Cancer Research and Treatment

Original Articles

Genitourinary cancer

Invasiveness of Upper Tract Urothelial Carcinoma: Clinical Significance and Integrative Diagnostic Strategy: Bokyung Ahn, Doeun Kim, Kye Jin Park, Ja-Min Park, Sun Young Yoon, Bumsik Hong, Yong Mee Cho, Deokhoon Kim; Cancer Res Treat. 2024;56(3):856-870. Published online December 18, 2023; DOI: https://doi.org/10.4143/crt.2023.1150

Abstract PDF Supplementary Material PubReader ePub

Purpose
In this study, we aimed to determine the clinicopathologic, radiologic, and molecular significance of the tumor invasiveness to further stratify the patients with high-grade (HG) upper tract urothelial carcinoma (UTUC) who can be treated less aggressively.
Materials and Methods
Clinicopathologic and radiologic characteristics of 166 surgically resected HG UTUC (48 noninvasive, and 118 invasive) cases were evaluated. Six noninvasive UTUC cases with intratumoral tumor grade heterogeneity were selected for whole-exome sequencing (WES) to understand the underlying molecular pathophysiology. Barcode-tagging sequencing was done for validation of the target genes from WES data.
Results
Patients with noninvasive UTUC showed no cancer-specific death with better cancer-specific survival (p < 0.001) and recurrence-free survival (p < 0.001) compared to the patients with invasive UTUC. Compared to the invasive UTUC, noninvasive UTUC was correlated to a low grade (LG) on the preoperative abdominal computed tomography (CT) grading system (p < 0.001), histologic intratumoral tumor grade heterogeneity (p=0.018), discrepancy in preoperative urine cytology diagnosis (p=0.018), and absence of urothelial carcinoma in situ (p < 0.001). WES of the heterogeneous components showed mutually shared HRAS and FGFR3 mutations shared between the HG and LG components. HRAS mutation was associated with the lower grade on preoperative abdominal CT and intratumoral tumor grade heterogeneity (p=0.045 and p < 0.001, respectively), whereas FGFR3 mutation was correlated to the absence of carcinoma in situ (p < 0.001).
Conclusion
According to our comprehensive analysis, HG noninvasive UTUC can be preoperatively suspected based on distinct preoperative radiologic, cytologic, histologic, and molecular features. Noninvasive HG UTUC shows excellent prognosis and thus should be treated less aggressively.

Citations

Citations to this article as recorded by

Papillary renal neoplasm with reverse polarity shows benign behavior: Results from a 77-case clinicopathological and molecular study
Yong Il Lee, Ja-Min Park, Sun Young Yoon, Cheryn Song, Yong Mee Cho
Annals of Diagnostic Pathology.2026; 80: 152498. CrossRef
Diagnostic accuracy of upper tract urothelial carcinoma using biopsy, urinary cytology, and nephroureterectomy specimens: A tertiary cancer center experience
Jianping Zhao, Yuan Shen, Ming Guo, Surena F Matin, Donna E Hansel, Charles C Guo
American Journal of Clinical Pathology.2024;[Epub] CrossRef
Clinical Significance of Tumor Location for Ureteroscopic Tumor Grading in Upper Tract Urothelial Carcinoma
Satoshi Katayama, Benjamin Pradere, Nico C. Grossman, Aaron M. Potretzke, Stephen A. Boorjian, Alireza Ghoreifi, Siamak Daneshmand, Hooman Djaladat, John P. Sfakianos, Andrea Mari, Zine-Eddine Khene, David D’andrea, Nozomi Hayakawa, Kazutoshi Fujita, Axel
Journal of Endourology.2024; 38(11): 1156. CrossRef
Development and validation of a radiomics-based nomogram for predicting pathological grade of upper urinary tract urothelial carcinoma
Yanghuang Zheng, Hongjin Shi, Shi Fu, Haifeng Wang, Xin Li, Zhi Li, Bing Hai, Jinsong Zhang
BMC Cancer.2024;[Epub] CrossRef

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The Prognosis and the Role of Adjuvant Chemotherapy for Node-Positive Bladder Cancer Treated with Neoadjuvant Chemotherapy Followed by Surgery: Hyehyun Jeong, Kye Jin Park, Yongjune Lee, Hyung-Don Kim, Jwa Hoon Kim, Shinkyo Yoon, Bumsik Hong, Jae Lyun Lee; Cancer Res Treat. 2022;54(1):226-233. Published online May 6, 2021; DOI: https://doi.org/10.4143/crt.2021.365

Abstract PDF Supplementary Material PubReader ePub

Purpose
This study aims to evaluate the prognosis of pathologically node-positive bladder cancer after neoadjuvant chemotherapy, the role of adjuvant chemotherapy in these patients, and the value of preoperative clinical evaluation for lymph node metastases.
Materials and Methods
Patients who received neoadjuvant chemotherapy followed by partial/radical cystectomy and had pathologically confirmed lymph node metastases between January 2007 and December 2019 were identified and analyzed.
Results
A total of 53 patients were included in the study. The median age was 61 years (range, 34 to 81 years) with males comprising 86.8%. Among the 52 patients with post-neoadjuvant/pre-operative computed tomography results, only 33 patients (63.5%) were considered positive for lymph node metastasis. Sixteen patients (30.2%) received adjuvant chemotherapy (AC group), and 37 patients did not (no AC group). With the median follow-up duration of 67.7 months, the median recurrence-free survival (RFS) and the median overall survival (OS) was 8.5 months and 16.2 months, respectively. The 2-year RFS and OS rates were 23.3% and 34.6%, respectively. RFS and OS did not differ between the AC group and no AC group (median RFS, 8.8 months vs. 6.8 months, p=0.772; median OS, 16.1 months vs. 16.3 months, p=0.479). Thirty-eight patients (71.7%) experienced recurrence. Distant metastases were the dominant pattern of failure in both the AC group (91.7%) and no AC group (76.9%).
Conclusion
Patients with lymph node-positive disease after neoadjuvant chemotherapy followed by surgery showed high recurrence rates with limited survival outcomes. Little benefit was observed with the addition of adjuvant chemotherapy.

Citations

Citations to this article as recorded by

A Predictive Nomogram for Development of Lymph Node Metastasis in Muscle-Invasive Bladder Cancer Following Neoadjuvant Therapy
Garrett K. Harada, Steven N. Seyedin, Olivia Heutlinger, Armon Azizi, Audree Hsu, Arash Rezazadeh, Michael Daneshvar, Greg E. Gin, Edward M. Uchio, Giovanna A. Giannico, Jeremy P. Harris, Aaron B. Simon, Jeffrey V. Kuo, Nataliya Mar
Advances in Radiation Oncology.2025; 10(1): 101671. CrossRef
Resultados oncológicos de pacientes con afectación ganglionar tras quimioterapia neoadyuvante y cistectomía radical para el cáncer de vejiga músculo-invasivo: estudio observacional multicéntrico del Grupo de Trabajo de Carcinoma Urotelial de la sección de
G. Marcq, W. Kassouf, M. Roumiguié, B. Pradere, L.S. Mertens, S. Albisinni, A. Cimadamore, J. Yuen-Chun Teoh, M. Moschini, E. Laukhtina, A. Mari, F. Soria, A. Gallioli, F. del Giudice, D. d’Andrea, W. Krajewski, J.B. Beauval, E. Xylinas, D. Pouessel, P. S
Actas Urológicas Españolas.2025; 49(2): 501701. CrossRef
Oncological outcomes of patients with node positive disease following neoadjuvant chemotherapy and radical cystectomy for muscle-invasive bladder cancer: A multicenter observational study of the EAU Young Academic Urologists (YAU) urothelial carcinoma wor
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Actas Urológicas Españolas (English Edition).2025; 49(2): 501701. CrossRef
Differential Outcomes in Bladder Cancer After Neoadjuvant Chemotherapy: An International Multi-Institutional Study Comparing Isolated Nodal Disease vs Persistent Muscle-Invasive Disease
Andres M. Acosta, Mohammed Saad, Alcides Chaux, Jennifer B. Gordetsky, Lan Zheng, Charles Guo, Mohamed Bikhet, Adeboye O. Osunkoya, Katrina Collins, Muhammad T. Idrees, Geert J.L.H. van Leenders, Pilar Gonzalez-Peramato, Kristine M. Cornejo, Michelle S. H
Urology.2025; 200: 127. CrossRef
Demonstrating the non-inferiority of robotic radical cystectomy for cT3–cT4 urothelial carcinoma in the era of neoadjuvant chemotherapy: a propensity score-matched analysis
Il Woo Park, Tae Il Noh, Seok Ho Kang, Jong Jin Oh, Seung Hwan Jeong, Won Sik Ham, Jieun Heo, Hyun Hwan Sung, Byong Chang Jeong, Geehyun Song, Ho Kyung Seo, Kyung Hwan Kim, Jong Kil Nam, Wook Nam, Yun-Sok Ha, Joongwon Choi, Wan Song, Bumjin Lim
Journal of Robotic Surgery.2025;[Epub] CrossRef
Influence of Neoadjuvant Chemotherapy on Survival Outcomes of Radical Cystectomy in Pathologically Proven Positive and Negative Lymph Nodes
Krystian Kaczmarek, Bartosz Małkiewicz, Karolina Skonieczna-Żydecka, Artur Lemiński
Cancers.2023; 15(19): 4901. CrossRef
Comparison of responses to neoadjuvant and adjuvant chemotherapies in muscle-invasive bladder cancer
Serhat Sekmek, Gökhan Ucar, Irfan Karahan, Dogan Bayram, Selin Aktürk Esen, Ismet Seven, Mehmet Ali Nahit Sendur, Dogan Uncu
African Journal of Urology.2023;[Epub] CrossRef

9,441 View
197 Download
6 Web of Science
7 Crossref

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