Journal article
The Impact of Upper Tract Urothelial Carcinoma Diagnostic Modality on Intravesical Recurrence after Radical Nephroureterectomy: A Single Institution Series and Updated Meta-Analysis
The Journal of urology, Vol.206(3), pp.558-567
09/2021
DOI: 10.1097/JU.0000000000001834
PMID: 33908802
Abstract
Diagnostic ureteroscopic biopsy for upper tract urothelial carcinoma (UTUC) has been hypothesized to increase intravesical recurrence of urothelial carcinoma after radical nephroureterectomy (RNU). Moreover, the impact of ureteroscopy without biopsy or percutaneous biopsy on intravesical recurrence remains unknown. Herein, we compared post-RNU intravesical recurrences across UTUC diagnostic modalities.
Patients undergoing RNU at our institution between 1995 and 2019 were categorized by UTUC diagnostic modality: 1) no ureteroscopy or percutaneous biopsy; 2) percutaneous biopsy; 3) ureteroscopy without biopsy; 4) ureteroscopic biopsy. Intravesical recurrences were compared using Kaplan-Meier analyses and Cox-proportional hazard models. Results of group 4 vs 1 were pooled with the literature using a fixed effects meta-analysis.
In a cohort of 834 RNU patients, 210 (25.2%) had undergone no ureteroscopy, 57 (6.6%) percutaneous biopsy, 125 (15.0%) ureteroscopy without biopsy, and 442 (53.0%) ureteroscopic biopsy. Two-year intravesical recurrence rates were 15.0%, 12.7%, 18.4%, and 21.9% for groups 1 through 4, respectively (p=0.09). Multivariable analysis found that group 4 had increased intravesical recurrences (HR 1.40, p=0.04) relative to group 1 while group 2 (HR 1.07, p=0.87) and group 3 (HR 1.15, p=0.54) did not. Group 4 remained associated with intravesical recurrence on subset analyses accounting for post-RNU surveillance cystoscopy frequency. On meta-analysis including 11 other series, ureteroscopic biopsy was associated with intravesical recurrence (HR 1.47, p <0.01).
Ureteroscopic biopsy before RNU, but not percutaneous biopsy or ureteroscopy without biopsy, was associated with increased intravesical recurrence. Clinical trials of intravesical chemotherapy after ureteroscopic biopsy are warranted to reduce intravesical recurrences.
Details
- Title: Subtitle
- The Impact of Upper Tract Urothelial Carcinoma Diagnostic Modality on Intravesical Recurrence after Radical Nephroureterectomy: A Single Institution Series and Updated Meta-Analysis
- Creators
- Vidit Sharma - Mayo ClinicTanner S Miest - The University of Texas MD Anderson Cancer CenterTristan S Juvet - Mayo ClinicAmir Toussi - University of Pittsburgh Medical CenterVignesh Packiam - University of IowaKarim Chamie - University of California, Los AngelesSurena F Matin - The University of Texas MD Anderson Cancer CenterStephen A Boorjian - Mayo Clinic in ArizonaR Houston Thompson - Department of Urology, Mayo Clinic , Rochester, Minnesota.Igor Frank - Mayo Clinic in ArizonaMatthew K Tollefson - Mayo Clinic in ArizonaAaron M Potretzke - Mayo Clinic
- Resource Type
- Journal article
- Publication Details
- The Journal of urology, Vol.206(3), pp.558-567
- DOI
- 10.1097/JU.0000000000001834
- PMID
- 33908802
- ISSN
- 1527-3792
- eISSN
- 1527-3792
- Language
- English
- Date published
- 09/2021
- Academic Unit
- Urology
- Record Identifier
- 9984320062202771
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