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El enfermo crónico en la fase final de su enfermedad en Cuidado Intensivo requiere la transición del cuidado curativo al cuidado paliativo. Revisión de la literatura
Title
1056
Detection of FGFR3 mutations from urine sediment DNA to predict the risk of intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma Eur Urol Suppl 2015;14/2;e1056
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Seisen T.1 , Rouprêt M. 1 , Cancel-Tassin G.2 , Léon P. 1 , Compérat E. 3 , Drouin S. 1 , Phé V. 1 , Renard-Penna R.4 , Mozer P. 1 , Cussenot O.1 1 Hopital
Pitié - Salpêtrière, Dept. of Urology, Paris, France, 2 Hopital Pitié - Salpêtrière, Dept. of Cancer Research, Paris, France, 3 Hopital
Pitié - Salpêtrière, Dept. of Pathology, Paris, France, 4 Hopital Pitié - Salpêtrière, Dept. of Radiology, Paris, France INTRODUCTION & OBJECTIVES: To assess the role of FGFR3 mutations, detected from urine sediment DNA, in intravesical recurrence (IVR) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). MATERIAL & METHODS: Freshly voided urine samples were obtained from 46 patients before undergoing RNU to treat UTUC. DNA was extracted from urine sediments to perform allele-specific PCR assays for the detection of R248C, S249C, G372C and Y375C mutations. Kaplan Meier method and log-rank test have been used to analyse IVR-free survival according to FGFR-3 status. Univariate and multivariate Cox regression analyses have been conducted to determine predictors of IVR. RESULTS: Overall, FGFR3 mutations occurred in 21 (46%) patients. The mutation in codon 249 was the most frequent (13/61%), followed by Y375C (4/19%), R248C (2/10%) and G372C (2/10%). Patients with FGFR3 mutations were more likely to develop ureteral (57% vs 40%; p=0.04) superficial (81% vs 52%; p=0.04), low-grade (67% vs 8%; p<0.001) tumours without concomitant CIS (10% vs 40%; p<0.001) or lymphovascular invasion (5% vs 60% ; p<0.001). An IVR was diagnosed in 13 (28%) patients within a median time of 19.9 [15-27] months. The incidence of IVR was significantly greater in patients with FGFR3 mutations (43% vs 16%; p=0,04). The five-years IVR-free survival rates were 52% and 82% in wild type and mutant patients, respectively (p=0,12) (Figure 1). In multivariate analysis, current smocker status (HR=2.42; p=0.006), previous bladder cancer (HR=2.14; p<0.001), positive pre-operative urinary cytology (HR=2.25; p<0.001), ureteral tumour location (HR=1.55; p=0.002), multifocality (HR=2.69; p<0.001), invasive pT stage (HR=1.78; p=0.004) were significantly correlated to IVR. However, FGFR3 mutations were not an independent predictor of IVR (HR=2,39; p=0,09).
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/1056.html[19/02/2015 08:05:55]
Title
CONCLUSIONS: We found clinical evidence that supported the general idea that both the intra-luminal seeding of a single transformed cell and the pan-urothelial field defect mechanisms are deeply involved with IVR after RNU. Furthermore, although FGFR3 mutations were not an independent predictor of IVR, there was an increased risk for developing a bladder cancer after RNU in FGFR3 mutant patients.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/1056.html[19/02/2015 08:05:55]
1056
Detection of FGFR3 mutations from urine sediment DNA to predict the risk of intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma Eur Urol Suppl 2015;14/2;e1056
Print! Print!
Seisen T.1 , Rouprêt M. 1 , Cancel-Tassin G.2 , Léon P. 1 , Compérat E. 3 , Drouin S. 1 , Phé V. 1 , Renard-Penna R.4 , Mozer P. 1 , Cussenot O.1 1 Hopital
Pitié - Salpêtrière, Dept. of Urology, Paris, France, 2 Hopital Pitié - Salpêtrière, Dept. of Cancer Research, Paris, France, 3 Hopital
Pitié - Salpêtrière, Dept. of Pathology, Paris, France, 4 Hopital Pitié - Salpêtrière, Dept. of Radiology, Paris, France INTRODUCTION & OBJECTIVES: To assess the role of FGFR3 mutations, detected from urine sediment DNA, in intravesical recurrence (IVR) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). MATERIAL & METHODS: Freshly voided urine samples were obtained from 46 patients before undergoing RNU to treat UTUC. DNA was extracted from urine sediments to perform allele-specific PCR assays for the detection of R248C, S249C, G372C and Y375C mutations. Kaplan Meier method and log-rank test have been used to analyse IVR-free survival according to FGFR-3 status. Univariate and multivariate Cox regression analyses have been conducted to determine predictors of IVR. RESULTS: Overall, FGFR3 mutations occurred in 21 (46%) patients. The mutation in codon 249 was the most frequent (13/61%), followed by Y375C (4/19%), R248C (2/10%) and G372C (2/10%). Patients with FGFR3 mutations were more likely to develop ureteral (57% vs 40%; p=0.04) superficial (81% vs 52%; p=0.04), low-grade (67% vs 8%; p<0.001) tumours without concomitant CIS (10% vs 40%; p<0.001) or lymphovascular invasion (5% vs 60% ; p<0.001). An IVR was diagnosed in 13 (28%) patients within a median time of 19.9 [15-27] months. The incidence of IVR was significantly greater in patients with FGFR3 mutations (43% vs 16%; p=0,04). The five-years IVR-free survival rates were 52% and 82% in wild type and mutant patients, respectively (p=0,12) (Figure 1). In multivariate analysis, current smocker status (HR=2.42; p=0.006), previous bladder cancer (HR=2.14; p<0.001), positive pre-operative urinary cytology (HR=2.25; p<0.001), ureteral tumour location (HR=1.55; p=0.002), multifocality (HR=2.69; p<0.001), invasive pT stage (HR=1.78; p=0.004) were significantly correlated to IVR. However, FGFR3 mutations were not an independent predictor of IVR (HR=2,39; p=0,09).
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/1056.html[19/02/2015 08:05:55]
Title
CONCLUSIONS: We found clinical evidence that supported the general idea that both the intra-luminal seeding of a single transformed cell and the pan-urothelial field defect mechanisms are deeply involved with IVR after RNU. Furthermore, although FGFR3 mutations were not an independent predictor of IVR, there was an increased risk for developing a bladder cancer after RNU in FGFR3 mutant patients.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/1056.html[19/02/2015 08:05:55]