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PROGNOSTICS FACTORS, MOLECULAR MARKERS AND PREDICTIVE TOOLS IN UPPER TRACT UROTHELIAL CARCINOMA


Authors: E. Xylinas;  T. Klatte;  S. Matin;  S. F. Shariat
Published in: Urol List 2013; 11(3): 30-39

Overview

Upper tract urothelial carcinoma is a rare disease and the outcomes of patients with UTUC are heterogeneous and, therefore, difficult to predict. The lack of randomized trials in patients with UTUC makes decisions complex. Accurate estimation of treatment success, complications, and long-term morbidity are essential for patients to make informed medical decisions. Recently researchers have developed prognostic tools based on statistical models to obtain the most accurate and reliable predictions. Among the available decision tools, nomograms currently represent the most accurate and widely used tools for prediction of outcomes in patients with cancer. The authors of this article discuss the established prognostic factors in UTUC (including clinic-pathological features and molecular markers) and the currently available predictive tools.

Key words:
upper tract urothelial carcinoma, prognostics factors, molecular markers


Sources

1. Roupret M, Zigeuner R, Palou J et al. European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update. Eur Urol 2011; 59: 584–594.

2. Ehdaie B, Chromecki TF, Lee RK et al. Obesity adversely impacts disease specific outcomes in patients with upper tract urothelial carcinoma. J Urol 2011; 186: 66–72.

3. Fajkovic H, Cha EK, Jeldres C et al. Prognostic value of extranodal extension and other lymph node parameters in patients with upper tract urothelial carcinoma. J Urol 2012; 187: 845–851.

4. Kikuchi E, Margulis V, Karakiewicz PI et al. Lymphovascular invasion predicts clinical outcomes in patients with node-negative upper tract urothelial carcinoma. J Clin Oncol 2009; 27: 612–618.

5. Raman JD, Ng CK, Scherr DS et al. Impact of tumor location on prognosis for patients with upper tract urothelial carcinoma managed by radical nephroureterectomy. Eur Urol 2010; 57: 1072–1079.

6. Shariat SF, Favaretto RL, Gupta A et al. Gender differences in radical nephroureterectomy for upper tract urothelial carcinoma. World J Urol 2011; 29: 481–486.

7. Lughezzani G, Burger M, Margulis V et al. Prognostic factors in upper urinary tract urothelial carcinomas: a comprehensive review of the current literature. Eur Urol 2012; 62: 100–114.

8. Ouzzane A, Colin P, Xylinas E et al. Ureteral and multifocal tumours have worse prognosis than renal pelvic tumours in urothelial carcinoma of the upper urinary tract treated by nephroureterectomy. Eur Urol 2011; 60: 1258–1265.

9. Xylinas E, Rink M, Cha EK et al. Impact of Distal Ureter Management on Oncologic Outcomes Following Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma. Eur Urol, 2012

10. Shariat SF, Kattan MW, Vickers AJ et al. Critical review of prostate cancer predictive tools. Future Oncol 2009; 5: 1555–1584.

11. Lughezzani G, Jeldres C, Isbarn H et al. Nephroureterectomy and segmental ureterectomy in the treatment of invasive upper tract urothelial carcinoma: a population-based study of 2299 patients. Eur J Cancer 2009; 45: 3291–3297.

12. Shariat SF, Godoy G, Lotan Y et al. Advanced patient age is associated with inferior cancer-specific survival after radical nephroureterectomy. BJU Int 2010; 105: 1672–1677.

13. Chromecki TF, Ehdaie B, Novara G et al. Chronological age is not an independent predictor of clinical outcomes after radical nephroureterectomy. World J Urol 2011; 29: 473–480.

14. Lughezzani G, Sun M, Perrotte P et al. Gender-related differences in patients with stage I to III upper tract urothelial carcinoma: results from the Surveillance, Epidemiology, and End Results database. Urology 2010; 75: 321–327.

15. Raman JD, Messer J, Sielatycki JA et al. Incidence and survival of patients with carcinoma of the ureter and renal pelvis in the USA, 1973–2005. BJU Int 2011; 107: 1059–1064.

16. Martinez-Salamanca JI, Shariat SF, Rodriguez JC et al. Prognostic role of ECOG performance status in patients with urothelial carcinoma of the upper urinary tract: an international study. BJU Int 2012; 109: 1155–1161.

17. Berod AA, Colin P, Yates DR et al. The role of American Society of Anesthesiologists scores in predicting urothelial carcinoma of the upper urinary tract outcome after radical nephroureterectomy: results from a national multi-institutional collaborative study. BJU Int, 2012; 110: E1035–E1040.

18. McLaughlin JK, Silverman DT, Hsing AW et al. Cigarette smoking and cancers of the renal pelvis and ureter. Cancer Res 1992; 52: 254–257.

19. Rink M, Xylinas E, Margulis V et al. Impact of smoking on oncologic outcomes of upper tract urothelial carcinoma after radical nephroureterectomy. Eur Urol 2013; 63: 1082–1090.

20. Cho KS, Hong SJ, Cho NH et al. Grade of hydronephrosis and tumor diameter as preoperative prognostic factors in ureteral transitional cell carcinoma. Urology 2007; 70: 662–666.

21. Ito Y, Kikuchi E, Tanaka N et al. Preoperative hydronephrosis grade independently predicts worse pathological outcomes in patients undergoing nephroureterectomy for upper tract urothelial carcinoma. J Urol 2011; 185: 1621–1626.

22. Brien JC, Shariat SF, Herman MP et al. Preoperative hydronephrosis, ureteroscopic biopsy grade and urinary cytology can improve prediction of advanced upper tract urothelial carcinoma. J Urol 2010; 184: 69–73.

23. Ng CK, Shariat SF, Lucas SM et al. Does the presence of hydronephrosis on preoperative axial CT imaging predict worse outcomes for patients undergoing nephroureterectomy for upper-tract urothelial carcinoma? Urol Oncol 2011; 29: 27–32.

24. Raman JD, Shariat SF, Karakiewicz PI et al. Does preoperative symptom classification impact prognosis in patients with clinically localized upper-tract urothelial carcinoma managed by radical nephroureterectomy? Urol Oncol 2011; 29: 716–723.

25. Inman BA, Tran VT, Fradet Y et al. Carcinoma of the upper urinary tract: predictors of survival and competing causes of mortality. Cancer 2009; 115: 2853–2862.

26. Park J, Ha SH, Min GE et al. The protective role of renal parenchyma as a barrier to local tumor spread of upper tract transitional cell carcinoma and its impact on patient survival. J Urol 2009; 182: 894–899.

27. Zigeuner RE, Hutterer G, Chromecki T et al. Bladder tumour development after urothelial carcinoma of the upper urinary tract is related to primary tumour location. BJU Int 2006; 98: 1181–1186.

28. Favaretto RL, Shariat SF, Chade DC et al. The effect of tumor location on prognosis in patients treated with radical nephroureterectomy at Memorial Sloan-Kettering Cancer Center. Eur Urol 2010; 58: 574–580.

29. Chromecki TF, Cha EK, Fajkovic H et al. The impact of tumor multifocality on outcomes in patients treated with radical nephroureterectomy. Eur Urol 2012; 61: 245–253.

30. Simone G, Papalia R, Loreto A et al. Independent prognostic value of tumour diameter and tumour necrosis in upper urinary tract urothelial carcinoma. BJU Int 2009; 103: 1052–1057.

31. Pieras E, Frontera G, Ruiz X et al. Concomitant carcinoma in situ and tumour size are prognostic factors for bladder recurrence after nephroureterectomy for upper tract transitional cell carcinoma. BJU Int 2010; 106: 1319–1323.

32. Guarnizo E, Pavlovich CP, Seiba M et al. Ureteroscopic biopsy of upper tract urothelial carcinoma: improved diagnostic accuracy and histopathological considerations using a multi-biopsy approach. J Urol 2000; 163: 52–55.

33. Mullerad M, Russo P, Golijanin D et al. Bladder cancer as a prognostic factor for upper tract transitional cell carcinoma. J Urol 2004; 172: 2177–2181.

34. Xylinas E, Colin P, Audenet F et al. Intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinomas: predictors and impact on subsequent oncological outcomes from a national multicenter study. World J Urol 2013; 31: 61–68.

35. Novara G, De Marco V, Dalpiaz O et al. Independent predictors of contralateral metachronous upper urinary tract transitional cell carcinoma after nephroureterectomy: multi-institutional dataset from three European centers. Int J Urol 2009; 16: 187–191.

36. Waldert M, Karakiewicz PI, Raman JD et al. A delay in radical nephroureterectomy can lead to upstaging. BJU Int 2010; 105: 812–817.

37. Ni S, Tao W, Chen Q et al. Laparoscopic versus open nephroureterectomy for the treatment of upper urinary tract urothelial carcinoma: a systematic review and cumulative analysis of comparative studies. Eur Urol 2012; 61: 1142–1153.

38. Hanna N, Sun M, Trinh QD et al. Propensity-score-matched comparison of perioperative outcomes between open and laparoscopic nephroureterectomy: a national series. Eur Urol 2012; 61: 715–721.

39. Simone G, Papalia R, Guaglianone S et al. Laparoscopic versus open nephroureterectomy: perioperative and oncologic outcomes from a randomised prospective study. Eur Urol 2009; 56: 520–526.

40. Lughezzani G, Sun M, Perrotte P et al. Should bladder cuff excision remain the standard of care at nephroureterectomy in patients with urothelial carcinoma of the renal pelvis? A population-based study. Eur Urol 2010; 57: 956–962.

41. Roscigno M, Brausi M, Heidenreich A et al. Lymphadenectomy at the time of nephroureterectomy for upper tract urothelial cancer. Eur Urol 2011; 60: 776–783.

42. Kondo T, Tanabe K. Role of lymphadenectomy in the management of urothelial carcinoma of the bladder and the upper urinary tract. Int J Urol 2012; 19: 710–721.

43. Xylinas E, Rink M, Margulis V et al. Prediction of true nodal status in patients with pathological lymph node negative upper tract urothelial carcinoma at radical nephroureterectomy. J Urol 2013; 189: 468–473.

44. Margulis V, Shariat SF, Matin SF et al. Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer 2009; 115: 1224–1233.

45. Lopez-Beltran A, Bassi P, Pavone-Macaluso M et al. Handling and pathology reporting of specimens with carcinoma of the urinary bladder, ureter, and renal pelvis. Eur Urol 2004; 45: 257–266.

46. Wheat JC, Weizer AZ, Wolf JS, Jr. et al. Concomitant carcinoma in situ is a feature of aggressive disease in patients with organ confined urothelial carcinoma following radical nephroureterectomy. Urol Oncol 2012; 30: 252–258.

47. Otto W, Shariat SF, Fritsche HM et al. Concomitant carcinoma in situ as an independent prognostic parameter for recurrence and survival in upper tract urothelial carcinoma: a multicenter analysis of 772 patients. World J Urol 2011; 29: 487–494.

48. Xylinas E, Rink M, Margulis V et al. Multifocal carcinoma in situ of the upper tract is associated with high risk of bladder cancer recurrence. Eur Urol 2012; 61: 1069–1070.

49. Bolenz C, Shariat SF, Fernandez MI et al. Risk stratification of patients with nodal involvement in upper tract urothelial carcinoma: value of lymph-node density. BJU Int 2009; 103: 302–306.

50. Novara G, Matsumoto K, Kassouf W et al. Prognostic role of lymphovascular invasion in patients with urothelial carcinoma of the upper urinary tract: an international validation study. Eur Urol 2010; 57: 1064–1071.

51. Remzi M, Haitel A, Margulis V et al. Tumour architecture is an independent predictor of outcomes after nephroureterectomy: a multi-institutional analysis of 1363 patients. BJU Int 2009; 103: 307–311.

52. Fritsche HM, Novara G, Burger M et al. Macroscopic sessile tumor architecture is a pathologic feature of biologically aggressive upper tract urothelial carcinoma. Urol Oncol 2010; 30: 666–672.

53. Zigeuner R, Shariat SF, Margulis V et al. Tumour necrosis is an indicator of aggressive biology in patients with urothelial carcinoma of the upper urinary tract. Eur Urol 2010; 57: 575–581.

54. Seitz C, Gupta A, Shariat SF et al. Association of tumor necrosis with pathological features and clinical outcome in 754 patients undergoing radical nephroureterectomy for upper tract urothelial carcinoma: an international validation study. J Urol 2010; 184: 1895–1900.

55. Colin P, Ouzzane A, Yates DR et al. Influence of Positive Surgical Margin Status After Radical Nephroureterectomy on Upper Urinary Tract Urothelial Carcinoma Survival. Ann Surg Oncol, 2012; 19: ­3613–3620.

56. Rink M, Robinson BD, Green DA et al. Impact of histological variants on clinical outcomes of patients with upper urinary tract urothelial carcinoma. J Urol 2012; 188: 398–404.

57. Xylinas E, Rink M, Margulis V et al. Histologic Variants of Upper Tract Urothelial Carcinoma Do Not Affect Response to Adjuvant Chemotherapy After Radical Nephroureterectomy. Eur Urol 2012; 62: e25–e26.

58. Ku JH, Byun SS, Jeong H et al. The Role of p53 on Survival of Upper Urinary Tract Urothelial Carcinoma: A Systematic Review and Meta-Analysis. Clin Genitourin Cancer, 2013; 11: 221–228.

59. Jeon HG, Jeong IG, Bae J et al. Expression of Ki-67 and COX-2 in patients with upper urinary tract urothelial carcinoma. Urology 2010; 76: 513 e7–e12.

60. Leibl S, Zigeuner R, Hutterer G et al. EGFR expression in urothelial carcinoma of the upper urinary tract is associated with disease progression and metaplastic morphology. APMIS 2008; 116: 27–32.

61. Nakanishi K, Hiroi S, Tominaga S et al. Expression of hypoxia-inducible factor-1alpha protein predicts survival in patients with transitional cell carcinoma of the upper urinary tract. Clin Cancer Res 2005; 11: 2583–2590.

62. Inoue K, Slaton JW, Karashima T et al. The prognostic value of angiogenesis factor expression for predicting recurrence and metastasis of bladder cancer after neoadjuvant chemotherapy and radical cystectomy. Clin Cancer Res 2000; 6: 4866–4873.

63. Fromont G, Roupret M, Amira N et al. Tissue microarray analysis of the prognostic value of E-cadherin, Ki67, p53, p27, survivin and MSH2 expression in upper urinary tract transitional cell carcinoma. Eur Urol 2005; 48: 764–770.

64. Nakanishi K, Tominaga S, Hiroi S et al. Expression of survivin does not predict survival in patients with transitional cell carcinoma of the upper urinary tract. Virchows Arch 2002; 441: 559–563.

65. Jeong IG, Kim SH, Jeon HG et al. Prognostic value of apoptosis-related markers in urothelial cancer of the upper urinary tract. Hum Pathol 2009; 40: 668–677.

66. Saito K, Kawakami S, Ohtsuka Y et al. The impact of preoperative serum C-reactive protein on the prognosis of patients with upper urinary tract urothelial carcinoma treated surgically. BJU Int 2007; 100: 269–273.

67. Lehmann J, Suttmann H, Kovac I et al. Transitional cell carcinoma of the ureter: prognostic factors influencing progression and survival. Eur Urol 2007; 51: 1281–1288.

68. Tanaka N, Kikuchi E, Shirotake S et al. The Predictive Value of C-reactive Protein for Prognosis in Patients with Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy: A Multi-institutional Study. Eur Urol 2012, doi: 10.1016/j.eururo.2012.11.050.

69. Stein B, Schrader AJ, Wegener G et al. Preoperative serum C- reactive protein: a prognostic marker in patients with upper urinary tract urothelial carcinoma. BMC Cancer 2013; 13: 101.

70. Roupret M, Catto J, Coulet F et al. Microsatellite instability as indicator of MSH2 gene mutation in patients with upper urinary tract transitional cell carcinoma. J Med Genet 2004; 41: e91.

71. Roupret M, Fromont G, Azzouzi AR et al. Microsatellite instability as predictor of survival in patients with invasive upper urinary tract transitional cell carcinoma. Urology 2005; 65: 1233–1237.

72. Favaretto RL, Shariat SF, Savage C et al. Combining imaging and ureteroscopy variables in a preoperative multivariable model for prediction of muscle-invasive and non-organ confined disease in patients with upper tract urothelial carcinoma. BJU Int 2012; 109: 77–82.

73. Matin SF, Margulis V, Kamat A et al. Incidence of downstaging and complete remission after neoadjuvant chemotherapy for high-risk upper tract transitional cell carcinoma. Cancer 2010; 116: 3127–3134.

74. Lane BR, Smith AK, Larson BT et al. Chronic kidney disease after nephroureterectomy for upper tract urothelial carcinoma and implications for the administration of perioperative chemotherapy. Cancer 2010; 116: 2967–2973.

75. Messer JC, Terrell JD, Herman MP et al. Multi-institutional validation of the ability of preoperative hydronephrosis to predict advanced pathologic tumor stage in upper-tract urothelial carcinoma. Urol Oncol, 2011; 31: 904–908.

76. Margulis V, Youssef RF, Karakiewicz PI et al. Preoperative multivariable prognostic model for prediction of nonorgan confined urothelial carcinoma of the upper urinary tract. J Urol 2010; 184: 453–458.

77. Shariat SF, Chade DC, Karakiewicz PI et al. Combination of multiple molecular markers can improve prognostication in patients with locally advanced and lymph node positive bladder cancer. J Urol 2010; 183: 68–75.

78. Roscigno M, Shariat SF, Margulis V et al. The extent of lymphadenectomy seems to be associated with better survival in patients with nonmetastatic upper-tract urothelial carcinoma: how many lymph nodes should be removed? Eur Urol 2009; 56: 512–518.

79. Jeldres C, Sun M, Lughezzani G et al. Highly predictive survival nomogram after upper urinary tract urothelial carcinoma. Cancer 2010; 116: 3774–3784.

80. Yates DR, Hupertan V, Colin P et al. Cancer-specific survival after radical nephroureterectomy for upper urinary tract urothelial carcinoma: proposal and multi-institutional validation of a post-operative nomogram. Br J Cancer 2012; 106: 1083–1088.

81. Cha EK, Shariat SF, Kormaksson M et al. Predicting clinical outcomes after radical nephroureterectomy for upper tract urothelial carcinoma. Eur Urol 2012; 61: 818–825.

82. Roupret M, Hupertan V, Seisen T et al. Prediction of cancer-specific survival after radical nephroureterectomy for upper tract urothelial carcinoma: development of an optimized post-operative nomogram using decision curve analysis. J Urol, 2013; 189: 1662–1669.

83. Nuhn P, May M, Fritsche HM et al. External validation of disease-free survival at 2 or 3 years as a surrogate and new primary endpoint for patients undergoing radical cystectomy for urothelial carcinoma of the bladder. Eur J Surg Oncol 2012; 38: 637–642.

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