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Editorial Comment on: Significant Predictive Factors for Prognosis of Primary Upper Urinary Tract Cancer after Radical Nephroureterectomy in Taiwanese Patients
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[10] Muntener M, Nielsen ME, Romero FR, et al. Long-term oncologic outcome after laparoscopic radical nephroureterectomy for upper tract transitional cell carcinoma. Eur Urol 2007;51:1639–44. [11] Raman JD, Sosa RE, Vaughan ED, Scherr DS. Pathologic features of bladder tumors after nephroureterectomy or segmental ureterectomy for upper urinary tract transitional cell carcinoma. Urology 2007;69:251–4. [12] Matsui Y, Utsunomiya N, Ichioka K, et al. Risk factors for subsequent development of bladder cancer after primary transitional cell carcinoma of the upper urinary tract. Urology 2005;65:279–83. [13] Kang CH, Yu TJ, Hsieh HH, et al. The development of bladder tumors and contralateral upper urinary tract tumors after primary transitional cell carcinoma of the upper urinary tract. Cancer 2003;98:1620–6. [14] Petkovic SD. Treatment of bilateral renal pelvic and ureteral tumors: a review of 45 cases. Eur Urol 1978;4:397–400. [15] Jiaan BP, Yu CC, Lee YH, Huang JK. Uraemia with concomitant urothelial cancer. Br J Urol 1993;72:458–61. [16] Inamoto H, Ozaki R, Matsuzaki T, Wakui M, Saruta T, Osawa A. Incidence and mortality patterns of malignancy and factors affecting the risk of malignancy in dialysis patients. Nephron 1991;59:611–7. [17] Hsueh TY, Huang YH, Chiu AW, Shen KH, Lee YH. A comparison of the clinical outcome between open and hand-assisted laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma. Br J Urol 2004;94:798–801. [18] Holmang S, Johansson SL. Bilateral metachronous ureteral and renal pelvic carcinoma: incidence, clinical presentation, histopathology, treatment and outcome. J Urol 2006;175:69–73. [19] Huang PC, Huang CY, Huang SW, et al. High incidence of and risk factors for metachronous bilateral upper tract urothelial carcinoma in Taiwan. Int J Urol 2006;13:864–9. [20] Wu CF, Chang PL, Chen CS, Chuang CK, Weng HH, Pang ST. The outcome of patients on dialysis with upper urin-
Editorial Comment on: Significant Predictive Factors for Prognosis of Primary Upper Urinary Tract Cancer after Radical Nephroureterectomy in Taiwanese Patients Arthur I. Sagalowsky Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA [email protected] Upper tract tumor (UTCC) is a relatively uncommon location within the overall spectrum of urothelial cancer. The article by Li et al [1] describes 260 cases of unilateral, localized disease in patients without prior bladder tumor who were treated by
[21]
[22]
[23]
[24]
[25]
[26]
[27]
[28]
[29]
[30]
ary tract transitional cell carcinoma. J Urol 2006;176:477– 81. Wu MJ, Lian JD, Yang CR, et al. High cumulative incidence of urinary tract transitional cell carcinoma after kidney transplantation in Taiwan. Am J Kidney Dis 2004;43: 1091–7. Kihara K, Fukui I, Higashi Y, Oshima H. Inhibitory effect of testosterone on gap junctional intercellular communication of human transitional cell carcinoma cell lines. Cancer Res 1990;50:2848–52. Cozad S, Smalley S, Austenfeld M, Noble M, Jennings S, Raymond R. Transitional cell carcinoma of the renal pelvis or ureter: patterns of failure. Urology 1995;46:796–800. Dragicevic D, Djokic M, Pekmezovic T, et al. Survival of patients with transitional cell carcinoma of the ureter and renal pelvis in Balkan endemic nephropathy and nonendemic areas of Serbia. Br J Urol 2007;99:1357–62. Novara G, Marco VD, Gottardo F, et al. Independent predictors of cancer-specific survival in transitional cell carcinoma of the upper urinary tract. Cancer 2007;110:1715– 22. van der Poel HG, Antonini N, van Tinteren H, Horenblas S. Upper urinary tract cancer: location is correlated with prognosis. Eur Urol 2005;48:438–44. Ataus S, Onal B, Tunc B, et al. Factors affecting the survival of patients treated by standard nephroureterectomy for transitional cell carcinoma of the upper urinary tract. Int Urol and Nephrol 2006;38:9–13. Yang CY, Chiu HF, Chang CC, Ho SC, Wu TN. Bladder cancer mortality reduction after installation of a tapwater supply system in an arsenious-endemic area in southwestern Taiwan. Environ Res 2005;98:127–32. Cosyns JP, Jadoul M, Squifflet JP, Wese FX, van Ypersele de Strihou C. Urothelial lesions in Chinese-herb nephropathy. Am J Kidney Dis 1999;33:1101–7. Nortier JL, Martinez MM, Schmeiser HH, et al. Urothelial carcinoma associated with the use of a Chinese herb (Aristolochia fangchi). N Engl J Med 2000;342:1686–92.
radical nephroureterectomy in Taiwan over a contemporary 15-yr period. In multivariate analysis, T stage most correlated with outcome as in other reports. Several findings in the current series were unique from series in Europe and the United States. The high rate of liver metastases is surprising. One wonders if the high rate of hepatitis endemic to the area had an impact on disease behavior. UTCC was proportionately more common in women and equaled the rate in men. Yet, subsequent bladder tumor remained more common in men, especially in those with renal insufficiency (hazard ratio of 3). The prevalence of UTCC was particularly high in southern Taiwan areas with endemic black foot disease, a condition that is due to arsenic intoxica-
european urology 54 (2008) 1127–1135
tion in the water. The authors offer the interesting speculation that the higher rate of UTCC in women in Taiwan may be due to their exposure to carcinogens from herbs or water in the dense smoke created by steaming in cooking food. Although this remains to be proven and may suggest to readers in other parts of the world that the results in the current series apply to a ‘‘regionally’’ unique form of the disease, the opportunity to learn about the process of UTCC carcinogenesis from this large experience is valuable.
1135
Reference [1] Li C-C, Chang T-H, Wu W-J, et al. Significant predictive factors for prognosis of primary upper urinary tract cancer after radical nephroureterectomy in Taiwanese patients. Eur Urol 2008;54:1127–35.
DOI: 10.1016/j.eururo.2008.01.055 DOI of original article: 10.1016/j.eururo.2008.01.054
european urology 54 (2008) 1127–1135
[10] Muntener M, Nielsen ME, Romero FR, et al. Long-term oncologic outcome after laparoscopic radical nephroureterectomy for upper tract transitional cell carcinoma. Eur Urol 2007;51:1639–44. [11] Raman JD, Sosa RE, Vaughan ED, Scherr DS. Pathologic features of bladder tumors after nephroureterectomy or segmental ureterectomy for upper urinary tract transitional cell carcinoma. Urology 2007;69:251–4. [12] Matsui Y, Utsunomiya N, Ichioka K, et al. Risk factors for subsequent development of bladder cancer after primary transitional cell carcinoma of the upper urinary tract. Urology 2005;65:279–83. [13] Kang CH, Yu TJ, Hsieh HH, et al. The development of bladder tumors and contralateral upper urinary tract tumors after primary transitional cell carcinoma of the upper urinary tract. Cancer 2003;98:1620–6. [14] Petkovic SD. Treatment of bilateral renal pelvic and ureteral tumors: a review of 45 cases. Eur Urol 1978;4:397–400. [15] Jiaan BP, Yu CC, Lee YH, Huang JK. Uraemia with concomitant urothelial cancer. Br J Urol 1993;72:458–61. [16] Inamoto H, Ozaki R, Matsuzaki T, Wakui M, Saruta T, Osawa A. Incidence and mortality patterns of malignancy and factors affecting the risk of malignancy in dialysis patients. Nephron 1991;59:611–7. [17] Hsueh TY, Huang YH, Chiu AW, Shen KH, Lee YH. A comparison of the clinical outcome between open and hand-assisted laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma. Br J Urol 2004;94:798–801. [18] Holmang S, Johansson SL. Bilateral metachronous ureteral and renal pelvic carcinoma: incidence, clinical presentation, histopathology, treatment and outcome. J Urol 2006;175:69–73. [19] Huang PC, Huang CY, Huang SW, et al. High incidence of and risk factors for metachronous bilateral upper tract urothelial carcinoma in Taiwan. Int J Urol 2006;13:864–9. [20] Wu CF, Chang PL, Chen CS, Chuang CK, Weng HH, Pang ST. The outcome of patients on dialysis with upper urin-
Editorial Comment on: Significant Predictive Factors for Prognosis of Primary Upper Urinary Tract Cancer after Radical Nephroureterectomy in Taiwanese Patients Arthur I. Sagalowsky Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA [email protected] Upper tract tumor (UTCC) is a relatively uncommon location within the overall spectrum of urothelial cancer. The article by Li et al [1] describes 260 cases of unilateral, localized disease in patients without prior bladder tumor who were treated by
[21]
[22]
[23]
[24]
[25]
[26]
[27]
[28]
[29]
[30]
ary tract transitional cell carcinoma. J Urol 2006;176:477– 81. Wu MJ, Lian JD, Yang CR, et al. High cumulative incidence of urinary tract transitional cell carcinoma after kidney transplantation in Taiwan. Am J Kidney Dis 2004;43: 1091–7. Kihara K, Fukui I, Higashi Y, Oshima H. Inhibitory effect of testosterone on gap junctional intercellular communication of human transitional cell carcinoma cell lines. Cancer Res 1990;50:2848–52. Cozad S, Smalley S, Austenfeld M, Noble M, Jennings S, Raymond R. Transitional cell carcinoma of the renal pelvis or ureter: patterns of failure. Urology 1995;46:796–800. Dragicevic D, Djokic M, Pekmezovic T, et al. Survival of patients with transitional cell carcinoma of the ureter and renal pelvis in Balkan endemic nephropathy and nonendemic areas of Serbia. Br J Urol 2007;99:1357–62. Novara G, Marco VD, Gottardo F, et al. Independent predictors of cancer-specific survival in transitional cell carcinoma of the upper urinary tract. Cancer 2007;110:1715– 22. van der Poel HG, Antonini N, van Tinteren H, Horenblas S. Upper urinary tract cancer: location is correlated with prognosis. Eur Urol 2005;48:438–44. Ataus S, Onal B, Tunc B, et al. Factors affecting the survival of patients treated by standard nephroureterectomy for transitional cell carcinoma of the upper urinary tract. Int Urol and Nephrol 2006;38:9–13. Yang CY, Chiu HF, Chang CC, Ho SC, Wu TN. Bladder cancer mortality reduction after installation of a tapwater supply system in an arsenious-endemic area in southwestern Taiwan. Environ Res 2005;98:127–32. Cosyns JP, Jadoul M, Squifflet JP, Wese FX, van Ypersele de Strihou C. Urothelial lesions in Chinese-herb nephropathy. Am J Kidney Dis 1999;33:1101–7. Nortier JL, Martinez MM, Schmeiser HH, et al. Urothelial carcinoma associated with the use of a Chinese herb (Aristolochia fangchi). N Engl J Med 2000;342:1686–92.
radical nephroureterectomy in Taiwan over a contemporary 15-yr period. In multivariate analysis, T stage most correlated with outcome as in other reports. Several findings in the current series were unique from series in Europe and the United States. The high rate of liver metastases is surprising. One wonders if the high rate of hepatitis endemic to the area had an impact on disease behavior. UTCC was proportionately more common in women and equaled the rate in men. Yet, subsequent bladder tumor remained more common in men, especially in those with renal insufficiency (hazard ratio of 3). The prevalence of UTCC was particularly high in southern Taiwan areas with endemic black foot disease, a condition that is due to arsenic intoxica-
european urology 54 (2008) 1127–1135
tion in the water. The authors offer the interesting speculation that the higher rate of UTCC in women in Taiwan may be due to their exposure to carcinogens from herbs or water in the dense smoke created by steaming in cooking food. Although this remains to be proven and may suggest to readers in other parts of the world that the results in the current series apply to a ‘‘regionally’’ unique form of the disease, the opportunity to learn about the process of UTCC carcinogenesis from this large experience is valuable.
1135
Reference [1] Li C-C, Chang T-H, Wu W-J, et al. Significant predictive factors for prognosis of primary upper urinary tract cancer after radical nephroureterectomy in Taiwanese patients. Eur Urol 2008;54:1127–35.
DOI: 10.1016/j.eururo.2008.01.055 DOI of original article: 10.1016/j.eururo.2008.01.054