- Email: [email protected]
Re: Ching-Chia Li, Tu-Hao Chang, Wen-Jeng Wu, 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
european urology 55 (2009) e69–e70
available at www.sciencedirect.com journal homepage: www.europeanurology.com
Letter to the Editor Re: Ching-Chia Li, Tu-Hao Chang, Wen-Jeng Wu, 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 Multiple investigators throughout the world have evaluated the prognostic factors of upper urinary tract urothelial carcinoma. Recently, a large-scale retrospective Taiwanese study published by Li et al demonstrated the influence of renal function on subsequent bladder recurrence after nephroureterectomy [1], the gold standard of treatment in UT-UC. The study also indicated that male patients were at higher risk of intravesical relapse. However, the two factors did not affect the cancer-specific survival. Traditional prognostic parameters for tumour stage and grade were documented as major prognostic factors in patients with UT-UC. Based on their finding, Li et al suggested that male patients with impaired renal function should receive long-term regular surveillance. In our own series, we also identified that advancing chronic kidney disease had negative impact on bladder recurrence; however, cancer-specific survival was not inferior [2]. Our study assumed that the mechanisms of bladder recurrence and metastasis differed. Aristolochic acid-associated nephropathy was proven to be associated with multifocal disease of UC. In another Taiwanese study, Chang et al found Chinese herb exposure to be a risk factor for development of UC: Intake of traditional herbal medicines has been very popular in Taiwanese society, and incidence of UC is higher in patients with end-stage renal disease [3]. In addition, the study indicated that patients with impaired renal function are expected to be at immunosuppressive conditions, exposure to greater concentrations of urinary carcinogenic substances, and impaired DNA repair. These factors all contribute to de novo bladder
cancer occurrence. Several studies support that tumour intraluminal seeding is another mechanism for bladder recurrence [4]. We suggest that pathophysiology of bladder recurrence after operation in patients with UT-UC might be more complex, particularly in Taiwan. Vascular invasion has been investigated and the prognostic implication has been identified in an increasing number of articles. In contrast, the vascular anatomy in dialysis or higher-stage CKD patients could differ from normal subjects. Atrophic regional renal vasculatures and less renal parenchyma tissue in these patients might decrease the probability of haematogenous dissemination. Our hypothesis is supported by increasing evidence demonstrating that vascular invasion is a stronger independent factor to predict metastasis [5]. Conflicts of interest: The authors have nothing to disclose.
References [1] Li C-C, Chang T-H, Wu W-J, et al. Significant predictive factors for prognosis of primary upper tract cancer after radical nephroureterectomy in Taiwanese patients. Eur Urol 2008;54:1127–35. [2] Chung SD, Huang KH, Lai MK, et al. CKD as a risk factor for bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma. Am J Kidney Dis 2007;50:743–53. [3] Chang CH, Yang CM, Yang AH. Renal diagnosis of chronic hemodialysis patients with urinary tract transitional cell carcinoma in Taiwan. Cancer 2007;109:1487–92. [4] Zigeuner RE, Hutterer G, Chromecki T, Rehak P, Langner C. Bladder tumour development after urothelial carcinoma of the upper urinary tract is related to primary tumour location. Br J Urol 2006;98:1181–6. [5] Langner C, Hutterer G, Chromecki T, Winkelmayer I, Rehak P, Zigeuner R. pT classification, grade, and vascular invasion as prognostic indicators in urothelial carcinoma of the upper urinary tract. Mod Pathol 2006;19:272–9.
DOI of original article: 10.1016/j.eururo.2008.01.054 0302-2838/$ – see back matter # 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.
doi:10.1016/j.eururo.2008.02.051
e70
european urology 55 (2009) e69–e70
Shiu-Dong Chunga,b Hong-Jeng Yub Shih-Chieh Chuehb,* a Division of Urology, Department of Surgery, Far-Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan b Department of Urology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
*Corresponding author. Department of Urology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan. Tel. +886 2 23123456x5265; Fax: +886 2 23219145 E-mail address: [email protected] (S.-C. Chueh) February 29, 2008 Published online on March 18, 2008
available at www.sciencedirect.com journal homepage: www.europeanurology.com
Letter to the Editor Re: Ching-Chia Li, Tu-Hao Chang, Wen-Jeng Wu, 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 Multiple investigators throughout the world have evaluated the prognostic factors of upper urinary tract urothelial carcinoma. Recently, a large-scale retrospective Taiwanese study published by Li et al demonstrated the influence of renal function on subsequent bladder recurrence after nephroureterectomy [1], the gold standard of treatment in UT-UC. The study also indicated that male patients were at higher risk of intravesical relapse. However, the two factors did not affect the cancer-specific survival. Traditional prognostic parameters for tumour stage and grade were documented as major prognostic factors in patients with UT-UC. Based on their finding, Li et al suggested that male patients with impaired renal function should receive long-term regular surveillance. In our own series, we also identified that advancing chronic kidney disease had negative impact on bladder recurrence; however, cancer-specific survival was not inferior [2]. Our study assumed that the mechanisms of bladder recurrence and metastasis differed. Aristolochic acid-associated nephropathy was proven to be associated with multifocal disease of UC. In another Taiwanese study, Chang et al found Chinese herb exposure to be a risk factor for development of UC: Intake of traditional herbal medicines has been very popular in Taiwanese society, and incidence of UC is higher in patients with end-stage renal disease [3]. In addition, the study indicated that patients with impaired renal function are expected to be at immunosuppressive conditions, exposure to greater concentrations of urinary carcinogenic substances, and impaired DNA repair. These factors all contribute to de novo bladder
cancer occurrence. Several studies support that tumour intraluminal seeding is another mechanism for bladder recurrence [4]. We suggest that pathophysiology of bladder recurrence after operation in patients with UT-UC might be more complex, particularly in Taiwan. Vascular invasion has been investigated and the prognostic implication has been identified in an increasing number of articles. In contrast, the vascular anatomy in dialysis or higher-stage CKD patients could differ from normal subjects. Atrophic regional renal vasculatures and less renal parenchyma tissue in these patients might decrease the probability of haematogenous dissemination. Our hypothesis is supported by increasing evidence demonstrating that vascular invasion is a stronger independent factor to predict metastasis [5]. Conflicts of interest: The authors have nothing to disclose.
References [1] Li C-C, Chang T-H, Wu W-J, et al. Significant predictive factors for prognosis of primary upper tract cancer after radical nephroureterectomy in Taiwanese patients. Eur Urol 2008;54:1127–35. [2] Chung SD, Huang KH, Lai MK, et al. CKD as a risk factor for bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma. Am J Kidney Dis 2007;50:743–53. [3] Chang CH, Yang CM, Yang AH. Renal diagnosis of chronic hemodialysis patients with urinary tract transitional cell carcinoma in Taiwan. Cancer 2007;109:1487–92. [4] Zigeuner RE, Hutterer G, Chromecki T, Rehak P, Langner C. Bladder tumour development after urothelial carcinoma of the upper urinary tract is related to primary tumour location. Br J Urol 2006;98:1181–6. [5] Langner C, Hutterer G, Chromecki T, Winkelmayer I, Rehak P, Zigeuner R. pT classification, grade, and vascular invasion as prognostic indicators in urothelial carcinoma of the upper urinary tract. Mod Pathol 2006;19:272–9.
DOI of original article: 10.1016/j.eururo.2008.01.054 0302-2838/$ – see back matter # 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.
doi:10.1016/j.eururo.2008.02.051
e70
european urology 55 (2009) e69–e70
Shiu-Dong Chunga,b Hong-Jeng Yub Shih-Chieh Chuehb,* a Division of Urology, Department of Surgery, Far-Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan b Department of Urology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
*Corresponding author. Department of Urology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan. Tel. +886 2 23123456x5265; Fax: +886 2 23219145 E-mail address: [email protected] (S.-C. Chueh) February 29, 2008 Published online on March 18, 2008