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Progres En Urologie : Journal de... Nov 2014To describe the epidemiology, the risk and genetic factors involved in carcinogenesis pathways of upper urinary tumors UTUCs. (Review)
Review
AIM
To describe the epidemiology, the risk and genetic factors involved in carcinogenesis pathways of upper urinary tumors UTUCs.
MATERIAL
A systematic review of the scientific literature was performed from the database Medline (National Library of Medicine, PubMed) and websites of the HAS and the ANSM using the following keywords: epidemiology; risk factor; tobacco; aristolochic acid; urothelial carcinoma; ureter; renal pelvis. The search was focused on the characteristics, the mode of action, the efficiency and the side effects of the various drugs concerned.
RESULTS
The estimated UTUC incidence is 1.2 cases/100,000 inhabitant per year in Europe. The incidence of renal pelvis tumor has been stable for 30years, while the frequency of ureteric locations has increased over time. Locally advanced stage and high grade are more frequent at the time of diagnosis. The median age for diagnosis is 70-years-old. Male-to-female ratio is nearly 2. Main carcinogenic factors are tobacco consumption and occupational exposure. There are specific risk factors for UTUC such acid aristolochic (balkan's nephropathy and Chinese herbs nephropathy). Familial cases are distinct from sporadic cases. UTUCs belong to the HNPCC syndrome and they rank third in its tumor spectrum.
CONCLUSION
UTUCs are scarce tumors with specific epidemiologic characteristics. UTUCs share common risk factors with other urothelial carcinomas such as bladder tumors but have also specific risk factors that clinicians should know.
Topics: Balkan Nephropathy; Benzidines; Carcinoma, Transitional Cell; Genetic Predisposition to Disease; Humans; Hydrocarbons, Chlorinated; Incidence; Inflammation; Occupational Exposure; Polycyclic Aromatic Hydrocarbons; Prevalence; Risk Factors; Sex Distribution; Smoking; Urinary Tract Infections; Urologic Neoplasms; Urothelium
PubMed: 25158329
DOI: 10.1016/j.purol.2014.06.012 -
Progres En Urologie : Journal de... Nov 2014To propose a state of the art regarding imaging techniques for the diagnosis and work-up of upper tract urothelial carcinoma (UTUC). (Review)
Review
OBJECTIVE
To propose a state of the art regarding imaging techniques for the diagnosis and work-up of upper tract urothelial carcinoma (UTUC).
METHODS
A systematic review of the scientific literature was performed in the Medline database (PubMed) until 2014 using different associations of the following keywords: urothelial carcinomas; upper urinary tract; ureter; renal pelvis; CT scan; MRI; ultrasound; urography.
RESULTS
Imaging has a prominent role in the diagnosis, extension and follow-up assessment of upper tract urothelial cancers (UTUC). The couple ultrasound/intravenous urography made way for the multidetector computed tomography urography (MDCTU) and for the magnetic resonance imaging urography (MRU), which can also be combined in some cases. This review of the literature presents available techniques for the exploration of the upper urinary tract, the main protocols (in particular the interest of furosemide addition), details the interpretation techniques for searching UTUC on serial imaging, as well as the main differential diagnoses, and their accuracy. Finally, the role of imaging, according to patient's context is discussed. The combination or fusion of different modalities (CT, MR…) for the same objective is highlighted and presented as the likely evolution of UTUC imaging.
CONCLUSION
MDCTU is nowadays the gold standard imaging modality for the diagnosis of UTUC.
Topics: Carcinoma, Transitional Cell; Diagnosis, Differential; Diagnostic Imaging; Diuretics; Furosemide; Humans; Urologic Neoplasms; Urothelium
PubMed: 25224591
DOI: 10.1016/j.purol.2014.07.009 -
Progres En Urologie : Journal de... Nov 2014To describe the main prognostic factors with an impact on survival of patients diagnosed with upper tract urothelial carcinomas (UTUC). (Review)
Review
[Prognostic factors of upper tract urothelial carcinomas and impact on survival: a systematic review for the yearly scientific report of the French National Association of Urology].
AIM
To describe the main prognostic factors with an impact on survival of patients diagnosed with upper tract urothelial carcinomas (UTUC).
MATERIAL AND METHODS
A systematic review of the literature has been performed using Pubmed without timeline restriction with the following keywords (MeSH): urothelial carcinoma; ureter; renal pelvis; prognosis; recurrence; survival; predictive models; nomogram.
RESULTS
The level of evidence was low (3) in every available studies. There were 4 categories of prognostic factors in UTUCs: clinical (patient and tumor characteristics); surgical; pathological and molecular. The most important pre-operative prognostic factors were: size>3cm, grade (biopsy and cytology); multifocality; important hydronephrosis; co-morbidity (ASA), ECOG status, and a surgical delay of no more than 3months. After surgery, the most important prognostic factors are: stage, grade, carcinoma in situ, lymphovascular invasion and lymph node involvement. Serum markers from inflammation (CRP) could be useful for the prediction of advanced stages. Molecular markers are still under evaluation.
CONCLUSION
The identification of prognostic factors in UTUC has improved over the past years. These prognostic factors can be considered alone but also as a panel or inside predictive tools to predict accurately patient's survival.
Topics: Biomarkers, Tumor; C-Reactive Protein; Carcinoma, Transitional Cell; Humans; Hydronephrosis; Lymphatic Metastasis; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Prognosis; Time-to-Treatment; Urologic Neoplasms; Urothelium
PubMed: 25199726
DOI: 10.1016/j.purol.2014.07.013 -
Progres En Urologie : Journal de... Nov 2014Upper tract urothelial carcinomas (UTUC) are rare tumors. Pathologist have a crucial role in establishing the diagnosis and the evaluation of the prognosis of these... (Review)
Review
PURPOSE
Upper tract urothelial carcinomas (UTUC) are rare tumors. Pathologist have a crucial role in establishing the diagnosis and the evaluation of the prognosis of these tumors.
MATERIAL AND METHODS
A systematic review of the scientific literature was performed in the Medline database (PubMed) using different associations of the following key words alone or concomittantly: ureter; renal pelvis; urothelial carcinoma; specimen; pathology; histology; classification; grade; stage; prognosis. A particular search was done on the characteristics of the specimen management provided by urologists to pathologists and main prognostic specificities expected in UTUCs.
RESULTS
Urinary cytology and biopsies are useful to provide the grade of the tumor according to the WHO classification 2004. The urologist needs to depict the clinical context to the pathologist in order to eliminate differential diagnosis. The main prognostic informations provided by the pathologist from the specimen analysis are the following: stage (TNM 2009), grade (WHO 2004), carcinoma in situ, location within upper tract, multifocality, necrosis, tumor size, lymphovascular invasion, margins and potentially microsatellite status when a HNPCC case is suspected.
CONCLUSION
The pathologic analysis of a UTUC specimen needs nowadays to fulfill standardised international criteria of quality. However, specific additional aspects reported in the literature (e.g., lymphovascular invasion) are not systematically depicted.
Topics: Adenocarcinoma; Biopsy; Carcinoma, Neuroendocrine; Carcinoma, Papillary; Carcinoma, Squamous Cell; Carcinoma, Transitional Cell; Humans; Immunohistochemistry; Lymphatic Metastasis; Microsatellite Instability; Neoplasm Grading; Neoplasm Invasiveness; Neoplasm Staging; Prognosis; Urologic Neoplasms; Urothelium
PubMed: 25199727
DOI: 10.1016/j.purol.2014.07.003 -
Cancer Biology & Therapy Sep 2020Colorectal cancer (CRC) is a leading cause of cancer-related death. Epithelial-mesenchymal transition (EMT) is a major process in tumor metastasis development. This...
BACKGROUND
Colorectal cancer (CRC) is a leading cause of cancer-related death. Epithelial-mesenchymal transition (EMT) is a major process in tumor metastasis development. This systematic review aims to describe the role of long non-coding RNA (lncRNA) in EMT in CRC.
METHODS
The electronic databases, PubMed, Cochrane, and EMBASE, were searched from January1990 to June 2019 to identify studies examining lncRNA and their role in mediating EMT in CRC. Studies examining clinical specimens and/or in vitro experiments were included.
RESULTS
In 61 identified studies, 54 lncRNAs were increased in CRC compared to normal colorectal epithelium. Increased lncRNA expression was frequently associated with worse survival. Many lncRNAs mediate their effect through competitive endogenous RNA or transcription factor regulation. The ZEB1, 2/E-cadherin, Wnt/β-catenin signaling, and chromatin remodeling pathways are discussed in particular.
CONCLUSIONS
lncRNAs are major regulators of EMT and predictor adverse outcome in CRC patients. Future research must focus on delineating lncRNA function prior to potential clinical use.
Topics: Colorectal Neoplasms; Epithelial-Mesenchymal Transition; Humans; Neoplasm Metastasis; RNA, Long Noncoding
PubMed: 32730165
DOI: 10.1080/15384047.2020.1794239 -
Diagnostic and prognostic roles of CK20 in the pathology of urothelial lesions. A systematic review.Pathology, Research and Practice Jun 2019Cytokeratin 20 (CK20) is one of the most common immunohistochemical markers in the routine practice of a pathology lab, as biopsies from the urinary tract encompass a...
Cytokeratin 20 (CK20) is one of the most common immunohistochemical markers in the routine practice of a pathology lab, as biopsies from the urinary tract encompass a wide spectrum of lesions which may pose issues in their detection and classification. In this review, we aim to outline the diagnostic accuracy and prognostic value of CK20 in flat urothelial lesions, papillary non-invasive and invasive urothelial carcinoma, molecular subgroups and variant histology, and we briefly discuss its limitations and potential pitfalls.
Topics: Biomarkers, Tumor; Carcinoma, Papillary; Carcinoma, Transitional Cell; Humans; Keratin-20; Prognosis; Urinary Bladder Neoplasms; Urologic Neoplasms; Urothelium
PubMed: 30987832
DOI: 10.1016/j.prp.2019.04.005 -
Urologiia (Moscow, Russia : 1999) Jun 2017In a systematic review, to present an overview of the current situation in the field of tissue engineering of urinary bladder related to the use of cell lines... (Review)
Review
In a systematic review, to present an overview of the current situation in the field of tissue engineering of urinary bladder related to the use of cell lines pre-cultured on matrices. The selection of eligible publications was conducted according to the method described in the article Glybochko P.V. et al. "Tissue engineering of urinary bladder using acellular matrix." At the final stage, studies investigating the application of matrices with human and animal cell lines were analyzed. Contemporary approaches to using cell-based tissue engineering of the bladder were analyzed, including the formation of 3D structures from several types of cells, cell layers and genetic modification of injected cells. The most commonly used cell lines are urothelial cells, mesenchymal stem cells and fibroblasts. The safety and efficacy of any types of composite cell structures used in the cell-based bladder tissue engineering has not been proven sufficiently to warrant clinical studies of their usefulness. The results of cystoplasty of rat bladder are almost impossible to extrapolate to humans; besides, it is difficult to predict possible side effects. For the transition to clinical trials, additional studies on relevant animal models are needed.
Topics: Animals; Cell Line; Dogs; Fibroblasts; Humans; Mesenchymal Stem Cells; Models, Animal; Rats; Plastic Surgery Procedures; Tissue Engineering; Urinary Bladder; Urologic Surgical Procedures; Urothelium
PubMed: 28631918
DOI: 10.18565/urol.2017.2.116-121 -
The Journal of Urology Jun 2020We sought to assess the prognostic value of variant histology in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy. (Meta-Analysis)
Meta-Analysis
PURPOSE
We sought to assess the prognostic value of variant histology in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy.
MATERIALS AND METHODS
We searched PubMed®, Web of Science™, Cochrane Library and Scopus® databases in May 2019 according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Studies were deemed eligible if they compared overall, cancer specific and recurrence-free survival in patients with upper tract urothelial carcinoma with or without variant histology. Formal meta-analyses were performed for these outcomes.
RESULTS
We identified 32 studies with 16,052 patients, including 26 studies with 12,865 patients that were eligible for the meta-analysis. Variant histology was associated with poor outcomes in terms of cancer specific (pooled HR 2.00, 95% CI 1.57 to 2.56), overall (pooled HR 1.76, 95% CI 1.51 to 2.04) and recurrence-free survival (pooled HR 1.64, 95% CI 1.42 to 1.89). Subgroup analyses revealed that micropapillary (pooled HR 3.02, 95% CI 1.71 to 5.34), and squamous and/or glandular variant histologies (pooled HR 1.48, 95% CI 1.14 to 1.92) were also associated with poor cancer specific survival.
CONCLUSIONS
Variant histology in patients with upper tract urothelial carcinoma is associated with an increased risk of cancer specific and overall mortality and disease recurrence. Furthermore, variant histology was independently associated with cancer specific survival in the micropapillary, and squamous and/or glandular variant histology subgroups. It may be useful to incorporate variant histology into prognostic tools that help guide patients and physicians in selecting appropriate treatment strategies for upper tract urothelial carcinoma.
Topics: Carcinoma, Transitional Cell; Clinical Decision-Making; Disease-Free Survival; Feasibility Studies; Humans; Kaplan-Meier Estimate; Kidney; Kidney Neoplasms; Neoplasm Recurrence, Local; Nephroureterectomy; Patient Selection; Predictive Value of Tests; Prognosis; Ureter; Ureteral Neoplasms; Urothelium
PubMed: 31479406
DOI: 10.1097/JU.0000000000000523 -
European Journal of Cancer (Oxford,... Jul 2021Platinum-based combination chemotherapy is the standard treatment for patients with chemotherapy-eligible metastatic urothelial carcinoma (mUC). Immune-checkpoint... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Platinum-based combination chemotherapy is the standard treatment for patients with chemotherapy-eligible metastatic urothelial carcinoma (mUC). Immune-checkpoint inhibitors (ICIs) are currently assessed in this setting. This review aimed to assess the role of ICIs alone or in combination as first-line treatment in chemotherapy-eligible patients with mUC.
METHODS
Multiple databases were searched for articles published until November 2020. Studies were deemed eligible if they compared overall survival (OS), progression-free survival (PFS), objective response rates (ORRs), complete response rates (CRRs), durations of response (DORs) and adverse events (AEs) in chemotherapy-eligible patients with mUC.
RESULTS
Three studies met our eligibility criteria. ICI combination therapy was associated with significantly better OS and PFS, higher CRR and longer DOR than chemotherapy alone (hazard ratio [HR]: 0.85, 95% confidence interval [CI]: 0.76-0.94, P = 0.002; HR: 0.80, 95% CI: 0.71-0.90, P = 0.0002; odds ratio [OR]: 1.48, 95% CI: 1.12-1.96, P = 0.006; and mean difference: 1.39, 95% CI: 0.31-2.46, P = 0.01, respectively). ICI-chemotherapy combination therapy was also associated with significantly better OS and PFS, higher ORR and CRR and longer DOR than chemotherapy alone. Although OS and PFS benefits of ICI combination therapy were larger in patients with high expression of programmed death-ligand 1 (PD-L1), PD-L1 low expression patients also had a benefit; HR for OS (high PD-L1: HR 0.79 versus low PD-L1: HR 0.89) and PFS (high PD-L1: HR 0.74 versus low PD-L1: HR 0.82). ICI monotherapy was not associated with better oncological outcomes but was associated with better safety outcomes than chemotherapy alone.
CONCLUSIONS
Our analysis indicates a superior oncologic benefit to first-line ICI combination therapies in patients with chemotherapy-eligible mUC over standard chemotherapy. In contrast, ICI monotherapy was associated with favorable safety outcomes compared with chemotherapy but failed to show its superiority over chemotherapy in oncological benefits. PD-L1 status alone cannot help guide treatment decision-making. However, caution should be exercised in interpreting the conclusions drawn from this study, given that there is the heterogeneity of the population of interest, risk of bias and the nature of the studies evaluated whose data remain immature or unpublished.
Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; B7-H1 Antigen; Carcinoma; Clinical Decision-Making; Female; Humans; Immune Checkpoint Inhibitors; Male; Middle Aged; Patient Selection; Progression-Free Survival; Time Factors; Urinary Bladder Neoplasms; Urothelium
PubMed: 33962359
DOI: 10.1016/j.ejca.2021.03.049 -
Progres En Urologie : Journal de... Nov 2014Our purpose was to provide a state-of-the-art regarding the different non-surgical treatment modalities available for urologists in the modern management of upper... (Review)
Review
[Non-surgical treatment modalities available for the treatment of upper tract urothelial carcinomas: state-of-the-art review for the yearly scientific report of the French National Association of Urology].
INTRODUCTION
Our purpose was to provide a state-of-the-art regarding the different non-surgical treatment modalities available for urologists in the modern management of upper urinary tract carcinoma (UTUC).
MATERIALS AND METHODS
A systematic review of the literature was carried out on Medline and Embase databases: urinary tract; urothelial carcinoma; ureteral cancer; renal pelvis cancer; chemotherapy; radiotherapy; instillation.
RESULTS
The medical treatment of UTUC is based on the extrapolation of data coming from bladder cancer studies. It is based on instillation of topical agents in the upper tract, chemotherapy or radiotherapy. However, the fact that UTUCs are scarce and the lack of randomized prospective trials do not provide definitive conclusions on the impact of these treatments.
CONCLUSION
The optimal medical management of UTUC is mostly based on expert's opinion so far in combination with the surgical treatment. The international collaborations for UTUC that have been developed in recent years should provide concrete answers in the near future.
Topics: Administration, Intravesical; Antineoplastic Agents; BCG Vaccine; Carcinoma, Transitional Cell; Combined Modality Therapy; Humans; Urologic Neoplasms; Urothelium
PubMed: 25208728
DOI: 10.1016/j.purol.2014.07.002