- Email: [email protected]
MP7-20 THE ASSOCIATION BETWEEN RESECTION OF BLADDER CANCERS AROUND URETERAL ORIFICES AND UPPER TRACT UROTHELIAL CANCERS
THE JOURNAL OF UROLOGYâ
Vol. 193, No. 4S, Supplement, Friday, May 15, 2015
prediction of oncological outcomes after radical nephroureterectomy (RNU) for high grade upper tract urothelial carcinoma (UTUC) and selection of patients for adjuvant systemic therapy. We sought to externally validate the TALL score. METHODS: A single center cohort of 85 patients underwent RNU between 2007 e 2013 for high-grade, N0/NxM0 UTUC. The TALL sum of T ( T1 ¼ 1, T2 ¼ 2, T3 ¼ 3 and T4 ¼ 4), A (papillary ¼ 0 and sessile ¼ 1), LVI (lympho-vascular invasion absent ¼ 0 and present ¼ 1) and L (lymphadenectomy ¼ 0 and no lympadenectomy ¼ 1) was entered into a score (1e7). The score was used to divide patients into low-risk and high-risk for evaluation of oncological outcomes. KaplanMeier analyses and Cox-regression analyses were used to predict disease-free survival (DFS) and cancer-specific survival (CSS) after RNU. RESULTS: The study included 65 males (76.5%) with a median age of 69 years (range 38 -92). Pathological tumor stage (T) was T2 in 37 (43.5%) patients. Sessile architecture (A) was found in 15 (18%) and lympho-vascular invasion (LVI) in 20 (24%). Lymphadectomy (LND) was performed in 42 (49%). Five-year DFS and CSS rates were 70% and 75% in patients with low-risk (TALL 0e3) scores; 37% and 52% in high-risk (TALL 4e7) score patients (p < 0.001 and p ¼ 0.004; respectively). Cox-regression analyses showed that high-risk patients had significantly higher risk (3.7 times) of disease recurrence and cancer specific mortality compared to low-risk patients (HR 3.741; CI 1.714 - 8.165; P ¼ 0.001 for disease recurrence and HR 3.694; CI 1.405 e 9.71; P ¼ 0.008 for cancer specific mortality). CONCLUSIONS: We validated a multi-variable prognostic tool based on tumor stage, architecture, LVI, and performance of LND for the prediction of oncological outcomes after RNU for high grade UTUC. This validated prediction model can be used for patient counseling, selection for adjuvant systemic therapies, and design of clinical trials.
e71
(2nd-look URS) in patients with endoscopically-treated UTUC, and 2) assess the impact of 2nd-look URS on the outcome of the subsequent endoscopic evaluation and on the risk of tumour progression. METHODS: Clinical and surgical data from 41 patients with UTUC who underwent 2nd-look URS within 60 days since the first URS with concomitant laser photoablation at a single tertiary care referral centre from 2009 to 2013 were analysed. Follow-up timeschedule was based on EAU guidelines in all cases. Radical nephroureterectomy (RNU) was offered in case of local progression of the disease (defined as a massive tumour recurrence). Descriptive statistics tested the impact of 2nd-look URS outcome on the following endoscopic evaluation. Kaplan-Meier curves assessed progression-free survival (PFS) rates according to the tumour grade at first URS and the presence of tumour at 2nd-look URS. Cox regression analyses (CRA) identified predictors of PFS over time. RESULTS: CDR at 2nd-look URS was 51.2%. CDRs at 3rd URS were 81.3% and 41.2% in patients with a positive and negative 2nd-look URS, respectively (p¼0.02). Overall, 9 (22%) patients had a local progression of the disease after a mean (median) time of 18.4 (8.5) months and underwent RNU. At a mean (median) follow-up of 34.6 (27.6) months, tumour grade at 1st URS and 2nd-look URS outcome were significantly associated with PFS (i.e., 79% and 32% in patients with low- vs high-grade tumour at 1st URS, and 88% and 48% in patients with negative vs positive 2nd-look URS, respectively, all log rank<0.01). At CRA tumour grade at 1st URS and 2nd-look URS outcome achieved predictor status for PFS over time (HR¼6.1, CI-95%¼ .42-26.27 and HR¼5.39, CI-95%¼1.18-24.66, respectively, all p0.03). CONCLUSIONS: An early 2nd-look procedure in endoscopically treated patients with UTUC revealed a CDR of 51.2%. Findings at 2nd-look URS affected the outcome of the following endoscopic evaluation and the risk of a subsequent RNU. For those cases of technically not-available pathologic examination, 2nd-look URS may be considered as a surrogate marker of tumour grade and it may help clinicians to characterize UTUC aggressiveness. Further studies are needed to confirm the benefit of this approach on the patients outcome. Source of Funding: none
MP7-20
Source of Funding: None
THE ASSOCIATION BETWEEN RESECTION OF BLADDER CANCERS AROUND URETERAL ORIFICES AND UPPER TRACT UROTHELIAL CANCERS € Muammer Altok, Isparta, Turkey; Ali Feyzullah S ¸ ahin*, Sıtkı Un, Osman Koca, Rauf Taner Divrik, Izmir, Turkey
MP7-19 EARLY REPEATED URETEROSCOPY WITHIN 6e8 WEEKS AFTER A PRIMARY ENDOSCOPIC TREATMENT IN PATIENTS WITH UPPER TRACT UROTHELIAL CELL CARCINOMA - PRELIMINARY FINDINGS Luca Villa*, Jonathan Cloutier, Julien Letendre, Achilles Ploumidis, Paris, France; Andrea Salonia, Milan, Italy; Jean-Nicolas Cornu, Paris, France; Francesco Montorsi, Milan, Italy; Olivier Traxer, Paris, France INTRODUCTION AND OBJECTIVES: Early repeated flexible ureteroscopy (2nd-look URS) has never been considered throughout the conservative surgical management of patients with upper urinary tract urothelial carcinoma (UTUC). We sought to 1) evaluate the oncologic outcome of an early repeated ureteroscopic procedure
INTRODUCTION AND OBJECTIVES: To investigate the incidence, risk factors and predictors of developing Upper tract urothelial carcinoma(UTUC) after resection of primary bladder cancer localized around the ureteral orifice in a relatively large number of patients. METHODS: A total of 1608 patients with available data about tumor localization were included. The data about demographic and clinical features of patients and, pathologic findings were recorded. RESULTS: Among 1608 patients, 166 (10.3%) had bladder tumors involving the ureteral orifice. Of 166 patients with orifice involved bladder cancer, 22 (13.2%) had UTUC, whereas of 1442 patients without orifice involvement, 23 (1.6%) had UTUC (Table-1). Of all patients, 45 (2.8%) had UTUC. Grade, stage and size of tumor, the presence of hydronephrosis and the number of recurrence were different when patients with and without UTUC was compared (Table-2).
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THE JOURNAL OF UROLOGYâ
Vol. 193, No. 4S, Supplement, Friday, May 15, 2015
Among 166 patients bladder tumor involving ureteral orifice, hydronephrosis was detected in 55 (33.1%) at initial diagnosis, 22 (40%) of them the kidney was atrophic.(Figure-1). CONCLUSIONS: We detected a significant higher ratio of UTUC in patients with orifice involvement. Patients with bladder cancer around orifice must be closely examined and followed for UTUC. Table - 2 Characteristics
UTUC
Non-UTUC
45 (2.8%)
1563 (97.2%)
Mean ± SD age
62.5 10.4
63.4 11.7
0.571
Mean ± SD Follow-up (months)
66.1 62.5
47.6 56.2
0.055
M
41 (91.1%)
1397 (89.4%)
F
4 (8.9%)
166 (10.6%)
No pts
No. Gender (%)
Non-TCC Mix
Orifice
Non-Orifice
166 (10.3%)
1442 (89.7%)
Mean SD age
64.5 11.0
63.3 11.7
0.187
Mean SD Follow-up (months)
49.7 56.6
48 56.5
0.714
M
144 (86.7%)
1294 (89.7%)
F
22 (13.3%)
148 (10.3%)
TCC
158 (95.2%)
1343 (93.1%)
Non-TCC
7 (4.2%)
92 (6.4%)
Mix (TCC+SCC+Adeno Ca)
1 (0.6%)
7 (0.5%)
G1
50 (30.1%)
382 (26.5%)
G2
45 (27.1%)
341 (23.6%)
G3
48 (28.9%)
308 (21.4%)
No pts
No. Gender (%)
P
0.262 44 (97.8%)
1457 (93.2%)
1 (2.2%)
98 (6.3%)
0 (0%)
8 (0.5%)
No.TCC tumor grade (%)
0.316
No.TCC tumor grade (%)
0.019
0.666
G1
16 (35.6%)
416 (26.6%)
G2
20 (44.4%)
366 (23.4%)
No.TCC Tumor stage (%)
G3
5 (11.1%)
351 (22.5%)
Superficial Non-Invasive
51 (30.7%)
361 (25%)
Superficial Invasive
68 (41.0%)
556 (38.6%)
Superficial Non-Invasive
13 (28.9%)
399 (25.5%)
Muscle Invasive
45 (27.1%)
377 (26.1%)
Superficial Invasive
26 (57.8%)
598 (38.3%)
Muscle Invasive
4 (8.9%)
418 (26.7%)
2 (1.2%)
148 (10.3%)
Unknown
2 (4.4%)
148 (9.5%)
6 (3.6%)
45 (3.1%)
No.TCC Tumor stage (%)
0.010
Orifice Involved or Not (%) 22 (48.9%)
144 (9.2%)
Orifice not involved
23 (51.1%)
1419 (90.8%)
1 (2.2%)
50 (3.2%)
Carsinoma InSitu (CIS)(%)
CIS at initial diagnosis
0.717
CIS progression
3 (1.8%)
24 (1.7%)
Total CIS
9 (5.4%)
69 (4.8%)
Tumor < 3 cm
41 (24.7%)
391(27.1%)
Tumor 3 cm
109 (65.7%)
898 (62.3%)
16 (9.6%)
153 (10.6%)
Soliter
122 (73.5%)
874 (60.6%)
Multipl
41 (24.7%)
549 (38.1%)
3 (1.8%)
19 (1.3%)
55 (33.1%)
210 (14.6%)
0.0001
22 (13.3%)
23 (1.6%)
0.0001
0.001
CIS progression
6 (13.3%)
Total CIS
7 (15.6%)
71 (4.5%)
No. Tumor size (%)
20 (44.4%)
412 (26.4%)
Tumor < 3 cm
25 (55.6%)
982 (62.8%)
Tumor ‡ 3 cm
0 (0%)
169 (10.8%)
No. Tumor size (%)
21 (1.3%)
0.032
Unknown
No.Tumor number (%)
0.933
Soliter
28 (62.2%)
968 (61.9%)
Multipl
17 (37.8%)
573 (36.7%)
0 (0%)
22 (1.4%)
Hydronephrosis (initial diagnosis)(%)
Unknown 0.0001
None
24 (53.3%)
1318 (84.3%)
Hydronephrosis ± Atrophic kidney
20 (44.4%)
245 (15.7%)
Mean ± SD Bladder tumor reccurence number (total)
3.4 2.2
1.9 1.6
0.447
No.Tumor number (%)
Unknown
Unknown
0.687
Carsinoma InSitu (CIS)(%) 0.0001
Orifice involved
CIS at initial diagnosis
Unknown
P
0,235
No.tumor histology (%)
0.709
No.tumor histology (%) TCC
Table - 1 Characteristics
0.0001
0.003
Hydronephrosis (initial diagnosis)(%) Hydronephrosis Atrophic kidney Presence of UTUC
Source of Funding: None
Vol. 193, No. 4S, Supplement, Friday, May 15, 2015
prediction of oncological outcomes after radical nephroureterectomy (RNU) for high grade upper tract urothelial carcinoma (UTUC) and selection of patients for adjuvant systemic therapy. We sought to externally validate the TALL score. METHODS: A single center cohort of 85 patients underwent RNU between 2007 e 2013 for high-grade, N0/NxM0 UTUC. The TALL sum of T ( T1 ¼ 1, T2 ¼ 2, T3 ¼ 3 and T4 ¼ 4), A (papillary ¼ 0 and sessile ¼ 1), LVI (lympho-vascular invasion absent ¼ 0 and present ¼ 1) and L (lymphadenectomy ¼ 0 and no lympadenectomy ¼ 1) was entered into a score (1e7). The score was used to divide patients into low-risk and high-risk for evaluation of oncological outcomes. KaplanMeier analyses and Cox-regression analyses were used to predict disease-free survival (DFS) and cancer-specific survival (CSS) after RNU. RESULTS: The study included 65 males (76.5%) with a median age of 69 years (range 38 -92). Pathological tumor stage (T) was T2 in 37 (43.5%) patients. Sessile architecture (A) was found in 15 (18%) and lympho-vascular invasion (LVI) in 20 (24%). Lymphadectomy (LND) was performed in 42 (49%). Five-year DFS and CSS rates were 70% and 75% in patients with low-risk (TALL 0e3) scores; 37% and 52% in high-risk (TALL 4e7) score patients (p < 0.001 and p ¼ 0.004; respectively). Cox-regression analyses showed that high-risk patients had significantly higher risk (3.7 times) of disease recurrence and cancer specific mortality compared to low-risk patients (HR 3.741; CI 1.714 - 8.165; P ¼ 0.001 for disease recurrence and HR 3.694; CI 1.405 e 9.71; P ¼ 0.008 for cancer specific mortality). CONCLUSIONS: We validated a multi-variable prognostic tool based on tumor stage, architecture, LVI, and performance of LND for the prediction of oncological outcomes after RNU for high grade UTUC. This validated prediction model can be used for patient counseling, selection for adjuvant systemic therapies, and design of clinical trials.
e71
(2nd-look URS) in patients with endoscopically-treated UTUC, and 2) assess the impact of 2nd-look URS on the outcome of the subsequent endoscopic evaluation and on the risk of tumour progression. METHODS: Clinical and surgical data from 41 patients with UTUC who underwent 2nd-look URS within 60 days since the first URS with concomitant laser photoablation at a single tertiary care referral centre from 2009 to 2013 were analysed. Follow-up timeschedule was based on EAU guidelines in all cases. Radical nephroureterectomy (RNU) was offered in case of local progression of the disease (defined as a massive tumour recurrence). Descriptive statistics tested the impact of 2nd-look URS outcome on the following endoscopic evaluation. Kaplan-Meier curves assessed progression-free survival (PFS) rates according to the tumour grade at first URS and the presence of tumour at 2nd-look URS. Cox regression analyses (CRA) identified predictors of PFS over time. RESULTS: CDR at 2nd-look URS was 51.2%. CDRs at 3rd URS were 81.3% and 41.2% in patients with a positive and negative 2nd-look URS, respectively (p¼0.02). Overall, 9 (22%) patients had a local progression of the disease after a mean (median) time of 18.4 (8.5) months and underwent RNU. At a mean (median) follow-up of 34.6 (27.6) months, tumour grade at 1st URS and 2nd-look URS outcome were significantly associated with PFS (i.e., 79% and 32% in patients with low- vs high-grade tumour at 1st URS, and 88% and 48% in patients with negative vs positive 2nd-look URS, respectively, all log rank<0.01). At CRA tumour grade at 1st URS and 2nd-look URS outcome achieved predictor status for PFS over time (HR¼6.1, CI-95%¼ .42-26.27 and HR¼5.39, CI-95%¼1.18-24.66, respectively, all p0.03). CONCLUSIONS: An early 2nd-look procedure in endoscopically treated patients with UTUC revealed a CDR of 51.2%. Findings at 2nd-look URS affected the outcome of the following endoscopic evaluation and the risk of a subsequent RNU. For those cases of technically not-available pathologic examination, 2nd-look URS may be considered as a surrogate marker of tumour grade and it may help clinicians to characterize UTUC aggressiveness. Further studies are needed to confirm the benefit of this approach on the patients outcome. Source of Funding: none
MP7-20
Source of Funding: None
THE ASSOCIATION BETWEEN RESECTION OF BLADDER CANCERS AROUND URETERAL ORIFICES AND UPPER TRACT UROTHELIAL CANCERS € Muammer Altok, Isparta, Turkey; Ali Feyzullah S ¸ ahin*, Sıtkı Un, Osman Koca, Rauf Taner Divrik, Izmir, Turkey
MP7-19 EARLY REPEATED URETEROSCOPY WITHIN 6e8 WEEKS AFTER A PRIMARY ENDOSCOPIC TREATMENT IN PATIENTS WITH UPPER TRACT UROTHELIAL CELL CARCINOMA - PRELIMINARY FINDINGS Luca Villa*, Jonathan Cloutier, Julien Letendre, Achilles Ploumidis, Paris, France; Andrea Salonia, Milan, Italy; Jean-Nicolas Cornu, Paris, France; Francesco Montorsi, Milan, Italy; Olivier Traxer, Paris, France INTRODUCTION AND OBJECTIVES: Early repeated flexible ureteroscopy (2nd-look URS) has never been considered throughout the conservative surgical management of patients with upper urinary tract urothelial carcinoma (UTUC). We sought to 1) evaluate the oncologic outcome of an early repeated ureteroscopic procedure
INTRODUCTION AND OBJECTIVES: To investigate the incidence, risk factors and predictors of developing Upper tract urothelial carcinoma(UTUC) after resection of primary bladder cancer localized around the ureteral orifice in a relatively large number of patients. METHODS: A total of 1608 patients with available data about tumor localization were included. The data about demographic and clinical features of patients and, pathologic findings were recorded. RESULTS: Among 1608 patients, 166 (10.3%) had bladder tumors involving the ureteral orifice. Of 166 patients with orifice involved bladder cancer, 22 (13.2%) had UTUC, whereas of 1442 patients without orifice involvement, 23 (1.6%) had UTUC (Table-1). Of all patients, 45 (2.8%) had UTUC. Grade, stage and size of tumor, the presence of hydronephrosis and the number of recurrence were different when patients with and without UTUC was compared (Table-2).
e72
THE JOURNAL OF UROLOGYâ
Vol. 193, No. 4S, Supplement, Friday, May 15, 2015
Among 166 patients bladder tumor involving ureteral orifice, hydronephrosis was detected in 55 (33.1%) at initial diagnosis, 22 (40%) of them the kidney was atrophic.(Figure-1). CONCLUSIONS: We detected a significant higher ratio of UTUC in patients with orifice involvement. Patients with bladder cancer around orifice must be closely examined and followed for UTUC. Table - 2 Characteristics
UTUC
Non-UTUC
45 (2.8%)
1563 (97.2%)
Mean ± SD age
62.5 10.4
63.4 11.7
0.571
Mean ± SD Follow-up (months)
66.1 62.5
47.6 56.2
0.055
M
41 (91.1%)
1397 (89.4%)
F
4 (8.9%)
166 (10.6%)
No pts
No. Gender (%)
Non-TCC Mix
Orifice
Non-Orifice
166 (10.3%)
1442 (89.7%)
Mean SD age
64.5 11.0
63.3 11.7
0.187
Mean SD Follow-up (months)
49.7 56.6
48 56.5
0.714
M
144 (86.7%)
1294 (89.7%)
F
22 (13.3%)
148 (10.3%)
TCC
158 (95.2%)
1343 (93.1%)
Non-TCC
7 (4.2%)
92 (6.4%)
Mix (TCC+SCC+Adeno Ca)
1 (0.6%)
7 (0.5%)
G1
50 (30.1%)
382 (26.5%)
G2
45 (27.1%)
341 (23.6%)
G3
48 (28.9%)
308 (21.4%)
No pts
No. Gender (%)
P
0.262 44 (97.8%)
1457 (93.2%)
1 (2.2%)
98 (6.3%)
0 (0%)
8 (0.5%)
No.TCC tumor grade (%)
0.316
No.TCC tumor grade (%)
0.019
0.666
G1
16 (35.6%)
416 (26.6%)
G2
20 (44.4%)
366 (23.4%)
No.TCC Tumor stage (%)
G3
5 (11.1%)
351 (22.5%)
Superficial Non-Invasive
51 (30.7%)
361 (25%)
Superficial Invasive
68 (41.0%)
556 (38.6%)
Superficial Non-Invasive
13 (28.9%)
399 (25.5%)
Muscle Invasive
45 (27.1%)
377 (26.1%)
Superficial Invasive
26 (57.8%)
598 (38.3%)
Muscle Invasive
4 (8.9%)
418 (26.7%)
2 (1.2%)
148 (10.3%)
Unknown
2 (4.4%)
148 (9.5%)
6 (3.6%)
45 (3.1%)
No.TCC Tumor stage (%)
0.010
Orifice Involved or Not (%) 22 (48.9%)
144 (9.2%)
Orifice not involved
23 (51.1%)
1419 (90.8%)
1 (2.2%)
50 (3.2%)
Carsinoma InSitu (CIS)(%)
CIS at initial diagnosis
0.717
CIS progression
3 (1.8%)
24 (1.7%)
Total CIS
9 (5.4%)
69 (4.8%)
Tumor < 3 cm
41 (24.7%)
391(27.1%)
Tumor 3 cm
109 (65.7%)
898 (62.3%)
16 (9.6%)
153 (10.6%)
Soliter
122 (73.5%)
874 (60.6%)
Multipl
41 (24.7%)
549 (38.1%)
3 (1.8%)
19 (1.3%)
55 (33.1%)
210 (14.6%)
0.0001
22 (13.3%)
23 (1.6%)
0.0001
0.001
CIS progression
6 (13.3%)
Total CIS
7 (15.6%)
71 (4.5%)
No. Tumor size (%)
20 (44.4%)
412 (26.4%)
Tumor < 3 cm
25 (55.6%)
982 (62.8%)
Tumor ‡ 3 cm
0 (0%)
169 (10.8%)
No. Tumor size (%)
21 (1.3%)
0.032
Unknown
No.Tumor number (%)
0.933
Soliter
28 (62.2%)
968 (61.9%)
Multipl
17 (37.8%)
573 (36.7%)
0 (0%)
22 (1.4%)
Hydronephrosis (initial diagnosis)(%)
Unknown 0.0001
None
24 (53.3%)
1318 (84.3%)
Hydronephrosis ± Atrophic kidney
20 (44.4%)
245 (15.7%)
Mean ± SD Bladder tumor reccurence number (total)
3.4 2.2
1.9 1.6
0.447
No.Tumor number (%)
Unknown
Unknown
0.687
Carsinoma InSitu (CIS)(%) 0.0001
Orifice involved
CIS at initial diagnosis
Unknown
P
0,235
No.tumor histology (%)
0.709
No.tumor histology (%) TCC
Table - 1 Characteristics
0.0001
0.003
Hydronephrosis (initial diagnosis)(%) Hydronephrosis Atrophic kidney Presence of UTUC
Source of Funding: None