention (ie, local tumor excision or segmented ureterectomy), and radical surgery (nephroureterectomy). Demographic and cancer-related parameter data were collected. Logistic regression analysis was conducted to investigate predictors for surgical treatment. Kaplan-Meier curves and Cox regression were used to analyze survival outcomes. ResultsData from 774 patients were analyzed, including 205 in the no-surgery group, 181 in the local intervention group, and 388 in the radical surgery group. Older, African American patients with T1 stage disease were less likely to receive surgical treatment. Among surgically treated patients, renal pelvic tumors, and high-grade and T2 stage disease were associated with radical resection. Surgically treated patients had a longer median overall survival (OS) than in those treated nonsurgically (13, 35, and 47 months in no-surgery, local intervention, and radical surgery groups, respectively; p < 0.001). Although surgically treated patients demonstrated higher 5-year OS (8.8% [no surgery], 23.2% [local intervention], and 23.5% [r

关键词： Older adults Surgery Surveillance, Epidemiology, and End Results Survival Upper tract urothelial carcinoma TRANSITIONAL-CELL CARCINOMA radical nephroureterectomy EUROPEAN ASSOCIATION UROLOGY GUIDELINES SURVIVAL OUTCOMES COMPLICATIONS HEMATURIA SURGERY KIDNEY

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Lymphoepithelioma-like carcinoma of the upper urinary tract: A systematic review of case reports

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World Journal of Clinical Cases 2020年第4期8卷 771-781页

作者： Shi-Cong Lai Samuel Seery Wei Zhang Ming Liu Guan Zhang Jian-Ye Wang Department of Urology Beijing HospitalNational Center of GerontologyBeijing 100730China Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences Beijing 100730China School of Humanities and Social Sciences Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Department of Pathology Beijing HospitalNational Center of GerontologyBeijing 100730China Department of Urology China-Japan Friendship HospitalBeijing 100029China

BACKGROUND Lymphoepithelioma-like carcinomas(LELCs)are rare,malignant epithelial tumors,generally considered a subtype of squamous cell *** are undifferentiated and can occur in multiple tissues,although LELCs in the urinary tract are extremely *** such,evidence does not provide clinicians with guidelines for the best *** though this is a rare disease,it is associated with high morbidity and ***,we must learn to differentiate LELC types and identify risk factors for early *** To develop an evidence base to guide clinicians treating primary LELCs of the upper urinary tract(UUT-LELC).METHODS We performed a systematic review of all reports on UUT-LELC from the first published case in 1998 until October 2019,according to the PRISMA.A database was then developed by extracting data from previously published reports in order to analyze interactions between clinical characteristics,pathological features,interventions and *** was analyzed using Kaplan–Meier estimates,which were compared using log rank *** A total of 28 previously published cases were identified for *** median age was 72 years with a male to female ratio of 4:*** type LELCs were most common with 48.3%(n=14),followed by 37.9%(n=11)predominant LELCs and 3.4%(n=1)focal ***-Barr virus testing was negative in all *** patients received radical nephroureterectomy(RNU)-based ***-three patients survived with no evidence of further metastasis,although six died before the median 18 mo follow-up *** analysis suggests pure histological subtypes,and patients who receive complete tumor resection have more favorable *** always in cancer care,early identification generally increases the probability of interventional *** The most effective treatment for UUT-LELC is RNU-based *** cases are few in number,case reporting must be enhanced and publishing enco

关键词： Lymphoepithelioma-like carcinoma Prognosis radical nephroureterectomy Upper urinary tract Systematic review Case report

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