Preoperative hydronephrosis predicts adverse pathological features and postoperative survival in patients with high-grade upper tract urothelial carcinoma

ABSTRACT Purpose: Epidemiological studies reported conflicting results about preoperative hydronephrosis in upper tract urothelial carcinoma (UTUC). This study aimed to investigate the association between preoperative hydronephrosis and pathologic features and oncologic outcomes in patients with UTUC treated by radical nephroureterectomy (RNU). Materials and Methods: This was a retrospective, single-center cohort study of 377 patients treated by RNU without perioperative chemotherapy between January 2001 and December 2014. Logistic regression, Cox regression, and survival analyses were performed. Results: Among the 226 patients with high-grade UTUC, 132 (58%) had preoperative hydronephrosis. Multivariable logistic regression revealed that hydronephrosis was independently associated with advanced pT stage (P=0.017) and lymph node or lymphovascular invasion (P=0.002). Median follow-up was 36 months (interquartile range: 20-48 months). The 3- and 5-year overall survival (OS) rates in patients with hydronephrosis were significantly lower than in those without hydronephrosis (both P <0.001). The 3- and 5-year cancer-specific survival (CSS) rates in patients with hydronephrosis were significantly lower than in those without hydronephrosis (both P=0.001). Hydronephrosis was independently associated with OS and CSS (P=0.001 and P=0.004, respectively). Among the 151 patients with low-grade UTUC, hydronephrosis was not associated with pathologic features and postoperative survival. Conclusions: Preoperative hydronephrosis was significantly associated with adverse pathologic features and postoperative survival in patients with high-grade UTUC.

Radical cystectomy with pelvic lymphadenectomy: pathologic, operative and morbidity outcomes in a Brazilian cohort

ABSTRACT Introduction and Objective Radical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for muscle invasive bladder cancer and the oncologic outcomes following it are directly related to disease pathology and surgical technique. Therefore, we sought to analyze these features in a cohort from a Brazilian tertiary oncologic center and try to identify those who could negatively impact on the disease control. Patients and Methods We identified 128 patients submitted to radical cystectomy, for bladder cancer treatment, from January 2009 to July 2012 in one oncology tertiary referral public center (Mario Penna Institute, Belo Horizonte, Brazil). We retrospectively analyzed the findings obtained from their pathologic report and assessed the complications within 30 days of surgery. Results We showed similar pathologic and surgical findings compared to other large series from the literature, however our patients presented with a slightly higher rate of pT4 disease. Positive surgical margins were found in 2/128 patients (1.5%). The medium number of lymph nodes dissected were 15. Major complications (Clavien 3 to 5) within 30 days of cystectomy occurred in 33/128 (25.7%) patients. Conclusions In the management of invasive bladder cancer, efforts should focus on proper disease diagnosis and staging, and, thereafter, correct treatment based on pathologic findings. Furthermore, extended LND should be performed in all patients with RC indication. A critical analysis of our complications in a future study will help us to identify and modify some of the factors associated with surgical morbidity.

Predictive value of pretreatment inflammation-based prognostic scores (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio) for invasive bladder carcinoma

PURPOSE: Inflammation-based prognostic scores including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) are associated with oncologic outcomes in diverse malignancies. We evaluated the predictive value of pretreatment prognostic scores in differentiating nonmuscle invasive (NMIBC) and muscle invasive bladder cancer (MIBC). MATERIALS AND METHODS: Consecutive transurethral resection of bladder tumour (TURBT) cases from January 2011 to December 2013 were analysed retrospectively. Patient demographics, tumour characteristics and prognostic scores results were recorded. Receiver operating characteristics curves were used to determine prognostic score cutoffs. Univariate and multivariate binomial logistic regression analysis was performed to evaluate the association between variables and MIBC. RESULTS: A total of 226 patients were included, with 175 and 51 having NMIBC (stages Ta and T1) and MIBC (stage T2+) groups, respectively. Median age was 75 years and 174 patients were male. The NLR cutoff was 3.89 and had the greatest area under the curve (AUC) of 0.710, followed by LMR (cutoff218; AUC, 0.642). Full blood count samples were taken a median of 12 days prior to TURBT surgery. Multivariate logistic regression analysis identified tumour grade G3 (odds ration [OR], 32.848; 95% confidence interval [CI], 9.818-109.902; p=0.000), tumour size> or =3 cm (OR, 3.353; 95% CI, 1.347-8.345; p=0.009) and NLR> or =3.89 (OR, 8.244; 95% CI, 2.488-27.316; p=0.001) as independent predictors of MIBC. CONCLUSIONS: NLR may provide a simple, cost-effective and easily measured marker for MIBC. It can be performed at the time of diagnostic flexible cystoscopy, thereby assisting in the planning of further treatment.

Epithelial mesenchymal transition in urothelial carcinoma: Twist in the tale.

Context: Epithelial to mesenchymal transition (EMT) is a process involving conversion of cells from an epithelial to mesenchymal phenotype. The role of candidate genes promoting EMT and favoring a promigratory phenotype has been demonstrated in epithelial cancer. Existing scientific research has not yielded a clinically relevant biomarker with predictive capacity beyond grade and stage in bladder cancer. Aim: The purpose of this study is to evaluate the immunohistochemical expression pattern of a panel of epithelial and mesenchymal markers in paraffin-embedded archival material of primary urothelial carcinoma as evidence of EMT. Materials and Methods: Immunohistochemical expression of transcription factor twist, epithelial (E-cadherin, cytokeratin) and mesenchymal (vimentin, N-cadherin) markers was analyzed on archival paraffin-embedded tissue samples from 48 patients with diagnosis of primary urothelial carcinoma of bladder. Statistical Analysis: Karl Pearson's χ2 test was used to evaluate the association between the expression of immunohistochemical markers and various clinico-pathologic variables. Non-parametric Kendall's tau-b statistics was used to determine the correlation between categorical variables. Results and Conclusion: The study demonstrated statistically significant association of cytokeratin, E-cadherin, vimentin, and twist with stage and grade of bladder cancer. Since these markers form part of the spectrum of changes associated with EMT, the study establishes proof of concept of the existence of this process in vivo. A significant negative correlation was noted between the expression of twist and E-cadherin. Exploiting its role as a transcriptional repressor of E-cadherin, twist may prove to be a useful candidate for targeted therapy in urologic oncology.

An unusual case of non-disseminated bladder aspergillosis in a setting of transitional cell carcinoma.

A bladder infection of Aspergillus with no evidence of dissemination is rare. We present a case of Aspergillus infection with transitional cell carcinoma of the urinary bladder without any evidence of systemic involvement. A 65-year-old male diabetic whose main complaints were intermittent painful haematuria and nocturia had undergone nephroureterectomy a year and a half back for transitional cell carcinoma of right renal pelvis. Cystoscopy revealed bladder mucosa having fixed broad tumour with encrustation and bleeding on touch at the right vesico-ureteric junction. The histopathologic diagnosis was a high-grade transitional carcinoma with Aspergillus infection. Fungal culture of urine obtained after bladder wash yielded Aspergillus fumigatus.

Carcinoma de células transicionales en paciente con enfermedad poliquística renal autosómica dominante / Transitional cell carcinoma in a patient with autosomal dominant polycystic renal disease

Objetivo: Reportar un caso de una paciente con enfermedad poliquística renal autosómica dominante(EPRAD) asociada a la presencia de un carcinoma de células transicionales (CCT).Métodos: Paciente de 46 años de edad, con antecedentes de tabaquismo crónico. Se realiza el diagnóstico de EPRAD complicada con hematuria recurrente con origen en la unidad renal derecha. Resultados: Se realiza nefrectomía laparoscópica mano asistida con un tiempo operatorio de 1 hora25 minutos. El informe anatomopatológico de la pieza operatoria es compatible con carcinoma de CCT Grado 1 de Ash, correspondiendo a un estadio T1 N0 M0 de la Clasificación TNM de la AJCCUICCde 1997.Conclusión: Si bien la existencia de neoplasias renales en pacientes portadores de EPRAD constituye una entidad poco común, y que no presenta mayor incidencia que en la población general, debe considerarse como posibilidad diagnóstica en todos aquellos pacientes que evidencien síntomas o signos de complicación de su enfermedad poliquística, sobre todo en aquellos en los que se plantea la resolución quirúrgica de su patología.

Objetive: We report a patient with autosomal dominant polycystic renal disease (ADPRD) associated with transitional cell carcinoma (TCC).Methods: A 46 year old patient with history of chronic cigarette smoking was diagnosed of ADPRD with recurrent hematuria originated in the right renal unit. Results: A right hand-assisted laparoscopic nephrectomy was performed. Operative time was 85minutes. Pathological analysis showed a Grade 1 TCC, pT1 N0 M0.Conclusions: Renal neoplasias in ADPRD patients are infrequent baring the same incidence as normal patients. However, in symptomatic ADPRD patients, renal neoplasias should be kept in mind, especially if patients are to undergo surgery.

Pseudo-Meigs' syndrome associated to renal pelvis tumor

INTRODUCTION: Pseudo-Meigs' syndrome is associated with tumors different from the benign ovary tumor, but it has never been described in association to transitional cell carcinoma. CASE REPORT: A female 73 year-old patient presenting pleural effusion nonmetastatic associated with renal pelvis transitional cell carcinomathat resolved and did not recur after radical nephroureterectomy. COMMENTS: Renal pelvis transitional cell carcinoma can result in the Pseudo-Meigs' syndrome. Although being a rare clinical entity, the identification of such syndrome can result in an accurate diagnosis, leading to an efficient surgical treatment, without comorbidity for the patient.

Psoas abscess-like metastasis from transitional cell carcinoma of urinary bladder.

We report a 70-year-old male who presented with gross painless total haematuria associated with persistent left hip pain of one month duration. Computerised tomography of abdomen revealed a mass on the right lateral wall of urinary and abscess like lesion in the left psoas. He underwent transurethral resection of bladder tumour and ultrasonographical guided tru-cut biopsy of psoas lesion. Histopathology confirmed transitional cell carcinoma with metastasis to left psoas muscle. The presentation highlights the clinical and radiological features along with review of literature of rare metastatic site from transitional cell carcinoma of urinary bladder.

Recurrencia del cáncer vesical superficial con el uso de BCG / Recurrence in superficial bladder cancer with the use of BCG

La recurrencia del cáncer vesical superficial puede llegar a un 10-80 por ciento, la cual puede ser disminuida significativa con el uso de quimioterápicos o BCG post cirugía. El objetivo de este trabajo es analizar los resultados con el uso de BCG intravesical post cirugía, de acuerdo a nuestro protocolo de tratamiento. Se revisan retrospectivamente, las fichas clínicas de 108 pacientes, con diagnóstico de cáncer vesical, tratados en el Hospital Dr. Sótero del Río y en Clínica Integramédica. Sesenta y nueve pacientes con tumor vesical superficial (Tis, Ta, T1), (55 H y 14 M) fueron sometidos a resección transuretral. Un 55,1 por ciento (n=39) recibió BCG adyuvante y un 44,9 por ciento (n=31) fueron observados. El esquema de tratamiento fue de 25-27 mg de BCG/semana por 3 veces (esquema 1: n=4), 25-27 mg/semana por 6 veces (esquema 2: n=11) y 25-27 mg/semana por 6 veces más refuerzos (esquema 3: n=20). El control consistió en cistoscopia, con o sin citología urinaria, más estudio por imágenes del tórax y la vía urinaria superior. El seguimiento promedio fue de 36,2 meses, con una mediana de 16 meses (rango: 1-250 meses), en el 83,3 por ciento de los pacientes. La recurrencia global de los pacientes tratados y no tratados con BCG fue de 28,9 por ciento y 41,9 por ciento, respectivamente. En estadío 0is, 0a y I, la recurrencia con y sin BCG fue de un 25 por ciento y 100 por ciento, 25 por ciento y 37,5 por ciento, y de 35,7 por ciento y 38,5 por ciento, respectivamente. La recidiva de los tumores superficiales varió según el esquema de BCG empleado, siendo de un 50 por ciento con el esquema 1, 36,4 por ciento con el esquema 2 y 15,0 por ciento con el 3. En un subgrupo de 42 pacientes con tumores vesicales superficiales, todos seguidos por más de 12 meses, la recurrencia en los estadíos 0is y 0a y I, con y sin BCG, fue de 33,3 por ciento y 100 por ciento; 23,5 por ciento y 80 por ciento; y de 55,6 por ciento y 66,7 por ciento, respectivamente. En este subgrupo, la recidiva también resultó claramente dependiente del esquema de BCG utilizado, siendo de un 50 por ciento para el esquema 1, 44,4 por ciento para el esquema 2 y 20 por ciento para el 3. Estos resultados confirman la utilidad de un esquema de BCG con dosis de 25 o 27 mg por instilación. Para establecer fracaso o éxito en el tratamiento con BCG, el seguimiento debiera ser al menos de 12 meses, ya que una observación menor puede dar índices de recurrencia falsamente bajos...

Hepatitis granulomatosa por BCG / Granulamatous hepatitis due to BCG

Se reporta un caso de hepatitis granulomatosa secundaria a inmunoterapia con BCG por cáncer vesical, complicación infrecuente de este tratamiento. La evolución clínica fue favorable luego de tratar con fármacos antituberculosos

Metástasis peneanas por carcinoma transicional de vejiga / Metastasis in penis due to transitional carcinoma of bladder

Se presentan tres casos de metástasis en pene (una en glande y dos en cuerpos cavernosos), secundarias a carcinoma transicional de vejiga. Se exponen sus características clínicas e histológicas, así como la metodología diagnóstica empleada. Todos los pacientes fallecieron dentro de los dos meses de su descubrimiento. Se realiza una revisión de la literatura publicada. Se concluye que la presencia de estas lesiones indica mal pronóstico y progresión de la enfermedad de base

Transitional cell carcinoma of the ureter and struvite calculi

Context: The association of primary carcinoma of the ureter and lithiasis is extremely rare. We report a rare case of a primary carcinoma of the ureter with corariform calculus. Case Report: 60-year-old phaeodermal female, reported a history of right-side nephritic colic, hyperthermia and pyuria during the past 20 years andhad received treatment for urinary infections a number of times. The first clinical presentation was related to lithiasis and the tumor had not been shown up by excretory urography, cystoscopy or ultrasonography. Two months after the calculus had been eliminated, the patient began to have serious symptoms and a grade III transitional cell carcinoma of the ureter was discovered. Total nephroureterectomy and M.V.A.C. (Metrotrexate + Vinblastina + Doxo Rubicina + Cisplatina) chemotherapy were tried unsuccessfully. In this report we emphasize the diagnostic difficulty caused by the concomitant presence of the two pathologies. In our opinion, the rapid evolution in this case is directly related to the high grade of the tumor.

Transitional cell carcinoma of the urinary bladder with metastasis to the stomach

A rare case is presented here of an elderly Saudi male with a four year history of transitional cell carcinoma, resected three times and finally presenting with unusual metastasis to the stomach. This is the second case report and the first in the English literature

Microdosis de vacuna BCG en cáncer vesical superficial / Microdose of BCG vaccine in bladder cancer

Se tratan 23 pacientes con cáncer vesical operado, con BCG liofilizado endovesical en microdosis de 1 mgr. De 17 pacientes que terminaron tratamiento, 16 (94 por ciento) están libre de enfermedad con 50 meses de observación. 6 pacientes están actualmente sin recidivas con 6 meses de observación. Durante el tratamiento no se presentaron complicaciones. Los resultados obtenidos demuestran los beneficios de la microdosis de BCG en la profilaxis de recurrencias del cáncer vesical

Pielonefrite xantogranulomatosa, carcinoma de células transicionais da pélvis renal e pionefrose calculosa: uma rara associaçäo / Xanthogranulomatosus pyelonephritis, transitional cell carcinoma of the renal pelvis and calculous pyonephrosis: a rare association

Descreve-se a associaçäo entre pielonefrite xantogranulomatosa, carcinoma de células transicionais da pélvis renal e pionefrose por cálculo coraliforme em uma paciente jovem do sexo feminino que, submetida a tratamento cirúrgico e quimioterápico, apresentou sobrevida de 21 meses. Embora a associaçäo entre carcinoma de células transicionais da via excretora e calculose urinária näo constitua raridade (9,25%), näo existem relatos na literatura sobre presença simultânea desta com pielonefrite xantogranulomatosa