You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging II1 Apr 2018MP36-05 CHANGES IN PATTERN OF RECURRENCE OVER TIME AFTER RADICAL NEPHRECTOMY IN PATIENTS WITH LOCALIZED CLEAR CELL RENAL CELL CARCINOMA Kenji Tanabe, Kazutaka Saito, Kazuaki Nakagomi, Chizuru Arisawa, Tetsuro Tsukamoto, Tetsuo Okuno, Katsushi Nagahama, Akira Noro, Shinji Morimoto, Satoshi Kitahara, Kazunori Kihara, and Yasuhisa Fujii Kenji TanabeKenji Tanabe More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Kazuaki NakagomiKazuaki Nakagomi More articles by this author , Chizuru ArisawaChizuru Arisawa More articles by this author , Tetsuro TsukamotoTetsuro Tsukamoto More articles by this author , Tetsuo OkunoTetsuo Okuno More articles by this author , Katsushi NagahamaKatsushi Nagahama More articles by this author , Akira NoroAkira Noro More articles by this author , Shinji MorimotoShinji Morimoto More articles by this author , Satoshi KitaharaSatoshi Kitahara More articles by this author , Kazunori KiharaKazunori Kihara More articles by this author , and Yasuhisa FujiiYasuhisa Fujii More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1139AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Late recurrence is one of specific features in renal cell carcinoma (RCC). Longer follow-up more than 5-years is needed for the early detection of recurrence to allow surgical removal with curative intent. However, surveillance strategy should be based on its efficacy and medical burden of economic cost and radiation exposure. We aimed to evaluate the pattern of recurrence over time after radical nephrectomy for localized clear cell RCC (ccRCC). METHODS This study conducted from a multicenter database including RCC (n=2162) since 1981 to 2013 at 9 centers. Among them, patients who experienced recurrence after radical nephrectomy for localized ccRCC were subjects. Recurrence patients were divided in 4 time groups according to time to initial recurrence (<2, 2≤ and <5, 5≤ and <10, and ≥10 years). Associations between time groups and initial recurrence sites (lung, bone, lymph node, local, liver, kidney, adrenal gland, pancreas, others) were analyzed. Then we analyzed proportion of lung and pancreas recurrences as representative sited of early and late recurrence using Kaplan-Meier method. RESULTS During the follow-up period (median, 82.0 months), 161 patients (117 men, 44 women, median age 69 years at recurrence) had recurrence. The number of patients who experienced initial recurrence at lung, bone, and lymph node decrease over time with 24.0, 11.0, 4.0 events per year in these three sites after <2, 2≤ and <5, and 5≤ and <10 years, respectively, while the patients with recurrence at kidney, adrenal gland, and pancreas showed tendency to increase with 0.5, 3.3, 2.6 events per year in these three sites after <2, 2≤ and <5, and 5≤ and <10 years, respectively (Fig 1). As shown in Fig 2, a large proportion of lung recurrences developed earlier, whereas pancreas recurrences increased later. CONCLUSIONS The pattern of recurrence after nephrectomy changed over time in patients with localize ccRCC. On the basis of these findings, surveillance policy could be altered with follow-up duration. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e458 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Kenji Tanabe More articles by this author Kazutaka Saito More articles by this author Kazuaki Nakagomi More articles by this author Chizuru Arisawa More articles by this author Tetsuro Tsukamoto More articles by this author Tetsuo Okuno More articles by this author Katsushi Nagahama More articles by this author Akira Noro More articles by this author Shinji Morimoto More articles by this author Satoshi Kitahara More articles by this author Kazunori Kihara More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Background: The prognostic significance of tumor location for patients with upper urinary tract urothelial carcinoma (UUT-UC) has been disputed. Several papers have reported that ureteral cancer is associated with worse prognosis.Objective: To investigate the prognostic significance of the presence of ureteral tumors in UUT-UC patients who underwent radical nephroureterectomy (RNU).Design, setting, and participants: In this multicenter retrospective study, 1068 eligible patients (median follow-up: 40 mo [interquartile range: 17-77 mo]) were divided into three groups based on tumor location: renal pelvic, ureteral, and both-regional (having both renal pelvic and ureteral tumors). The ureteral and both-regional groups were subsequently integrated into the ureteral involvement group to evaluate its prognostic impact.Intervention: All patients underwent RNU.Outcome measurements and statistical analysis: The prognostic impact of tumor location on survival was analyzed.Results and limitations: The renal pelvic, ureteral, and both-regional groups consisted of 507 (47.5%), 430 (40.3%), and 131 (12.3%) patients, respectively. The ureteral and both-regional groups had a higher rate of lymphovascular invasion and lymph node metastasis compared with the renal pelvic group. The renal pelvic and both-regional tumors presented more frequently with locally advanced stages (pT3/T4) compared with the ureteral tumors. The 5-yr cancer-specific survival (CSS) and progression-free survival (PFS) rates of patients in the ureteral (70.5% and 66.7%, respectively) and both-regional groups (64.8% and 57.8%, respectively) were significantly worse than those in the renal pelvic group (81.9% and 78.1%, respectively). In a multivariate analysis, the presence of ureteral involvement was a significant prognostic factor for CSS (hazard ratio [HR]: 1.50; p = 0.006) and PFS (HR: 1.35; p = 0.023). This study is inherently limited by the biases associated with its retrospective and multicenter design.Conclusions: The presence of ureteral involvement had a significant impact on the survival of surgically treated UUT-UC patients associated with a poor prognosis.Patient summary: We demonstrated that the ureteral involvement was associated with poor survival compared with patients with renal pelvic tumor only in upper urinary tract urothelial patients treated by nephroureterectomy. (C) 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.

INTRODUCTION AND OBJECTIVES:We conducted a randomized, prospective, multicenter study comparing one immediate postoperative intravesical chemotherapy with short-term adjuvant intravesical chemotherapy after transurethral resection of bladder tumor (TURBT) in non-muscle invasive bladder carcinoma (NMIBC) with low or intermediate recurrent risk.The objective is to evaluate the efficacy of intravesical chemotherapy using pirarubicin for patients with low or intermediate risk.METHODS: This study was approved by the ethics committees of Kyoto Prefectural University of Medicine in September 2010.The recurrent risk was stratified using EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update.Between October 2010 and January 2015, 216 patients was enrolled in this study and 97 patients were excluded from this study after TURBT for their high recurrent risk of NMIBC.Remaining 109 with low or intermediate recurrent risk of NMIBC were randomized to one immediate postoperative intravesical instillation of pirarubicin (THP) 30mg (Group A), or additional intravesical chemotherapy of THP 30mg weekly for 8 weeks (Group B).The patients were examined by cystoscopy and urine cytological examination every 3 months after TURBt to determine bladder tumor recurrence.RESULTS: The 2-year recurrence free rate were 65.3% for Group A and 87.2% for Group B, respectively (log rank test, p ¼ 0.038).In patients with intermediate recurrent risk, the 2year recurrence free rate were 62.3% in Group A and 86.8% in group B, respectively (log rank test, p ¼ 0.0261).In patients with recurrent score between 5 and 9, the 2-year recurrence free rate were 91.7% in Group A and 25.0% in Group B (log rank test, p¼0.0052).There was no patient with progression during this period.Adverse events were documented in 0% and 24.4% in Group A and Group B, respectively.There was no patient with severe adverse event (Grade 3 or more).CONCLUSIONS: Additional instillation of THP 30mg weekly for 8 weeks reduced the risk of tumor recurrence without severe toxicity in NMIBC patients with intermediate recurrent risk.Our data provide a rationale for adjuvant intravesical chemotherapy after TURBT in NMIBC patients with intermediate recurrent risk.

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II1 Apr 2016PD29-12 LONGITUDINAL RENAL FUNCTION RECOVERY AFTER RADICAL NEPHRECTOMY AND RISK FACTORS FOR POSTOPERATIVE SEVERE RENAL IMPAIRMENT: A JAPANESE MULTICENTER STUDY Minato Yokoyama, Naoko Kawamura, Yasuhisa Fujii, Masaharu Inoue, Junichiro Ishioka, Noboru Numao, Yoh Matsuoka, Kazutaka Saito, Chizuru Arisawa, Tetsuo Okuno, Akira Noro, Shinji Morimoto, and Kazunori Kihara Minato YokoyamaMinato Yokoyama More articles by this author , Naoko KawamuraNaoko Kawamura More articles by this author , Yasuhisa FujiiYasuhisa Fujii More articles by this author , Masaharu InoueMasaharu Inoue More articles by this author , Junichiro IshiokaJunichiro Ishioka More articles by this author , Noboru NumaoNoboru Numao More articles by this author , Yoh MatsuokaYoh Matsuoka More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Chizuru ArisawaChizuru Arisawa More articles by this author , Tetsuo OkunoTetsuo Okuno More articles by this author , Akira NoroAkira Noro More articles by this author , Shinji MorimotoShinji Morimoto More articles by this author , and Kazunori KiharaKazunori Kihara More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.530AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study is to investigate longitudinal changes in renal function after radical nephrectomy (RN), and to explore risk factors for postoperative severe renal impairment in a Japanese multicenter cohort. METHODS Between 1994 and 2011, 1031 adult patients underwent RN at 5 hospitals in Japan. Of these, 701 patients who had no metastasis, end-stage renal disease or bilateral kidney cancer and who were followed-up for at least 1 year were enrolled into this study. The longitudinal change in postoperative estimated glomerular filtration rate (eGFR) during a 10-year follow-up period was evaluated according to the presence or absence of potential risk factors including greater age (≥ 65 years), chronic kidney disease (CKD) defined as eGFR < 60 mL/min/1.73 m2, hypertension (HT), diabetes mellitus (DM), and cardiovascular disease (CVD). The slope of annual change in eGFR was calculated using a linear mixed model analysis. Associations between the potential risk factors and a > 50% eGFR decrease were evaluated using a multivariate Cox regression model and the Kaplan-Meier method with a log-rank test. RESULTS The median age was 64 years, and preoperative eGFR was 69.6 mL/min/1.73 m2. CKD, HT, DM and CVD were present before RN in 178 (25.4%), 274 (42.8%), 106 (15.2%) and 111 (15.8%) patients, respectively. During the median follow-up of 62 months, end-stage renal disease requiring chronic dialysis eventually developed in 9 patients (1.3%). Overall, the mean eGFR, which decreased by 45.7 mL/min/1.73 m2 at 1 year after RN, recovered to 51.3 mL/min/1.73 m2 at 10 years after RN. The slope of the annual eGFR change was 0.34 (95% confidence interval: 0.17 - 0.50, P < 0.001) mL/min/1.73 m2/year. However, renal function did not significantly recover in patients with CKD, HT, DM or CVD. Of the 701 patients, 58 (8.3%) had postoperative severe renal impairment with a > 50% eGFR decrease. The multivariate analysis revealed that greater age and DM were independent risk factors for severe renal impairment. Survival curves were stratified with a 5-year > 50% eGFR decrease-free survival rate of 96.5%, 90.4% and 75.6% in patients with no, 1 and 2 risk factors, respectively (P < 0.001). CONCLUSIONS Renal function that had deteriorated immediately after RN recovered over time in Japanese patients. However, longitudinal renal function recovery in patients with CKD, HT, DM and CVD was not observed. Greater age and DM were independent risk factors for severe renal impairment. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e710-e711 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Minato Yokoyama More articles by this author Naoko Kawamura More articles by this author Yasuhisa Fujii More articles by this author Masaharu Inoue More articles by this author Junichiro Ishioka More articles by this author Noboru Numao More articles by this author Yoh Matsuoka More articles by this author Kazutaka Saito More articles by this author Chizuru Arisawa More articles by this author Tetsuo Okuno More articles by this author Akira Noro More articles by this author Shinji Morimoto More articles by this author Kazunori Kihara More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVES:To identify risk factors and develop a model for predicting recurrence of upper urinary tract urothelial carcinoma (UTUC) in the bladder in patients without a history of bladder cancer after radical nephroureterectomy (RNU).PATIENTS AND METHODS:We retrospectively reviewed 754 patients with UTUC without prior or concurrent bladder cancer or distant metastasis at 13 institutions in Japan. Univariate and multivariate Fine and Gray competing risks proportional hazards models were used to examine the cumulative incidence of bladder recurrence of UTUC. A risk stratification model and a nomogram were constructed. Two prediction models were compared using the concordance index (c-index) focusing on predictive accuracy and decision-curve analysis, which indicate whether a model is appropriate for decision-making and determining subsequent patient prognosis.RESULTS:The cumulative incidence rates of bladder UTUC recurrence at 1 and 5 years were 15 and 29%, respectively; the median time to bladder UTUC recurrence was 10 months. Multivariate analysis showed that papillary tumour architecture, absence of lymphovascular invasion and higher pathological T stage were both predictive factors for bladder cancer recurrence. The predictive accuracy of the risk stratification model and the nomogram for bladder cancer recurrence were not different (c-index: 0.60 and 0.62). According to the decision-curve analysis, the risk stratification was an acceptable model because the net benefit of the risk stratification was equivalent to that of the nomogram. The overall cumulative incidence rates of bladder cancer 5 years after RNU were 10, 26 and 44% in the low-, intermediate- and high-risk groups, respectively.CONCLUSIONS:We identified risk factors and developed a risk stratification model for UTUC recurrence in the bladder after RNU. This model could be used to provide both an individualised strategy to prevent recurrence and a risk-stratified surveillance protocol.

OBJECTIVES:To investigate longitudinal changes in renal function after radical nephrectomy, and to explore risk factors of postoperative severe renal impairment in a Japanese multicenter cohort.METHODS:The present retrospective study included 701 patients who had no metastasis, end-stage kidney disease or bilateral kidney cancer, who underwent radical nephrectomy and who were followed up for at least 1 year. The longitudinal change in postoperative renal function during a 10-year follow-up period was evaluated according to the presence or absence of potential risk factors including greater age, chronic kidney disease, hypertension, diabetes mellitus and cardiovascular disease. A slope of annual change in estimated glomerular filtration rate was analyzed using a linear mixed model. Associations between the potential risk factors and a >50% estimated glomerular filtration rate decrease were evaluated using a multivariate Cox regression model.RESULTS:Overall, the postoperative estimated glomerular filtration rate recovered over time with a significant positive slope of 0.34 mL/min/1.73 m(2)/year. Renal function did not tend to recover in patients with chronic kidney disease, hypertension, diabetes mellitus or cardiovascular disease. The multivariate analysis showed that greater age and diabetes mellitus were independent risk factors for severe renal impairment.CONCLUSIONS:Overall, patients who had deteriorated renal function immediately after radical nephrectomy recovered over time. However, patients with chronic kidney disease, hypertension, diabetes mellitus and cardiovascular disease did not tend to recover renal function postoperatively. Greater age and diabetes mellitus were independent risk factors for a >50% decrease in estimated glomerular filtration rate.

You have accessJournal of UrologyBladder Cancer: Non-invasive II1 Apr 2015PD17-07 IMPACT OF BLADDER NECK INVOLVEMENT ON PROGRESSION IN PATIENTS WITH PRIMARY NON-MUSCLE-INVASIVE BLADDER CANCER: A MULTICENTER VALIDATION STUDY Yasuhisa Fujii, Shingo Moriyama, Minato Yokoyama, Junji Yonese, Akira Noro, Chizuru Arisawa, Shinji Morimoto, Tetsuo Okuno, Satoshi Kitahara, Fumitaka Koga, Yasuyuki Sakai, Masahito Suzuki, Katsushi Nagahama, Toshifumi Izutani, Kazutaka Saito, and Kazunori Kihara Yasuhisa FujiiYasuhisa Fujii More articles by this author , Shingo MoriyamaShingo Moriyama More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Junji YoneseJunji Yonese More articles by this author , Akira NoroAkira Noro More articles by this author , Chizuru ArisawaChizuru Arisawa More articles by this author , Shinji MorimotoShinji Morimoto More articles by this author , Tetsuo OkunoTetsuo Okuno More articles by this author , Satoshi KitaharaSatoshi Kitahara More articles by this author , Fumitaka KogaFumitaka Koga More articles by this author , Yasuyuki SakaiYasuyuki Sakai More articles by this author , Masahito SuzukiMasahito Suzuki More articles by this author , Katsushi NagahamaKatsushi Nagahama More articles by this author , Toshifumi IzutaniToshifumi Izutani More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , and Kazunori KiharaKazunori Kihara More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.664AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We previously reported that bladder neck involvement (BNI) as well as tumor grade and stage was an independent risk factor for progression in primary non-muscle-invasive bladder cancer (NMIBC) in retrospective and prospective cohorts at a single institute (TMDU), and proposed a simple predictive scoring model for progression, consisting of tumor grade, stage and BNI, all of which were scored as one point, contributing equally to the model (Fujii et al., Eur Urol 1998; Kobayashi and Fujii et al., Urol Oncol 2014). In this study, we externally validated the impact of BNI on progression in NMIBC and the predictive ability of the scoring model using a large multicenter cohort. METHODS A total of 1335 Japanese patients who underwent transurethral resection for primary bladder tumors at 11 institutions not including TMDU between 2006 and 2010 and were pathologically diagnosed with Ta and T1 NMIBC were enrolled. We excluded patients with primary carcinoma in situ and patients with tumors located in the prostate urethra. Multivariate Cox proportional hazards regression models were used to identify the independent predictors for progression. The predictive ability of our model was assessed using Harrell's c-index. RESULTS Over a median follow-up of 48 months, 64 patients (4.8%) progressed. Progression probabilities at one and five years were 2.0% and 6.0%, respectively. Multivariate analysis revealed that tumor grade (HR 2.40, P=0.0012), stage (HR 2.69, P=0.0008) and BNI (HR 1.82, P=0.0315) were independent predictors of progression. Of the 248 patients with BNI, 21 (8.5%) progressed. When the patients were divided into three groups according to their score on our predictive model (0, 1 and 2–3 points), the groups had significantly different progression rates (P<0.0001). The c-index of the model was 0.597. CONCLUSIONS In this multicenter validation study, BNI is confirmed as a significant prognostic factor for progression in primary NMIBC. Our scoring model incorporating BNI is an easy means of estimating progression risk and can be used to determine the appropriate adjuvant treatment and follow-up procedures for individual patients. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e383-e384 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yasuhisa Fujii More articles by this author Shingo Moriyama More articles by this author Minato Yokoyama More articles by this author Junji Yonese More articles by this author Akira Noro More articles by this author Chizuru Arisawa More articles by this author Shinji Morimoto More articles by this author Tetsuo Okuno More articles by this author Satoshi Kitahara More articles by this author Fumitaka Koga More articles by this author Yasuyuki Sakai More articles by this author Masahito Suzuki More articles by this author Katsushi Nagahama More articles by this author Toshifumi Izutani More articles by this author Kazutaka Saito More articles by this author Kazunori Kihara More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

To investigate the oncological and functional outcome of distal ureterectomy compared with nephroureterectomy in the management of distal ureteral urothelial carcinoma. Using a database including upper urinary tract urothelial carcinoma patients ( n  = 1329), 282 patients were identified with urothelial carcinoma localized in the distal ureter on clinical evaluation. To adjust for potential baseline differences between groups, 43 patients undergoing distal ureterectomy were matched with 86 patients undergoing nephroureterectomy using propensity scoring. Cox regression models tested the effect of surgery type on recurrence-free survival and cancer-specific survival. Estimated glomerular filtration rate was measured before and after surgery. The median follow-up period was 50 months. There were no significant differences in 5-year recurrence-free survival and cancer-specific survival rates between the distal ureterectomy and nephroureterectomy groups ( P  = 0.22 and P  = 0.70, respectively). Multivariate analysis showed that surgery type was not associated with recurrence-free survival and cancer-specific survival ( P  = 0.90 and P  = 0.28, respectively). In the subanalysis, recurrence-free survival and cancer-specific survival in the distal ureterectomy group were equivalent to those of the nephroureterectomy group in both pTa-1 and pT2-4 patients. Renal function was better preserved in the distal ureterectomy group than in the nephroureterectomy group (rate of change in estimated glomerular filtration rate 2% vs −20%; P  < 0.001). The oncological outcome of distal ureterectomy is comparable with that of nephroureterectomy in distal ureteral urothelial carcinoma patients, and distal ureterectomy provides better preservation of renal function. Distal ureterectomy would be feasible for carefully selected patients with distal ureteral urothelial carcinoma.

Aim: To clarify how body mass index (BMI) affects the risk of death from upper urinary tract urothelial carcinoma (UUTUC) we investigated the impact of BMI on UUTUC using a Japanese multicenter database. Patients and Methods: Between January 1995 and December 2010, 1,329 patients with upper urinary tract tumors were treated in 13 institutions in Japan. From this group, a cohort of 1,014 patients treated with radical nephroureterectotny was retrospectively reviewed. BMI was categorized into the following three groups: BMI <22.5, BMI 22.5 to <25 and BMI The association between each group and cancer-specific survival (CSS) was analyzed using Cox proportional hazards regression models. Results: The median BMI was 22.4 kg/m(2) (interquartile range, 20.5-24.8). Out of all patients, 213 (21%) died of UUTUC. Hazard ratios of the BMI >= 25 and the BMI <22.5 group were 1.76 and 1.66, respectively. Conclusion: Both higher and lower BMI affect the prognosis of UUTUC treated with radical nephroureterectotny.

You have accessJournal of UrologyUrothelial Cancer: Natural History, Markers & Pathophysiology1 Apr 2013400 RISK STRATIFICATION FOR BLADDER RECURRENCE AFTER RADICAL NEPHROURETERECTOMY FOR UPPER URINARY TRACT UROTHELIAL CARCINOMA Junichiro Ishioka, Kazutaka Saito, Yoh Matsuoka, Noboru Numao, Fumitaka Koga, Hitoshi Masuda, Yasuhisa Fujii, Yasuyuki Sakai, Tetsuo Okuno, Chizuru Arisawa, Shigeyoshi Kamata, Katsushi Nagahama, Junji Yonese, Akira Noro, Toshihiko Tsujii, Shinji Morimoto, Satoshi Kitahara, Shuichi Goto, Yotsuo Higashi, and Kazunori Kihara Junichiro IshiokaJunichiro Ishioka Tokyo, Japan More articles by this author , Kazutaka SaitoKazutaka Saito Tokyo, Japan More articles by this author , Yoh MatsuokaYoh Matsuoka Tokyo, Japan More articles by this author , Noboru NumaoNoboru Numao Tokyo, Japan More articles by this author , Fumitaka KogaFumitaka Koga Tokyo, Japan More articles by this author , Hitoshi MasudaHitoshi Masuda Tokyo, Japan More articles by this author , Yasuhisa FujiiYasuhisa Fujii Tokyo, Japan More articles by this author , Yasuyuki SakaiYasuyuki Sakai Chiba, Japan More articles by this author , Tetsuo OkunoTetsuo Okuno Ibaraki, Japan More articles by this author , Chizuru ArisawaChizuru Arisawa Tokyo, Japan More articles by this author , Shigeyoshi KamataShigeyoshi Kamata Saitama, Japan More articles by this author , Katsushi NagahamaKatsushi Nagahama Chiba, Japan More articles by this author , Junji YoneseJunji Yonese Tokyo, Japan More articles by this author , Akira NoroAkira Noro Saitama, Japan More articles by this author , Toshihiko TsujiiToshihiko Tsujii Tokyo, Japan More articles by this author , Shinji MorimotoShinji Morimoto Ibaraki, Japan More articles by this author , Satoshi KitaharaSatoshi Kitahara Tokyo, Japan More articles by this author , Shuichi GotoShuichi Goto Hamamatsu, Japan More articles by this author , Yotsuo HigashiYotsuo Higashi Saitama, Japan More articles by this author , and Kazunori KiharaKazunori Kihara Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1789AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The risk factors for bladder recurrence after surgery for upper urinary tract urothelial carcinoma (UUT-UC) patients have not yet been clearly identified. We assessed the risk factors for metachronous bladder recurrence after UUT-UC treatment and developed a novel risk stratification model using a multi-center database. METHODS Of 1329 patients with UUT-UC in our database, 777 patients who underwent radical nephroureterectomy without prior or synchronous bladder cancer were the subjects of this study. The time to bladder recurrence was defined as the time from the date of radical nephroureterectomy to the date of the transurethral resection. UUT-UC-related death and other causesûrelated death were considered as informative and non-informative censoring, respectively. We used the proportional subdistribution hazards regression model to identify the risk factors for bladder recurrence. A novel prediction scoring model for bladder recurrence was developed. RESULTS With a median follow-up of 41 months (interquartile range 18–75), 171 (22%) patients had bladder recurrence and 72 (9%) died of UUT-UC. Cumulative incidence of bladder recurrence at 3 years was 26%. Univariate analysis showed that papillary tumor architecture (HR 1.75, p = 0.006) and no lymphvascular invasion (HR 1.48, p = 0.018) were significantly associated with bladder recurrence. Multivariate analysis revealed that papillary tumor architecture (HR 1.68, p = 0.019), no lymphvascular invasion (HR 1.57, p = 0.018), and higher pathologic T stage ≥pT2 (HR 1.71, p = 0.006) were independent and that sex (male) (HR 1.36, p = 0.097) was a marginally significant predictor of bladder recurrence. When all variables were scored as 1 point and the patients were divided into three risk groups of low, intermediate, and high according to their total score, the cumulative incidence of bladder recurrence at 3 years was clearly discriminated (p < 0.001). CONCLUSIONS This study proposed the first risk stratification model for bladder recurrence in UUT-UC. This model makes the estimation of recurrence easy and may help determine appropriate adjuvant treatment and surveillance regimens for patients. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e162 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Junichiro Ishioka Tokyo, Japan More articles by this author Kazutaka Saito Tokyo, Japan More articles by this author Yoh Matsuoka Tokyo, Japan More articles by this author Noboru Numao Tokyo, Japan More articles by this author Fumitaka Koga Tokyo, Japan More articles by this author Hitoshi Masuda Tokyo, Japan More articles by this author Yasuhisa Fujii Tokyo, Japan More articles by this author Yasuyuki Sakai Chiba, Japan More articles by this author Tetsuo Okuno Ibaraki, Japan More articles by this author Chizuru Arisawa Tokyo, Japan More articles by this author Shigeyoshi Kamata Saitama, Japan More articles by this author Katsushi Nagahama Chiba, Japan More articles by this author Junji Yonese Tokyo, Japan More articles by this author Akira Noro Saitama, Japan More articles by this author Toshihiko Tsujii Tokyo, Japan More articles by this author Shinji Morimoto Ibaraki, Japan More articles by this author Satoshi Kitahara Tokyo, Japan More articles by this author Shuichi Goto Hamamatsu, Japan More articles by this author Yotsuo Higashi Saitama, Japan More articles by this author Kazunori Kihara Tokyo, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVES:To develop and validate predictive models for postoperative estimated glomerular filtration rate and risk of chronic kidney disease after radical nephrectomy in Japanese patients.METHODS:The present retrospective study included a development cohort of 209 patients without preoperative chronic kidney disease who underwent radical nephrectomy between 1994 and 2008, and were followed up for longer than 3 years, and a validation cohort of 144 similar such patients. Univariate and multivariate linear regression or logistic regression analyses were carried out to identify the independent predictors of estimated glomerular filtration rate or chronic kidney disease 3 years after radical nephrectomy. Incorporating all independent predictors, predictive models for postoperative renal function were developed and externally validated.RESULTS:Age, the presence of diabetes mellitus, and preoperative estimated glomerular filtration rate were independent predictors of both postoperative estimated glomerular filtration rate and chronic kidney disease. A formula for predicting the postoperative estimated glomerular filtration rate and a nomogram for predicting the risk of postoperative chronic kidney disease were developed. The adjusted R(2) of the formula and area under the receiver operating characteristic curves of the nomogram were 0.446 and 0.865 in the development cohort, and 0.396 and 0.787 in the validation cohort, respectively.CONCLUSIONS:We developed and validated novel predictive models for the postoperative renal function 3 years after radical nephrectomy in Japanese patients.

You have accessJournal of UrologyUrothelial Cancer: upper Tract Tumors (I)1 Apr 2013687 BIMODAL PATTERN OF THE IMPACT OF BODY MASS INDEX ON CANCER-SPECIFIC SURVIVAL OF UPPER URINARY TRACT UROTHELIAL CARCINOMA PATIENTS: MULTI-CENTER STUDY IN A 1114-CASE TOKYO METROPOLITAN DATABASE OF UROLOGIC DISEASE (TMDU) COHORT Junichiro Ishioka, Hitoshi Masuda, Yoh Matsuoka, Noboru Numao, Fumitaka Koga, Kazutaka Saito, Yasuhisa Fujii, Yasuyuki Sakai, Tetsuo Okuno, Chizuru Arisawa, Shigeyoshi Kamata, Katsushi Nagahama, Junji Yonese, Akira Noro, Toshihiko Tsujii, Shinji Morimoto, Satoshi Kitahara, Shuichi Goto, Yotsuo Higashi, and Kazunori Kihara Junichiro IshiokaJunichiro Ishioka Tokyo, Japan More articles by this author , Hitoshi MasudaHitoshi Masuda Tokyo, Japan More articles by this author , Yoh MatsuokaYoh Matsuoka Tokyo, Japan More articles by this author , Noboru NumaoNoboru Numao Tokyo, Japan More articles by this author , Fumitaka KogaFumitaka Koga Tokyo, Japan More articles by this author , Kazutaka SaitoKazutaka Saito Tokyo, Japan More articles by this author , Yasuhisa FujiiYasuhisa Fujii Tokyo, Japan More articles by this author , Yasuyuki SakaiYasuyuki Sakai Chiba, Japan More articles by this author , Tetsuo OkunoTetsuo Okuno Ibaraki, Japan More articles by this author , Chizuru ArisawaChizuru Arisawa Tokyo, Japan More articles by this author , Shigeyoshi KamataShigeyoshi Kamata Saitama, Japan More articles by this author , Katsushi NagahamaKatsushi Nagahama Chiba, Japan More articles by this author , Junji YoneseJunji Yonese Tokyo, Japan More articles by this author , Akira NoroAkira Noro Saitama, Japan More articles by this author , Toshihiko TsujiiToshihiko Tsujii Tokyo, Japan More articles by this author , Shinji MorimotoShinji Morimoto Ibaraki, Japan More articles by this author , Satoshi KitaharaSatoshi Kitahara Tokyo, Japan More articles by this author , Shuichi GotoShuichi Goto Hamamatsu, Japan More articles by this author , Yotsuo HigashiYotsuo Higashi Saitama, Japan More articles by this author , and Kazunori KiharaKazunori Kihara Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.243AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although the association between obesity and urological cancers has been intensively investigated following their worldwide increase, the impact of obesity on the prognosis of upper urinary tract urothelial carcinoma (UUT-UC) has not yet been fully explored. Recently, a paper from the United States reported that a higher body mass index (BMI; kg/m2) worsened the prognosis of UUT-UC, whereas a study from Japan reported that a lower BMI worsened it. This discrepancy may be a result of the different BMI distributions between the cohorts. Therefore, we investigated the association between BMI and cancer-specific survival (CSS) of UUT-UC in 1114 Japanese patients with a relatively wide range of BMIs. METHODS Of 1329 patients with UUT-UC in the Tokyo Metropolitan Database of Urologic Disease (TMDU), 1114 without distant metastasis treated by nephroureterectomy were enrolled in this study. The association between BMI and CSS was analyzed using Cox proportional hazards regression models, with a categorical representation of BMI as the predictor variable. BMI was categorized into the following three groups: Group 1 (BMI 22.5 to <25), Group 2 (BMI 25 or greater), and Group 3 (BMI <22.5). Using group 1 as the reference, in accordance with the Asia Cohort Consortium BMI project (NEJM, 2011), we estimated the hazard ratios and 95% confidence intervals for Groups 2 and 3 after adjusting the established predictors. RESULTS Median BMI was 22.5 (range: 13.5û40.6). The number of patients in Groups 1, 2, and 3 was 285 (28%), 234 (23%), and 495 (49%), respectively. There were no significant differences in clinical and pathological findings among each groups. The median follow-up period was 38 months (interquartile range: 15û73), and 213 patients (21%) died of disease. In the total cohort, the 5-year CSS rate was 74%. The 5-year CSS rates in Groups 1, 2, and 3 were 80, 72, and 71%, respectively. Both above and below the range of 22.5 to 25, BMI was an independent predictor of CSS in multivariate analysis with established prognostic factors. CONCLUSIONS This is the first study demonstrating that the impact of BMI on the prognosis of UUT-UC has a bimodal pattern. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e282 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Junichiro Ishioka Tokyo, Japan More articles by this author Hitoshi Masuda Tokyo, Japan More articles by this author Yoh Matsuoka Tokyo, Japan More articles by this author Noboru Numao Tokyo, Japan More articles by this author Fumitaka Koga Tokyo, Japan More articles by this author Kazutaka Saito Tokyo, Japan More articles by this author Yasuhisa Fujii Tokyo, Japan More articles by this author Yasuyuki Sakai Chiba, Japan More articles by this author Tetsuo Okuno Ibaraki, Japan More articles by this author Chizuru Arisawa Tokyo, Japan More articles by this author Shigeyoshi Kamata Saitama, Japan More articles by this author Katsushi Nagahama Chiba, Japan More articles by this author Junji Yonese Tokyo, Japan More articles by this author Akira Noro Saitama, Japan More articles by this author Toshihiko Tsujii Tokyo, Japan More articles by this author Shinji Morimoto Ibaraki, Japan More articles by this author Satoshi Kitahara Tokyo, Japan More articles by this author Shuichi Goto Hamamatsu, Japan More articles by this author Yotsuo Higashi Saitama, Japan More articles by this author Kazunori Kihara Tokyo, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyUrothelial Cancer: upper Tract Tumors (I)1 Apr 2013682 PRESENCE OF URETERAL TUMOR WAS ASSOCIATED WITH POOR PROGNOSIS IN UPPER URINARY TRACT UROTHELIAL CARCINOMA PATIENTS TREATED BY NEPHROURETERECTOMY: A MULTICENTER DATABASE STUDY OF 1063 PATIENTS Yuma Waseda, Kazutaka Saito, Junichiro Ishioka, Yoh Matsuoka, Noboru Numao, Fumitaka Koga, Hitoshi Masuda, Yasuhisa Fujii, Yasuyuki Sakai, Tetsuo Okuno, Chizuru Arisawa, Shigeyoshi Kamata, Katsuji Nagahama, Junji Yonese, Akira Noro, Toshihiko Tsujii, Shinji Morimoto, Yotsuo Higashi, Iwao Fukui, and Kazunori Kihara Yuma WasedaYuma Waseda Tokyo, Japan More articles by this author , Kazutaka SaitoKazutaka Saito Tokyo, Japan More articles by this author , Junichiro IshiokaJunichiro Ishioka Tokyo, Japan More articles by this author , Yoh MatsuokaYoh Matsuoka Tokyo, Japan More articles by this author , Noboru NumaoNoboru Numao Tokyo, Japan More articles by this author , Fumitaka KogaFumitaka Koga Tokyo, Japan More articles by this author , Hitoshi MasudaHitoshi Masuda Tokyo, Japan More articles by this author , Yasuhisa FujiiYasuhisa Fujii Tokyo, Japan More articles by this author , Yasuyuki SakaiYasuyuki Sakai chiba, Japan More articles by this author , Tetsuo OkunoTetsuo Okuno Ibaraki, Japan More articles by this author , Chizuru ArisawaChizuru Arisawa Tokyo, Japan More articles by this author , Shigeyoshi KamataShigeyoshi Kamata Saitama, Japan More articles by this author , Katsuji NagahamaKatsuji Nagahama chiba, Japan More articles by this author , Junji YoneseJunji Yonese Tokyo, Japan More articles by this author , Akira NoroAkira Noro Saitama, Japan More articles by this author , Toshihiko TsujiiToshihiko Tsujii Tokyo, Japan More articles by this author , Shinji MorimotoShinji Morimoto Ibaraki, Japan More articles by this author , Yotsuo HigashiYotsuo Higashi Saitama, Japan More articles by this author , Iwao FukuiIwao Fukui Tokyo, Japan More articles by this author , and Kazunori KiharaKazunori Kihara Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.238AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The prognostic significance of tumor location for patients with upper urinary tract urothelial carcinoma (UUT-UC) has been disputed. Several reports have suggested the tendency of worse prognosis of patients with a ureteral tumor as the dominant lesion. We investigated the prognostic significance of the presence of ureteral tumor regardless of dominancy to evaluate the significance of tumor location in UUT-UC patients using a multicenter database. METHODS Among 1329 UUT-UC patients in Tokyo Metropolitan Database of Urologic disease (TMDU), 1063 patients who underwent radical nephroureterectomy without concurrent radical cystectomy and whose data were complete and available were eligible for the study. Patients who had a ureteral tumor, despite the presence of renal pelvic tumor, were categorized in the ureteral tumor group. Patients with only renal pelvic tumors were categorized in the renal pelvic tumor group. Cox proportional hazards model was used to evaluate prognostic significance of each factor on cancer-specific survival (CSS). RESULTS During the follow-up period (median 38 months, interquartile range 16 to 76 months), 236 (22%) patients died of disease. The 5- and 10-year CSS rates of the total 1063 patients were 73% and 68%, respectively. The renal pelvic and the ureteral tumor groups consisted of 498 (47%) and 565 (53%) patients, respectively. The ureteral tumor group had a higher stage, grade, rate of lymphvascular invasion (LVI) and lymph node metastasis compared to the renal pelvic group. In a multivariate analysis, the presence of a ureteral tumor was a significant prognostic factor for CSS as were age, performance status, pT stage, grade, LVI and pN. The ureteral group 5-year CSS rate (67%) was worse than that of the renal pelvic tumor group (80%; p<0.001). CONCLUSIONS In our current cohort, the presence of a ureteral tumor had a significant impact on the survival of UUT-UC patients treated surgically. The presence of a ureteral tumor was associated with poor prognosis. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e280 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yuma Waseda Tokyo, Japan More articles by this author Kazutaka Saito Tokyo, Japan More articles by this author Junichiro Ishioka Tokyo, Japan More articles by this author Yoh Matsuoka Tokyo, Japan More articles by this author Noboru Numao Tokyo, Japan More articles by this author Fumitaka Koga Tokyo, Japan More articles by this author Hitoshi Masuda Tokyo, Japan More articles by this author Yasuhisa Fujii Tokyo, Japan More articles by this author Yasuyuki Sakai chiba, Japan More articles by this author Tetsuo Okuno Ibaraki, Japan More articles by this author Chizuru Arisawa Tokyo, Japan More articles by this author Shigeyoshi Kamata Saitama, Japan More articles by this author Katsuji Nagahama chiba, Japan More articles by this author Junji Yonese Tokyo, Japan More articles by this author Akira Noro Saitama, Japan More articles by this author Toshihiko Tsujii Tokyo, Japan More articles by this author Shinji Morimoto Ibaraki, Japan More articles by this author Yotsuo Higashi Saitama, Japan More articles by this author Iwao Fukui Tokyo, Japan More articles by this author Kazunori Kihara Tokyo, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...