- Email: [email protected]
425 INTRAVESICAL RECURRENCE AFTER SURGICAL MANAGEMENT OF UROTHELIAL CARCINOMA OF THE UPPER URINARY TRACT
across Gleason score groups. If we only considerer patients with PSA < 4 ng/mL, tT was slightly lower in PC patients (4.43 vs. 4.30 pg/mL, respectively; p=0.23). For these patients the best diagnostic test still was f/t PSA ratio comparing to tT/tPSA ratio and to tT levels (AUC: 0.63 (95%CI: 0.54-0.71) vs. 0.58 (95%CI: 0.49-0.66) vs. 0.55(95%CI: 0.46-0.63), respectively). Conclusions: These results indicate that tT serum values were similar between patients with pathology proved different prostatic diagnosis and they don’t have any clinical utility in screening for PC. The f/t PSA ratio still was the best diagnostic tool to help detecting PC.
Poster Session 36 MANAGEMENT OF NON MUSCLE INVASIVE UROTHELIAL TUMOURS: UPPER TRACT TUMOURS AND ENDOVESICAL THERAPY Sunday, 20 March, 12.15-13.45, Hall C
425
Intravesical recurrence after surgical management of urothelial carcinoma of the upper urinary tract
Hirano D., Okada Y., Nagane Y., Mochida J., Yamaguchi K., Hirakata H., Kawata N., Takahashi S. Nihon University School of Medicine, Dept. of Urology, Tokyo, Japan Introduction & Objectives: The incidence of upper urinary tract (UUT) urothelial carcinoma (UC) is relatively rare, account for 5 to 10% of all UCs, while the incidence of subsequent intravesical recurrence in patients who underwent nephroureterectomy is relatively high, account for 15 to 50%. Several investigators reported possible risk factors for predicting intravesical recurrence; however, most of these studies analyzed a comparatively small number of patients, and the outcomes have remained controversial. In the present study, we assessed the clinical and pathological risk factors for intravesical recurrence in patients undergoing surgical management of UUT-UC in our institution including a relatively large number of patients. Materials & Methods: We identified a study population of 143 consecutive patients without previous and concurrent bladder cancer who underwent nephrouretectomy for UUT-UCs (77 pelvic, 57 ureteral and 9 both tumors) at our institution between 1995 and 2010. Bladder tumor development was assessed in relation to UUTUC location, tumor multifocality (single 125, multifocal 18), tumor size (median: 3.3 cm, range: 0.5 - 10.0 cm), stage (pTa,1: 40, pT2: 31, pT3: 64, pT4: 8) , grade (low: 61, high: 82), lymphovascular invasion (negative: 74, positive: 69), lymph node metastasis (negative: 69, positive: 12, unknown: 62), operation time (median: 265min, range: 135 - 332 min), mode of operation (open: 129, laparo: 14), preoperative urinary cytology (negative: 59, positive: 51, undone: 33), perioperative chemotherapy (undone: 97, done: 46), age (median: 68 ys, range: 32 - 85 ys) and gender (male: 117, female: 26). The median follow-up was 38 months (3-162). In the univariate and multivariate analyses both the logistic regression and the Cox proportional hazards model were used. Results: Of the 143 patients, 49 (34%) developed recurrent bladder cancer after a median interval of 6.5 months, and in 48 (98%) of these patients the subsequent bladder cancer arose within 2 years of the treatment. Tumor multifocality and tumor site (located in ureter) were determined as a risk factor for recurrent bladder cancers in univariate analyses. In a multivariate analysis only tumor multifocality (relative risk: 3.684, 95%CI: 1.521-8.926, p=0.0039) was an independent predictor of subsequent bladder tumor development. However, there was no significant impact of the other factors on subsequent intravesical recurrence. Ten-year cancer-specific survival rates were 52% in the patients without bladder recurrence and 67% in the patients with intravesical recurrence, respectively (p=0.0691). Conclusions: The risk of developing a bladder cancer after surgery for UUT-UCs is significantly related to tumor multifocality. Even though most metachronous bladder cancers occur within 2 years of treatment, it is necessary to follow such patient with multifocal tumors in UUT more closely using cystoscopy.
426
Upper urinary tract tumour with or without previous bladder cancer: Does it make a difference?
Palou J.1, Chantada V.2, Cansino J.R.3, Burgos F.J.4, Ramón De Fata F.5, Amón Sesmero J.H.6, Rioja C.7, Serrano A.8, Fariña L.9 On behalf of the Spanish Cooperative Group in upper urinary tract tumours, Spain 1 Fundació Puigvert, Dept. of Urology, Barcelona, Spain, 2Complejo Hospitalaria Universitario, Dept. of Urology, A Coruña, Spain, 3Hospital Universitario La Paz, Dept. of Urology, Madrid, Spain, 4Hospital Ramón y Cajal, Dept. of Urology, Madrid, Spain, 5Hospital Universitario Getafe, Dept. of Urology, Madrid, Spain, 6Hospital Universitario Río Hortega, Dept. of Urology, Valladolid, Spain, 7Hospital Royo Villanova, Dept. of Urology, Zaragoza, Spain, 8Hospital Universitario Guadalajara, Dept. of Urology, Guadalajara, Spain, 9Hospital POVISA, Dept. of Urology, Vigo, Spain
Introduction & Objectives: Primary urothelial cell carcinomas in the upper urinary tract (UUT-UCC) are often invasive tumors. They are mainly diagnosed in the workup because of hematuria and/or lumbar pain. There is no clear data of the difference in clinical symptoms, diagnosis and treatment according to the history of previous bladder cancer (BC) in UUT-UCC.We present an evaluation of the differences in patients with UUT-UCC according to the past history of BC on different aspects in the diagnosis and management of these patients. Materials & Methods: This is a retrospective analysis of 931 patients diagnosed and treated of UUT-UCC in a Spanish Collaborative group in UUT-UUC from 1950 to 2010. They all underwent cystoscopy ±TURBT and were treated because of the presence of an UTT-UCC. We analyse according to BC (no tumour, previous, concomitant or both) the following variables: age, sex, location of the tumour in the upper tract (calyx, renal pelvis, upper ureter, mid ureter, lower ureter), multifocality (solitary/multiple), clinical symptoms (microhematuria, macrohematuria, lumbar pain, follow-up of bladder cancer), tumor grade, pathological stage and surgical treatment.Contingency tables and chi-square test were used for categorical variables and analysis of variance (ANOVA) for quantitative variables. Results: Of 931 patients, including 80.9% males, 25.8 % had previous BC, 15.5% concomitant and 3.2 % both, with a mean age of 65.5 ± 20. Women had less past history of BC (p=0.001). In the different groups of patients with BC there was not a difference in stage or grade but CIS was more often present in concomitant tumours (p=0.02). Those patients with bladder cancer were older (p=0.02) and had more tumours located in the distal ureter (p=0.001), more multiple upper tract tumours (p< 0.001), multiple locations in the upper tract (p=0.003), less invasive tumours in the upper tract (p<0.001), and were mainly diagnosed by imaging (p<0.001). Because of the stage they were mainly treated with endourological procedures (from 34 to 50 % vs 12.5%, p<0.001). Conclusions: UUT-UUC diagnosed after bladder cancer have different clinical presentation and are mainly diagnosed with the imaging in the follow-up. They are more commonly non-muscle invasive, more located in the lower ureter and solved more often with endourology than primary tumours without previous history of bladder cancer.
427
Endoscopic management of upper tract TCC: 20-year single centre experience
Cutress M.L., Wells-Cole S., Stewart G.D., Phipps S., Thomas B.G., Tolley D.A. Western General Hospital, Dept. of Urology, Edinburgh, United Kingdom Introduction & Objectives: We have over 20 years’ experience of the minimally invasive management of upper tract TCC (UTTCC) within our institution. The aim of this study was to report the long-term outcomes of the endoscopic management of UTTCC patients, treated either ureteroscopically or percutaneously. Materials & Methods: We undertook a review of our departmental operation records and selected patients who underwent endoscopic management of UTTCC as their primary treatment, either via ureteroscopy or percutaneous resection. Outcomes were obtained via retrospective analysis of notes, electronic records and registry data. Results: Between January 1991 and October 2010, 75 patients underwent endoscopic management of UTTCC. The mean age of patients at diagnosis was 67.4 (range 36-86) years. All patients underwent ureteroscopy. 13% of patients (n=10) underwent percutaneous resection as either a primary (9%, n=7) or secondary (4%, n=3) procedure, or both (3%, n=2). Median and mean length of follow up were 77 and 48 months respectively (range 0-153 months). Upper tract recurrence occurred in 65% (n=49). 12% (n=9) eventually proceeded to nephroureterectomy. Overall survival was 57% (n=43). Patients who died were on average older at the time of diagnosis than surviving patients (70.3 years compared to 65.3 years), and mean age of death was 75.4 years. Histological data is recorded and the relationship of tumour grade and TCC-specific survival will be presented. Conclusions: Our experience of endoscopic management of UTTCC represents one of the largest patient series reported with long-term follow-up. Upper-tract recurrence is common which mandates regular ureteroscopic surveillance. However, this approach allows renal preservation and relatively few patients underwent nephro-ureterectomy in our cohort. The overall survival of patients with upper tract TCC managed endoscopically can be favourable, in the context of their mean age and long-term follow-up.
428
Smoking behaviour is a risk factor for recurrence after transurethral resection of non-muscle invasive bladder cancer
Lammers R.J.M.1, Witjes W.P.J.2, Hendricksen K.1, Caris C.T.M.2, Janzing-Pastors M.H.C.2, Witjes J.A.1 1 Radboud University Nijmegen Medical Centre, Dept. of Urology, Nijmegen, The Netherlands, 2CuraTrial, SMO & Research, Arnhem, The Netherlands Introduction & Objectives: Cigarette smoking is one of the most well-established risk factors for bladder cancer: smokers have an overall two- to four-fold increase in risk of developing bladder cancer. In this study we investigated the influence of smoking on the development of recurrences and progression in patients with nonmuscle invasive bladder cancer (NMIBC). Materials & Methods: 730 patients underwent transurethral resection for NMIBC.
Eur Urol Suppl 2011;10(2):147
Poster Session 36 MANAGEMENT OF NON MUSCLE INVASIVE UROTHELIAL TUMOURS: UPPER TRACT TUMOURS AND ENDOVESICAL THERAPY Sunday, 20 March, 12.15-13.45, Hall C
425
Intravesical recurrence after surgical management of urothelial carcinoma of the upper urinary tract
Hirano D., Okada Y., Nagane Y., Mochida J., Yamaguchi K., Hirakata H., Kawata N., Takahashi S. Nihon University School of Medicine, Dept. of Urology, Tokyo, Japan Introduction & Objectives: The incidence of upper urinary tract (UUT) urothelial carcinoma (UC) is relatively rare, account for 5 to 10% of all UCs, while the incidence of subsequent intravesical recurrence in patients who underwent nephroureterectomy is relatively high, account for 15 to 50%. Several investigators reported possible risk factors for predicting intravesical recurrence; however, most of these studies analyzed a comparatively small number of patients, and the outcomes have remained controversial. In the present study, we assessed the clinical and pathological risk factors for intravesical recurrence in patients undergoing surgical management of UUT-UC in our institution including a relatively large number of patients. Materials & Methods: We identified a study population of 143 consecutive patients without previous and concurrent bladder cancer who underwent nephrouretectomy for UUT-UCs (77 pelvic, 57 ureteral and 9 both tumors) at our institution between 1995 and 2010. Bladder tumor development was assessed in relation to UUTUC location, tumor multifocality (single 125, multifocal 18), tumor size (median: 3.3 cm, range: 0.5 - 10.0 cm), stage (pTa,1: 40, pT2: 31, pT3: 64, pT4: 8) , grade (low: 61, high: 82), lymphovascular invasion (negative: 74, positive: 69), lymph node metastasis (negative: 69, positive: 12, unknown: 62), operation time (median: 265min, range: 135 - 332 min), mode of operation (open: 129, laparo: 14), preoperative urinary cytology (negative: 59, positive: 51, undone: 33), perioperative chemotherapy (undone: 97, done: 46), age (median: 68 ys, range: 32 - 85 ys) and gender (male: 117, female: 26). The median follow-up was 38 months (3-162). In the univariate and multivariate analyses both the logistic regression and the Cox proportional hazards model were used. Results: Of the 143 patients, 49 (34%) developed recurrent bladder cancer after a median interval of 6.5 months, and in 48 (98%) of these patients the subsequent bladder cancer arose within 2 years of the treatment. Tumor multifocality and tumor site (located in ureter) were determined as a risk factor for recurrent bladder cancers in univariate analyses. In a multivariate analysis only tumor multifocality (relative risk: 3.684, 95%CI: 1.521-8.926, p=0.0039) was an independent predictor of subsequent bladder tumor development. However, there was no significant impact of the other factors on subsequent intravesical recurrence. Ten-year cancer-specific survival rates were 52% in the patients without bladder recurrence and 67% in the patients with intravesical recurrence, respectively (p=0.0691). Conclusions: The risk of developing a bladder cancer after surgery for UUT-UCs is significantly related to tumor multifocality. Even though most metachronous bladder cancers occur within 2 years of treatment, it is necessary to follow such patient with multifocal tumors in UUT more closely using cystoscopy.
426
Upper urinary tract tumour with or without previous bladder cancer: Does it make a difference?
Palou J.1, Chantada V.2, Cansino J.R.3, Burgos F.J.4, Ramón De Fata F.5, Amón Sesmero J.H.6, Rioja C.7, Serrano A.8, Fariña L.9 On behalf of the Spanish Cooperative Group in upper urinary tract tumours, Spain 1 Fundació Puigvert, Dept. of Urology, Barcelona, Spain, 2Complejo Hospitalaria Universitario, Dept. of Urology, A Coruña, Spain, 3Hospital Universitario La Paz, Dept. of Urology, Madrid, Spain, 4Hospital Ramón y Cajal, Dept. of Urology, Madrid, Spain, 5Hospital Universitario Getafe, Dept. of Urology, Madrid, Spain, 6Hospital Universitario Río Hortega, Dept. of Urology, Valladolid, Spain, 7Hospital Royo Villanova, Dept. of Urology, Zaragoza, Spain, 8Hospital Universitario Guadalajara, Dept. of Urology, Guadalajara, Spain, 9Hospital POVISA, Dept. of Urology, Vigo, Spain
Introduction & Objectives: Primary urothelial cell carcinomas in the upper urinary tract (UUT-UCC) are often invasive tumors. They are mainly diagnosed in the workup because of hematuria and/or lumbar pain. There is no clear data of the difference in clinical symptoms, diagnosis and treatment according to the history of previous bladder cancer (BC) in UUT-UCC.We present an evaluation of the differences in patients with UUT-UCC according to the past history of BC on different aspects in the diagnosis and management of these patients. Materials & Methods: This is a retrospective analysis of 931 patients diagnosed and treated of UUT-UCC in a Spanish Collaborative group in UUT-UUC from 1950 to 2010. They all underwent cystoscopy ±TURBT and were treated because of the presence of an UTT-UCC. We analyse according to BC (no tumour, previous, concomitant or both) the following variables: age, sex, location of the tumour in the upper tract (calyx, renal pelvis, upper ureter, mid ureter, lower ureter), multifocality (solitary/multiple), clinical symptoms (microhematuria, macrohematuria, lumbar pain, follow-up of bladder cancer), tumor grade, pathological stage and surgical treatment.Contingency tables and chi-square test were used for categorical variables and analysis of variance (ANOVA) for quantitative variables. Results: Of 931 patients, including 80.9% males, 25.8 % had previous BC, 15.5% concomitant and 3.2 % both, with a mean age of 65.5 ± 20. Women had less past history of BC (p=0.001). In the different groups of patients with BC there was not a difference in stage or grade but CIS was more often present in concomitant tumours (p=0.02). Those patients with bladder cancer were older (p=0.02) and had more tumours located in the distal ureter (p=0.001), more multiple upper tract tumours (p< 0.001), multiple locations in the upper tract (p=0.003), less invasive tumours in the upper tract (p<0.001), and were mainly diagnosed by imaging (p<0.001). Because of the stage they were mainly treated with endourological procedures (from 34 to 50 % vs 12.5%, p<0.001). Conclusions: UUT-UUC diagnosed after bladder cancer have different clinical presentation and are mainly diagnosed with the imaging in the follow-up. They are more commonly non-muscle invasive, more located in the lower ureter and solved more often with endourology than primary tumours without previous history of bladder cancer.
427
Endoscopic management of upper tract TCC: 20-year single centre experience
Cutress M.L., Wells-Cole S., Stewart G.D., Phipps S., Thomas B.G., Tolley D.A. Western General Hospital, Dept. of Urology, Edinburgh, United Kingdom Introduction & Objectives: We have over 20 years’ experience of the minimally invasive management of upper tract TCC (UTTCC) within our institution. The aim of this study was to report the long-term outcomes of the endoscopic management of UTTCC patients, treated either ureteroscopically or percutaneously. Materials & Methods: We undertook a review of our departmental operation records and selected patients who underwent endoscopic management of UTTCC as their primary treatment, either via ureteroscopy or percutaneous resection. Outcomes were obtained via retrospective analysis of notes, electronic records and registry data. Results: Between January 1991 and October 2010, 75 patients underwent endoscopic management of UTTCC. The mean age of patients at diagnosis was 67.4 (range 36-86) years. All patients underwent ureteroscopy. 13% of patients (n=10) underwent percutaneous resection as either a primary (9%, n=7) or secondary (4%, n=3) procedure, or both (3%, n=2). Median and mean length of follow up were 77 and 48 months respectively (range 0-153 months). Upper tract recurrence occurred in 65% (n=49). 12% (n=9) eventually proceeded to nephroureterectomy. Overall survival was 57% (n=43). Patients who died were on average older at the time of diagnosis than surviving patients (70.3 years compared to 65.3 years), and mean age of death was 75.4 years. Histological data is recorded and the relationship of tumour grade and TCC-specific survival will be presented. Conclusions: Our experience of endoscopic management of UTTCC represents one of the largest patient series reported with long-term follow-up. Upper-tract recurrence is common which mandates regular ureteroscopic surveillance. However, this approach allows renal preservation and relatively few patients underwent nephro-ureterectomy in our cohort. The overall survival of patients with upper tract TCC managed endoscopically can be favourable, in the context of their mean age and long-term follow-up.
428
Smoking behaviour is a risk factor for recurrence after transurethral resection of non-muscle invasive bladder cancer
Lammers R.J.M.1, Witjes W.P.J.2, Hendricksen K.1, Caris C.T.M.2, Janzing-Pastors M.H.C.2, Witjes J.A.1 1 Radboud University Nijmegen Medical Centre, Dept. of Urology, Nijmegen, The Netherlands, 2CuraTrial, SMO & Research, Arnhem, The Netherlands Introduction & Objectives: Cigarette smoking is one of the most well-established risk factors for bladder cancer: smokers have an overall two- to four-fold increase in risk of developing bladder cancer. In this study we investigated the influence of smoking on the development of recurrences and progression in patients with nonmuscle invasive bladder cancer (NMIBC). Materials & Methods: 730 patients underwent transurethral resection for NMIBC.
Eur Urol Suppl 2011;10(2):147