Diagnostic ureteroscopy prior to nephroureterectomy for urothelial carcinoma is associated with a high risk of bladder recurrence despite technical precautions to avoid tumor spillage.

PURPOSE: There have recent reports in the literature of increased rates of bladder recurrence (BR) after radical nephroureterectomy (RNU) when diagnostic flexible ureteroscopy (DFU) was performed before RNU. The technical heterogeneity of DFU was a major bias in these studies. Our purpose was to evaluate the impact of a standardized DFU technique before RNU on the risk of BR. METHODS: A retrospective monocenter study including patients who underwent RNU for upper tract urothelial carcinoma (UTUC) between 2005 and 2017. 171 patients were identified. 78 patients were excluded owing to a history of bladder cancer before RNU or neo-adjuvant/adjuvant chemotherapy. 93 included patients were stratified according to pre-RNU ureteroscopy (DFU + 70 patients) or no pre-RNU ureteroscopy (DFU-23 patients). The standardized DFU technique consisted of systematic ureteral sheath (ch9-10), flexible ureteroscopy, biopsy, and drainage with a mono-J/bladder catheter to avoid contact of contaminated urine of the upper tract with the bladder. RESULTS: Epidemiological, initial staging, and postoperative tumoral characteristics were similar in both groups. Mean follow-up was 35 months [2-166], 47(50%) BR occurred with 41(87%) in the DFU + group, and pre-RNU-DFU was an independent predictive factor of BR (OR = 4[1.4-11.9], P = 0.01) (Cox regression model). The characteristics of BR were similar in both groups, although BR occurred earlier in DFU + (427 days vs. 226 days (P = 0.07)). CONCLUSION: Bladder recurrence after diagnostic ureteroscopy + nephroureterectomy was high despite technical precautions to avoid contact of bladder mucosa with contaminated urine from the upper urinary tract. Post-DFU endovesical instillation should be investigated.

[Does diagnostic ureterorenoscopy increase the risk of bladder recurrence after total nephroureterectomy? A review of the literature]. / L'urétérorénoscopie diagnostique augmente-t-elle le risque de récidive vésicale après néphro-urétérectomie totale ? Une revue de la littérature.

OBJECTIVE: The objective of our study was to evaluate, in a review of the literature, the impact of diagnostic ureteroscopy before total nephroureterectomy (NUT) on the risk of bladder recurrence. METHODS: We conducted a literature review in the Pubmed database in March 2018. Initial research identified 45 publications. Following full text screening, 9 studies were finally included, with a total of 1041 NUT with URS prior versus 2909 NUT alone. The primary endpoint was bladder recurrence. Secondary objectives were specific survival and overall survival. RESULTS: Bladder recurrence was reported in the 9 studies included. Diagnostic ureteroscopy was significantly associated with an increased risk of post-NUT bladder recurrence (HZ 1.42 [1.29-1.56], P<0.01). The specific survival and overall survival at 5 years, were reported in respectively 4 and 2 studies. There was no impact of the pre-NUT diagnostic URS on the specific survival (HZ 0.75 [0.54-1.03], P=0.08) or post-NUT overall survival (HZ 1.15 [0.68-1.96], P=0.59). CONCLUSION: The URS diagnostic before NUT for TVEUS is associated with a significant increase in the risk of postoperative bladder recurrence.

[Optical coherence tomography of bladder resection specimen]. / Tomographie par densité optique des pièces de résection des tumeurs de vessie.

INTRODUCTION: The diagnosis of bladder urothelial tumors is based on bladder resection and histological analysis of the specimen. The time to obtain the results of the histological analysis increases the treatment delay. Furthermore, the lack of muscle on the specimen forces the surgeon to practice on other procedure. Full field optical coherence tomography (FFOCT) is a recent imaging technique to analyze tissue. The aim of our study was to evaluate the feasibility and diagnostic accuracy of FFOCT to detect muscle and tumor in bladder resection specimen. PATIENTS AND METHODS: We analyzed with the FFOCT technique bladder resection specimen of 24 consecutives patients. Three readers did the blind analyze of the images, looking for the presence of muscle and tumor on each specimen. Their results were compared with histological analysis to calculate diagnostic accuracy for each reader. RESULTS: Mean sensibilities for the detection of muscle and tumor were respectively 75% and 81%. Mean specificities for the detection of muscle and tumor were respectively 78.3% and 55.3%. CONCLUSIONS: Our results suggest that the FFOCT is feasible to analyze bladder resection specimen. Sensibilities and specificities calculated are encouraging for the detection of muscle and tumor. The accuracy of this detection and early-staging tool should be validated by larger studies. LEVEL OF EVIDENCE: 3.

Accuracy and prognostic value of variant histology and lymphovascular invasion at transurethral resection of bladder.

OBJECTIVES: To evaluate the concordance rate of lymphovascular invasion (LVI) and variant histology (VH) of transurethral resection (TUR) with radical cystectomy (RC) specimens. Furthermore, to evaluate the value of LVI and VH at TUR for predicting non-organ confined (NOC) disease, lymph node metastasis, and survival outcomes. PATIENTS AND METHODS: Two hundred and sixty-eight patients who underwent TUR and subsequent RC were reviewed. Logistic regression analyses were performed to evaluate the association of LVI and VH with NOC and lymph node metastasis at RC. Cox regression analyses were used to estimate recurrence-free survival (RFS) and cancer-specific survival (CSS). RESULTS: LVI and VH were detected in 13.8 and 11.2% of TUR specimens, and in 30.2 and 25.4% of RC specimens, respectively. The concordance rate between LVI and VH at TUR and subsequent RC was 69.8 and 83.6%, respectively. They were both associated with adverse pathological features such as lymph node metastasis and advanced stage. TUR LVI and VH were both independently associated with lymph node metastasis and TUR VH was independently associated with NOC. On univariable Cox regression analyses, TUR LVI was associated with RFS and CSS while TUR VH was only associated with RFS. Only TUR LVI was independently associated with RFS. CONCLUSION: Detection of LVI is missed in a third of TUR specimens while VH seems more accurately identified. TUR LVI and VH are associated with more advanced disease and LVI predicts disease recurrence. Assessment and reporting of LVI and VH on TUR specimen are important for risk stratification and decision-making.

[Impact of neoadjuvant chemotherapy on therapeutic management of muscle-invasive bladder cancer]. / Impact de la chimiothérapie néoadjuvante sur la prise en charge des tumeurs de vessie infiltrant le muscle.

OBJECTIVE: Assess the toxicity of neoadjuvant chemotherapy (NAC), its impact on surgical schedule and postoperative morbidity of cystectomy for muscle-invasive bladder cancer (MIBC). PATIENTS AND METHODS: Retrospective multicentric study of 78 patients who underwent a cystectomy from January 2009 to March 2012 for MIBC. The following criteria have been studied: toxicity of NC (WHO classification), precystectomy interval, postoperative morbidity (Clavien), duration of stay, downsizing on CT-scan before cystectomy, and free of cancer pathology (pT0). RESULTS: Seventy-eight patients had been included, thirty-nine had a NAC. Thirty-three percent had a incomplete chemotherapy because of toxicity. Forty-eight percent had a significant toxicity and grade ≥ 3 toxicity was 33%. Median time between diagnosis and cystectomy was 12.6 weeks (0.7-38), 18 weeks with NAC (group 1) versus eight weeks without NAC (group 2) (P=0.01). In case of toxicity, the delay was 3.5 weeks longer (P=0.12). After cystectomy, 60% of patients had at least one postoperative complication; including 23% had major morbidity. NAC did not increase neither postoperative morbidity (P=0.15) nor duration of stay (18 vs 20 days; P=0.2). Radiological response rate to NC was 38%. pT0 rate was 79 vs 7.7%. The increase of precystectomy interval after NC did not worsen the pathological stage (P=0.5). CONCLUSION: NC had a high toxicity, but without impact on postoperative morbidity, and precystectomy interval did not have any impact on the prognosis. LEVEL OF EVIDENCE: 5.

Papillary urothelial neoplasm of low malignant potential with osseous metaplasia in a 19-year-old chronic smoker: A case report with review of literature.

Urothelial tumors characteristically occur in elderly persons, more commonly in males with typical complaints of hematuria. Although few studies attempted to describe clinic-pathological features of urothelial malignancies in young patients, due to heterogeneity in the inclusion of age groups under "young patients" no reliable conclusions can be derived. Herein, we are describing an interesting case of papillary urothelial neoplasm of low malignant potential with osseous metaplasia in a 19-year-old chronic smoker young patient presented with chief complaints of abdominal pain with a review of the literature.

Head-to-head comparisons of 68Ga-PSMA-11 and 18F-FDG PET/CT in evaluating patients with upper tract urothelial carcinoma: a prospective pilot study.

PURPOSE: To prospectively compare the uptake of 68Ga-prostate specific membrane antigen (68Ga-PSMA)-11 and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in upper tract urothelial carcinoma (UTUC) and investigate the correlation between radiological parameters and pathological features of UTUC. METHODS: Clinicopathologic and imaging data were collected from 10 UTUC patients who underwent preoperative 68Ga-PSMA-11 and 18F-FDG PET/CT scans. The diagnostic capabilities of both imaging techniques were analyzed and compared in UTUC. Angiogenesis in the malignancies was assessed using Chalkley counting and the expression of folate hydrolase 1 (FOLH1) and glucose transporter 1 (GLUT1) in UTUC were evaluated in the surgical specimens. Double immunofluorescence staining of PSMA and CD34 was used to examine tumor neovascularization. Tracer uptake and expression were compared and explored. Additionally, 10 patients with clear cell renal cell carcinoma (ccRCC) were included for prospective, comparative research. RESULTS: Ten UTUC patients with 12 malignant lesions and another 10 ccRCC patients were included. 18F-FDG PET/CT demonstrated a more effective detection of UTUC foci compared to 68Ga-PSMA-11 PET/CT (the SUVmax of 18.48 ± 6.73 vs. 4.38 ± 1.45, P < 0.01). Immunohistochemical analysis revealed a statistically significant difference in the expression of PSMA and GLUT1 in UTUC (P = 0.048), with higher pathological grades showing more intense GLUT1 staining than PSMA (75% vs. 12.5%). The Chalkley counting of angiogenesis in ccRCC was significantly higher than that in UTUC (229.34 vs. 71.67), which was proportional to 68Ga-PSMA-11 PET/CT SUVmax (both P < 0.05). CONCLUSION: 18F-FDG PET/CT holds better clinical potential for evaluating UTUC and detecting lymph node metastasis compared to 68Ga-PSMA-11 PET/CT, likely due to the relatively scant expression of FOLH1 in tumor neovascular endothelium while the abundant expression of GLUT1 in malignancy. Furthermore, the lower neovascular density in UTUC should not be overlooked.

Evaluation of the value of Preoperative Sialic Acid Levels in Diagnosis and Localization of Urothelial Tumors.

Objective: To explore SA levels in the serum of urothelial tumor patients and their correlation with clinical pathological features and localization. Materials and Methods: Our research retrospectively collected data from 591 patients with urothelial tumors between July 2014 and April 2018. The SA levels in the serum of urothelial tumor patients and their correlation with clinical pathological features and localization were investigated. Univariate and multivariate logistic regression analyses were further performed to identify independent associations. Results: The levels of SA were significantly associated with the malignant degree (tumor grade and infiltration) of bladder cancer and tumor localization (all p < 0.05). The multivariate logistic regression model showed that SA levels were independently associated with the presence of high-grade urothelial carcinoma (BUC: HR = 1.941, UTUC: HR = 3.820, all p <0.05) and upper urinary tract urothelial carcinoma (HR = 2.047, p < 0.05). Finally, we validated the diagnosis and localization value of SA in an independent cohort from another institutions. Conclusions: Elevated serum SA levels are an independent predictor of high-grade urothelial carcinoma and upper urinary tract urothelial carcinoma, indicating that SA levels may be a potential biomarker for the diagnosis, prognosis and localization of urothelial tumors.

[Gross hematuria and usefulness of urinary cytology: Experience at hematuria one stop clinic.] / Citología de orina por lavado y hematuria macroscópica monosintomática: experiencia sobre su utilidad en una consulta de alta resolución.

OBJECTIVE: To report the diagnostic accuracy and liability of the instrumentalized urine cytology in the preliminary study of monosyntomatic gross haematuria. METHODS: A retrospective, descriptive and analytic study of the patients that complained of macroscopic hematuria at the one-stop clinic between 2011 and 2018. The complementary tests requested were: kidney/bladder ultrasounds, urethrocystoscopy and urinary instrumentalized cytology. All the urine cytology samples were examined by the same pathologist. RESULTS: 1122 patients were reviewed with ultrasonography and cystoscopy. Bladder tumor was detected in 354 patients (31.5%) and other urological malignancies were found in 33 cases (2.9%). Urinary instrumentalized cytologies were collected in 804 patients (71.4%), being positive in 236 cases (29.4%). Sensitivity and specificity of urinary cytology for urothelial tumor detection were 55.1% and 85.7%, respectively. Cytology was positive in 181 patients (52.1%) with visible bladder tumors through cystoscopy, in 7 patients (0.87%) without visible bladder tumors. In 433 patients with ultrasonography and cystoscopy both negative, urine cytology was performed with a negative result (38.6%). CONCLUSION: The usefulness of instrumentalized urinary cytology to diagnose urothelial tumors is restricted in terms of monosymptomatic gross haematuria one stop clinic. It allows the diagnosis of a very limited number of cases tumors and leaves a significant number of them out. In case of gross hematuria and negative imaging, urine cytology can be requested as a differed complementary.

OBJETIVO: Evaluar la precisión y rentabilidad diagnósticas de la citología urinaria por lavado en el estudio inicial de la hematuria macroscópica monosintomática en el contexto de una consulta de alta resolución.MÉTODOS: Estudio retrospectivo, descriptivo y analítico de las pruebas diagnósticas solicitadas en la consulta de hematuria de alta resolución entre 2011 y 2018. Se evaluaron la ecografía de aparato urinario, la uretrocistoscopia y particularmente la citología de orina por lavado vesical. Las muestras de citología urinaria fueron revisadas por el mismo patólogo. RESULTADOS: 1122 pacientes con ecografía y cistoscopia. Se detectó tumor vesical en 354 pacientes (31,5%) y otros tumores urológicos en 33 casos (2,9%). Se recogió citología urinaria por lavado en 804 pacientes (71,4%), siendo positiva en 236 casos (29,4%). La sensibilidad y especificidad de la citología urinaria para detectar tumor urotelial fue del 55,1%, y del 85,7%, respectivamente. En los pacientes con tumor vesical visible por cistoscopia la citología fue positiva en 181 pacientes (52,1%). En los casos sin tumor vesical visible hubo 7 pacientes (0,87%) con citología positiva. En 433 pacientes con ecografía y cistoscopia negativas se recogió citología urinaria cuyo resultado fue negativo (38,6%).CONCLUSIÓN: La citología urinaria por lavado tiene una utilidad limitada en el estudio inicial de la hematuria macroscópica de una consulta de alta resolución. Permite el diagnóstico de un reducido número de tumores uroteliales, obviando un porcentaje significativo de ellos. En caso de hematuria macroscópica monosintomática y pruebas de imagen negativas, la citología urinaria podría usarse como prueba complementaria diferida.

Mucinous adenocarcinoma of renal pelvis in a young male: a diagnostic challenge.

Primary mucinous adenocarcinoma of the renal pelvis is an extremely rare tumor with only a handful of cases reported to date. Clinical and radiological features are not specific, and hence, histopathological examination holds the key for definitive diagnosis. This tumor has mainly been described in the elderly population, with less than five cases reported in individuals aged <35 years. Here, we report a case of primary mucinous adenocarcinoma of the renal pelvis in a young male. A 31-year-old male presented with a history of right-sided flank pain for the past year. On examination, he had right-sided costovertebral tenderness. Computed tomography (CT) scan revealed the presence of a hyperdense mass lesion in the right renal pelvis with severe hydronephrosis and cortical thinning. Because of the non-functioning status, right nephrectomy was performed. To our surprise, histopathology showed the presence of mucinous adenocarcinoma of the renal pelvis with carcinoma in situ of the ureter. This case describes a rare presentation of primary mucinous adenocarcinoma of the renal pelvis, and highlights the importance of histopathological examination in reaching the correct diagnosis.

Metastatic urothelial carcinoma to the liver with unknown primary tumor.

Cancer of unknown primary (CUP), a rare and aggressive clinical entity, accounts for approximately 3% of all malignancies. CUP with urothelial origin is even more unusual, with no other cases reported in the current literature. As imaging and other studies often do not reveal the tumor origin, the approach to CUP involves a focused search for the primary tumor, relying on guidance from immunohistochemical staining of biopsy specimens. Treatment consists of standard therapies directed at the most likely tumor origin.

Differential expression of S1P receptor subtypes in human bladder transitional cell carcinoma.

PURPOSE: Sphingosine 1 phosphate (S1P), S1P receptors (S1PRs) and their signaling pathways play an important role in the fate of cancer cells. The expression pattern of S1PR subtypes (S1PR1-S1PR5) may alter in cancer development stages, depending on the origin and the pathologic features of tumors. The present study aimed to examine the relationship between plasma S1P levels and the expression of S1PR subtypes in bladder tumors. METHODS/PATIENTS: These changes were evaluated in terms of the pathologic grades and stages of human bladder cancer samples. For this, tumor biopsies from 41 new bladder cancer patients as well as 26 normal-looking bladder tissues were collected and processed for immunohistochemistry (IHC) and quantitative real-time RT-PCR of S1PR subtypes. Plasma S1P level was measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). RESULTS: The results show that tissue S1PR1, S1PR2 and S1PR3 are over-expressed in all tumors regardless of their pathological grade (~ 3, ~ 6 and ~ 104 folds, respectively). These results were corroborated by IHC data showing accumulation of S1PR subtypes 1 and 2 in the tissues. Plasma S1P in the plasma samples from patients was in the range of control samples (Controls; 256 ± 47; patients, 270 ± 41). CONCLUSIONS: Overexpression of S1PR1, S1PR2 and S1PR3 in bladder tumor biopsies which were corroborated with the pathological grades and stages may suggest that S1PR profile in tumor biopsies is a promising marker in the diagnosis of bladder carcinoma.

Multicentric small cell neuroendocrine neoplasm of the renal pelvis and ureter with concomitant focal high-grade urothelial carcinoma of the ureter: A case report.

Malignant small cell neuroendocrine tumors of the pelvi-calyceal system are rare, and even more uncommon is their occurrence with concomitant transitional cell carcinoma, in the same renal unit. We present such a case for its unique presentation.

Curcumin inhibits urothelial tumor development by suppressing IGF2 and IGF2-mediated PI3K/AKT/mTOR signaling pathway.

We have previously reported that curcumin inhibits urothelial tumor development in a rat bladder carcinogenesis model. In this study, we report that curcumin inhibits urothelial tumor development by suppressing IGF2 and IGF2-mediated PI3K/AKT/mTOR signaling pathway. Curcumin inhibits IGF2 expression at the transcriptional level and decreases the phosphorylation levels of IGF1R and IRS-1 in bladder cancer cells and N-methyl-N-nitrosourea (MNU)-induced urothelial tumor tissue. Ectopic expression of IGF2 and IGF1R, but not IGF1, in bladder cancer cells restored this process, suggesting that IGF2 is a target of curcumin. Moreover, introduction of constitutively active AKT1 abolished the inhibitory effect of curcumin on cell proliferation, migration, and restored the phosphorylation levels of 4E-BP1 and S6K1, suggesting that curcumin functions via suppressing IGF2-mediated AKT/mTOR signaling pathway. In summary, our results reveal that suppressing IGF2 and IGF2-mediated PI3K/AKT/mTOR signaling pathway is one of the mechanisms of action of curcumin. Our findings suggest a new therapeutic strategy against human bladder cancer caused by aberrant activation of IGF2, which are useful for translational application of curcumin.

Prognostic role of N-cadherin expression in patients with non-muscle-invasive bladder cancer.

PURPOSE: To assess the role of N-cadherin as a prognostic biomarker in patients with non-muscle-invasive bladder cancer (NMIBC) treated with transurethral resection with or without adjuvant intravesical therapy. PATIENTS AND METHODS: Immunohistochemistry using monoclonal mouse antibody was used to evaluate the expression status of N-cadherin in 827 patients with NMIBC. N-cadherin was considered positive if any immunoreactivity with membranous staining was detected. Multivariable Cox regression models were performed to evaluate the prognostic effect of N-cadherin on survival outcomes. RESULTS: N-cadherin expression was observed in 333 patients (40.3%); it was associated with pT1 stage and high tumor grade (both were P<0.001). Median follow-up was 55 months (interquartile range: 18-106). On multivariable Cox regression analyses that adjusted for the effect of the standard clinicopathologic features, N-cadherin expression remained associated with recurrence-free survival (P = 0.007) but not progression-free survival (P = 0.3), cancer-specific survival (P = 0.2), or overall survival (P = 0.9). Adding N-cadherin to a model for prediction of disease recurrence modestly improved its discrimination from 72.8% to 73.4%. CONCLUSION: N-cadherin is expressed in approximately 2/5 patients with NMIBC. Its expression is associated with adverse pathological features and higher risk of disease recurrence but not progression. N-cadherin could be incorporated in predictive tools to assist in recurrence prediction helping thereby in patient selection regarding adjuvant therapies and follow-up planning.

Elevated preoperative plasma fibrinogen level is an independent predictor of malignancy and advanced stage disease in patients with bladder urothelial tumors.

PURPOSE: To investigate the association between preoperative plasma fibrinogen levels and clinicopathological features in patients with bladder urothelial tumors. METHODS: In this retrospective single-center study, we evaluated preoperative plasma fibrinogen levels in 503 patients newly diagnosed with bladder urothelial tumors between January 2009 and October 2014. All patients received surgical intervention as the primary treatment method. Associations between preoperative plasma fibrinogen levels and clinicopathological parameters were analyzed. Univariate and multivariate logistic regression analyses were performed to identify independent associations. RESULTS: The mean preoperative fibrinogen level in patients with bladder urothelial carcinoma (BUC) was significantly higher than that in patients with papilloma or papillary urothelial neoplasm of low malignant potential (PUNLMP) (P = 0.004). Additionally, patients with BUC with advanced-stage disease showed elevated plasma fibrinogen levels compared to patients with early-stage disease (high-grade BUC vs. low-grade BUC: P = 0.002; muscle-invasive BUC vs. non-muscle-invasive BUC: P = 0.010). In a multivariate regression model, a plasma fibrinogen level >3.04 g/L was identified to be independently associated with the presence of BUC (hazard ratio [HR] = 1.653, P = 0.047), high-grade BUC (HR = 1.869, P = 0.004), and muscle-invasive BUC (HR = 1.870, P = 0.044). CONCLUSIONS: Elevated preoperative plasma fibrinogen level is an independent predictor of malignancy as well as advanced-stage carcinoma in patients with bladder urothelial tumors, suggesting that plasma fibrinogen may be a promising diagnostic and prognostic biomarker for bladder tumors.

Predictors, pathological characteristics and outcomes of bladder recurrences following nephroureterectomy.

OBJECTIVES: To analyze the predictors for bladder recurrence (BR) after nephroureterectomy (NU) for upper urinary tract tumors (UUTT), as well as its pathological characteristics, outcomes and impact on survival. MATERIAL AND METHODS: Retrospective study of 117 patients who underwent laparoscopic nephroureterectomy by UUTT between 2007-2012 at our center. The potential predictors for BR were analyzed using Cox regression; Kaplan-Meier curves were employed to study survival. RESULTS: The sample was composed of 85 men (73%) and 32 women (27%), with a mean age of 70 years. After a mean follow-up of 26 months, 23 patients presented BR (19.6%). In the multivariate analysis, sex (p=.003; HR [female], 3.8) and the location of the UUTT in the distal ureter (p=.002; HR, 4.8) were independent predictors for BR. The median time to BR was 8 months. Fifteen patients presented a nonmuscle-invasive BR (65.2%), and 8 presented a muscle-invasive BR (34.8%). All BRs, except for 2, appeared during the first 2 years. Five cases with nonmuscle-invasive BR presented a new BR. Six patients with muscle-invasive BR died before it could be determined whether cause of death was the BR or an UUTT relapse. The onset of BR showed no repercussion on the survival of patients with UUTT. CONCLUSIONS: Sex (female) and the location of the UUTT (distal ureter) are predictors for BR after NU. Patients with these characteristics might benefit from adjuvant intravesical treatment and closer monitoring. The onset for RV has no impact on the survival of patients with UUTT.

Sarcomatoid carcinoma of the renal pelvis: A case report.

Sarcomatoid carcinoma is a high-grade malignant neoplasm which exhibits morphological and/or immunohistochemical evidence of bidirectional epithelial and mesenchymal differentiation. Sarcomatoid carcinoma occurring in the upper urinary tract is rare. The present study reports a case of primary sarcomatoid carcinoma of the renal pelvis. A 49-year-old female patient was admitted to Beijing Chao-Yang Hospital for experiencing two weeks of intermittent hematuria. A computed tomography scan revealed a mass of 2 cm in diameter in the left renal pelvis. A retroperitoneoscopic nephroureterectomy combined with a bladder cuff excision was performed, and the final pathological diagnosis was sarcomatoid carcinoma of the renal pelvis. The patient did not receive systemic chemotherapy and radiotherapy. Regular follow-up was performed for 30 months, and there was no evidence of tumor local recurrence or distant metastasis.

Beclin 1 and bcl-2 expressions in bladder urothelial tumors and their association with clinicopathological parameters.

Beclin 1 plays a critical role in the regulation of autophagy, apoptosis, differentiation, as well as in the development and progression of cancer. The aim of this study was to examine the expression of beclin 1 and bcl-2 in bladder urothelial tumors, and to investigate the relationship between these two markers and clinicopathological parameters. Our study included 84 bladder urothelial tumors and 10 non-tumoral bladder tissues. Immunohistochemistry was performed on tissue microarray (TMA) sections and was evaluated semiquantitatively on the basis of the percentage of positively stained cells (proportion) and staining intensity. A significant association was found between the expression score of beclin 1 and pT stages of the urothelial tumors (p=0.012). Also, the level of beclin 1 expression inversely correlated with histological grade and pT stages (p=0.009, r=-0.284; p=0.001, r=-0.361, respectively). The bcl-2 expression level positively correlated with histological grade and pT stages of the urothelial tumors (p=0.026, r=0.243; p<0.0001, r=0.491, respectively). In addition, the level of beclin 1 expression tended to be inversely correlated with the bcl-2 expression level in urothelial tumors (p=0.055, r=-0.210). According to our data, down-regulation of beclin 1 expression and also bcl-2 overexpression seem to play an important role in the progression and aggressiveness of bladder urothelial tumors.

Factores pronósticos de recurrencia y mortalidad en pacientes con tumor de urotelio superior tratados con cirugía / Prognostic Factors of Recurrence and Mortality in Patients with Upper Urothelial Tumor Treated with Surgery

Objetivos: Identificación de factores pronósticos de recurrencia y mortalidad cáncer-específica en pacientes con tumor de urotelio superior tratados con cirugía. Materiales y métodos: Análisis retrospectivo de pacientes con tumor de urotelio superior operados entre 1999 y 2011 en nuestro centro (139 pacientes). Se recogieron variables demográficas, clínicas, diagnósticas y patológicas, así como el tratamiento realizado, complicaciones y evolución. Análisis descriptivo mediante la prueba de chi cuadrado (X2 ) para variables categóricas y el test ANOVA (Analysis of Variance) para variables continuas. Análisis univariante y multivariante mediante modelo de riesgos proporcionales de Cox. La significación estadística se consideró con un valor de p<0,05. Todos los cálculos fueron realizados con el paquete estadístico IBM® SPSS® Statistics v-21. Resultados: En el análisis multivariante se identificaron como factores predictores independientes de recurrencia el crecimiento sólido tumoral (cociente de riesgo [hazard ratio, HR]=4,02; p<0,001) y el alto grado citológico (G3) (HR=3,42; p=0,01). La presencia de tumor vesical previo o concomitante (HR=1,84; p=0,07) presentó una tendencia a la significación. Se identificaron como factores predictores independientes de mortalidad cáncer-específica la presencia de tumor vesical previo o concomitante (HR=2,23; p=0,02), el crecimiento sólido tumoral (HR=2,73; p=0,008), la presencia de hidronefrosis (HR=2,46; p=0,02) y el estadío patológico avanzado pT3-pT4 (HR=2,74; p=0,01). Conclusiones: En nuestra serie, la existencia de tumor vesical previo o sincrónico, el crecimiento tumoral sólido y el alto grado citológico se comportaron como factores pronósticos de recurrencia. La hidronefrosis, el tumor vesical previo o sincrónico, el estadío pT3-4 y el crecimiento tumoral sólido se comportaron como factores pronósticos de mortalidad cáncer-específica. (AU)

Objectives: Identification of prognostic factors for recurrence and cancer-specific mortality in patients with upper urothelial tumor treated with surgery. Materials and methods: Retrospective analysis of patients with upper urothelial tumor operated between 1999 and 2011 in our center (139 patients). Demographic, clinical, diagnostic and pathological variables were collected, as well as the treatment performed, complications and evolution. Descriptive analysis using the chi-square test (X2 ) for categorical variables and the ANOVA (Analysis of Variance) test for continuous variables. Univariate and multivariate analysis using the Cox proportional hazards model. Statistical significance was considered with a value of p<0.05. All calculations were made with the statistical package IBM® SPSS® Statistics v-21. Results: In the multivariate analysis, solid tumor growth (hazard ratio, HR=4.02, p<0.001) and high cytological grade (G3) (HR=3, were identified as independent predictors of recurrence. 42, p=0.01). The presence of a previous or concomitant bladder tumor (HR=1.84, p= 0.07) presented a tendency towards significance. The presence of a previous or concomitant bladder tumor (HR=2.23, p=0.02), the solid tumor growth (HR=2.73, p=0.008), the presence of hydronephrosis (HR =2.46, p=0.02) and the advanced pathological stage pT3-pT4 (HR=2.74, p=0.01). Conclusions: In our series, the existence of previous or synchronic bladder tumor, solid tumor growth and high cytological grade behaved as prognostic factors of recurrence. Hydronephrosis, previous or synchronous bladder tumor, stage pT3-4 and solid tumor growth behaved as prognostic factors for cancer-specific mortality.(AU)