Abstract
Background
Intravesical recurrence (IVR) after radical nephroureterectomy (RNU) for urothelial carcinoma of the upper urinary tract (UCUUT) is common. One of the mechanisms driving this is the implantation of cancer cells from the UCUUT at the RNUs. Therefore, their detection after RNU can assist in predicting IVR. This study aimed to examine the utility of UroVysion® as a tool for predicting bladder recurrence after RNU for UCUUT.
Methods
We prospectively enrolled 65 patients who received RNU for high-grade UCUUT between October 2013 and April 2017.
Results
Of the 65 patients, 54 (83.1%) who had both bladder urine samples available immediately after RNU (0 postoperative days: POD) and 5 days after RNU (5POD) were selected. We performed UroVysion® and cytology. Twenty-two patients showed IVR with 32 foci. UroVysion® results at 0POD (26 patients, 48.1%) and/or 5POD (31 patients, 57.4%) were positive in 42 (77.8%) patients. The sensitivity, specificity, positive predictive value, and negative predictive value of UroVysion® for included cases were measured for both 0POD and 5POD samples; they were determined to be 95.5% (21/22), 34.4% (11/32), 50.0% (21/42), and 91.7% (11/12), respectively. For cytology, these values were 75.0% (15/20), 52.9% (18/34), 48.4% (15/31), and 78.3% (18/23), respectively. Forty-two (64.6%) patients who were UroVysion®-positive demonstrated IVR. The IVR rate between the group positive for either 0POD or 5POD and that negative for both significantly differed for both UroVysion® (p = 0.019) and cytology (p = 0.046).
Conclusion
Multiple urine tests using UroVysion® after RNU could be a useful predictor for IVR.
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References
Seisen T, Granger B, Colin P et al (2015) A systematic review and meta-analysis of clinicopathologic factors linked to intravesical recurrence after radical nephroureterectomy to treat upper tract urothelial carcinoma. Eur Urol 67:1122–1133
Yamashita S, Ito A, Mitsuzuka K et al (2016) Clinical implications of intravesical recurrence after radical nephroureterectomy for upper urinary tract urothelial carcinoma. Int J Urol 23:378–384
Habuchi T, Takahashi R, Yamada H et al (1993) Metachronous multifocal development of urothelial cancers by intraluminal seeding. Lancet 342:1087–1088
Audenet F, Isharwal S, Cha EK et al (2019) Clonal relatedness and mutational differences between upper tract and bladder urothelial carcinoma. Clin Cancer Res 25:967–976
Jones TD, Wang M, Eble JN et al (2005) Molecular evidence supporting field effect in urothelial carcinogenesis. Clin Cancer Res 11:6512–6519
Takahashi T, Kakehi Y, Mitsumori K et al (2001) Distinct microsatellite alterations in upper urinary tract tumors and subsequent bladder tumors. J Urol 165:672–677
Xylinas E, Colin P, Audenet F et al (2013) 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 31:61–68
Tanaka N, Kikuchi E, Kanao K et al (2014) The predictive value of positive urine cytology for outcomes following radical nephroureterectomy in patients with primary upper tract urothelial carcinoma: a multi-institutional study. Urol Oncol 32(48):e19–26
Wang Y, Lang MR, Pin CL et al (2013) Comparison of the clonality of urothelial carcinoma developing in the upper urinary tract and those developing in the bladder. Springerplus 2:412
Roupret M, Babjuk M, Comperat E et al (2018) European association of urology guidelines on upper urinary tract urothelial carcinoma: 2017 update. Eur Urol 73:111–122. https://doi.org/10.1016/j.eururo.2017.1007.1036(Epub 2017 Sep 1011)
Ishioka J, Saito K, Kijima T et al (2015) Risk stratification for bladder recurrence of upper urinary tract urothelial carcinoma after radical nephroureterectomy. BJU Int 115:705–712
Ito A, Shintaku I, Satoh M et al (2013) Intravesical seeding of upper urinary tract urothelial carcinoma cells during nephroureterectomy: an exploratory analysis from the THPMG trial. Jpn J Clin Oncol 43:1139–1144
Ito A, Shintaku I, Satoh M et al (2013) Prospective randomized phase II trial of a single early intravesical instillation of pirarubicin (THP) in the prevention of bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma: the THP monotherapy study group trial. J Clin Oncol 31:1422–1427
Yamamoto S, Sakamoto S, Imamura Y et al (2019) Intravesical irrigation might prevent bladder recurrence in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma. Int J Urol 26:791–796
Hwang EC, Sathianathen NJ, Jung JH et al (2019) Single-dose intravesical chemotherapy after nephroureterectomy for upper tract urothelial carcinoma. Cochrane Database Syst Rev 5:CD013160
Gomella LG, Mann MJ, Cleary RC et al (2017) Fluorescence in situ hybridization (FISH) in the diagnosis of bladder and upper tract urothelial carcinoma: the largest single-institution experience to date. Can J Urol 24:8620–8626
Jin H, Lin T, Hao J et al (2018) A comprehensive comparison of fluorescence in situ hybridization and cytology for the detection of upper urinary tract urothelial carcinoma: a systematic review and meta-analysis. Medicine (Baltimore) 97:e13859
Sassa N, Iwata H, Kato M et al (2019) Diagnostic utility of urovysion combined with conventional urinary cytology for urothelial carcinoma of the upper urinary tract. Am J Clin Pathol 151:469–478
Rosenthal DL, Wojcik EM, Kurtycz DFI (2016) The paris system for reporting urinary cytology. Springer, New York
Pajor G, Alpar D, Kajtar B et al (2012) Automated signal pattern evaluation of a bladder cancer specific multiprobe-fish assay applying a user-trainable workstation. Microsc Res Tech 75:814–820
Sakamoto N, Naito S, Kumazawa J et al (2001) Prophylactic intravesical instillation of mitomycin C and cytosine arabinoside for prevention of recurrent bladder tumors following surgery for upper urinary tract tumors: a prospective randomized study. Int J Urol 8:212–216
Wu WJ, Ke HL, Yang YH et al (2010) Should patients with primary upper urinary tract cancer receive prophylactic intravesical chemotherapy after nephroureterectomy? J Urol 183:56–61
O’Brien T, Ray E, Singh R et al (2011) Prevention of bladder tumours after nephroureterectomy for primary upper urinary tract urothelial carcinoma: a prospective, multicentre, randomised clinical trial of a single postoperative intravesical dose of mitomycin C (the ODMIT-C Trial). Eur Urol 60:703–710
Yoo SH, Jeong CW, Kwak C et al (2019) Intravesical chemotherapy after radical nephroureterectomy for primary upper tract urothelial carcinoma: a systematic review and network meta-analysis. J Clin Med 8:1059
Xylinas E, Kluth L, Passoni N et al (2014) Prediction of intravesical recurrence after radical nephroureterectomy: development of a clinical decision-making tool. Eur Urol 65:650–658
Sazuka T, Sakamoto S, Nakamura K et al (2019) Impact of post-void residual urine volume on intravesical recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma. Int J Urol 26:1106–1112
Lotan Y, Inman BA, Davis LG et al (2019) Evaluation of the fluorescence in situ hybridization test to predict recurrence and/or progression of disease after bacillus calmette-guerin for primary high grade nonmuscle invasive bladder cancer: results from a prospective multicenter trial. J Urol 202:920–926
Babjuk M, Burger M, Comperat EM et al (2019) European association of urology guidelines on non-muscle-invasive bladder cancer (TaT1 and carcinoma in situ): 2019 update. Eur Urol 76:639–657
Matsumoto H, Shiraishi K, Azuma H et al (2020) Clinical practice guidelines for bladder cancer 2019 edition by the Japanese urological association: revision working position paper. Int J Urol 27:362–368
Ikeda A, Kojima T, Kawai K et al (2020) Risk for intravesical recurrence of bladder cancer stratified by the results on two consecutive UroVysion fluorescence in situ hybridization tests: a prospective follow-up study in Japan. Int J Clin Oncol 25:1163–1169
See WA, Chapman WH (1987) Tumor cell implantation following neodymium-YAG bladder injury: a comparison to electrocautery injury. J Urol 137:1266–1269
Goble NM, Clarke T, Hammonds JC (1989) Histological changes in the urinary bladder secondary to urethral catheterisation. Br J Urol 63:354–357
See WA, Chapman PH (1987) Heparin prevention of tumor cell adherence and implantation on injured urothelial surfaces. J Urol 138:182–186
See WA, Miller JS, Williams RD (1989) Pathophysiology of transitional tumor cell adherence to sites of urothelial injury in rats: mechanisms mediating intravesical recurrence due to implantation. Cancer Res 49:5414–5418
Reynolds JP, Voss JS, Kipp BR et al (2014) Comparison of urine cytology and fluorescence in situ hybridization in upper urothelial tract samples. Cancer Cytopathol 122:459–467
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Iwata, H., Sassa, N., Kato, M. et al. UroVysion® predicts intravesical recurrence after radical nephroureterectomy for urothelial carcinoma of the upper urinary tract: a prospective study. Int J Clin Oncol 26, 178–185 (2021). https://doi.org/10.1007/s10147-020-01785-9
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DOI: https://doi.org/10.1007/s10147-020-01785-9