Clinical Characteristics and Current Status of Treatment for Recurrent Bladder Cancer after Surgeries on Upper Tract Urothelial Carcinoma
Abstract
:1. Clonogenic Correlation and Tumor Implantation Theory
2. Comparison of the Characteristics of Recurrent and Primary BC
3. Risk Factors Affecting Recurrent BC
3.1. Patient-Specific Factors
3.1.1. Damaged eGFR
3.1.2. Venerable Age
3.1.3. Gender Difference
3.1.4. Smoking
3.1.5. Diabetes Mellitus with Poor Glycemic Control
3.1.6. Monocyte-to-Lymphocyte Ratio (MLR)
3.1.7. Neutrophil-to-Lymphocyte Ratio (NLR)
3.2. Tumor-Specific Factors
3.2.1. Multifocality of Upper Urinary Tract Tumors
3.2.2. Size of UTUC
3.2.3. Distal Ureteral Position
3.2.4. Lymph Node Involvement
3.2.5. Invasive pT Staging
3.2.6. Papillary Structure of Tumors
3.2.7. Extensive Tumor Necrosis
3.2.8. Concomitant Carcinoma In Situ (CIS)
3.3. Treatment-Specific Factors
3.3.1. Incomplete Excision
3.3.2. Immature Laparoscopic Technique
3.3.3. Surgery Time
3.3.4. Early Ureteral Ligation
3.3.5. Ureteroscopy
3.4. Molecular-Specific Factors
3.4.1. E-Calmodulin
3.4.2. Forkhead Box O3A
3.4.3. HER2
4. Current Treatment Measures for UTUC-BC
4.1. Prevention
4.1.1. Surgical Techniques
4.1.2. Intravesical Treatment
4.2. Monitoring during the Follow-Up
- Screening for smoking: Smoking is one of the risk factors for recurrence, as mentioned earlier. Crivelli JJ et al. analyzed six studies, estimating the effect of smoking for patients with UTUC after receiving RNU. Most of the studies were found a statistically significant relationship between smoking and IVR. The studies also found that smoking is associated with cancer-specific mortality for patients with UTUC-BC [31], so screening for smoking is also essential.
- Imaging: Computed tomography (CT) and intravenous urography of the bladder and ureter should be performed at least once a year. If necessary, MRI should also be added into the monitoring plan.
- Endoscopy: patients with UTUC must undergo endoscopic surveillance after RNU, and the surveillance program lasts for at least 5 years, with flexible cystoscopy recommended for the surveillance of male patients [14].
- Molecular biomarkers: Various molecular biomarkers can be used to help detect recurrent bladder cancer: e.g., tumor factors, UroVysion, and BTA tests. Using Kaplan–Meier analysis, Guan B et al. showed that UTUC patients with positive UroVysion results were more likely to develop IVR during the follow-up (p = 0.077). These data suggest that the urinary UroVysion test may be a powerful tool for predicting the risk of IVR in patients with UTUC [105]. Walsh et al. performed a study to evaluate the effectiveness of the BTA test in patients with UTUC and found that the sensitivity of the BTA was 82% and the specificity was 89%, which were significantly better than those of the urinalysis in the same group of patients (11% and 54%, respectively) [106]. However, the study conducted by Białek Ł et al. found moderate diagnostic accuracy when they were detecting bladder cancer for patients with UTUC by BTA [107]. Therefore, more evidence is needed for BTA to detect the occurrence of IVR in patients with UTUC. Tumor factors such as E-calmodulin and FGFR3 in molecular-specific factors have been shown to correlate with IVR, so these indicators can also be evaluated during the follow-up period.
4.3. Treatment
4.3.1. TUR-BT
4.3.2. En Bloc Resection of Bladder Tumor (ERBT)
4.3.3. Secondary Resection
4.3.4. Intravesical Chemotherapy
4.3.5. Photodynamic Diagnosis (PDD) and Radical Cystectomy (RC)
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Categories | Risk Factors | Reference |
---|---|---|
Patient specific factors | Damaged eGFR | Kuroda K et al. [20] Xylinas E et al. [21] Rasool M et al. [22] Chowdhury R et al. [23] |
Venerable age | Xylinas E et al. [15] Chromecki TF et al. [24] Shariat SF et al. [25] | |
Gender difference | Chien TM et al. [26] Chen CH et al. [27] Xylinas E et al. [15] Ploussard G et al. [28] Seisen T et al. [29] | |
Smoking | Xylinas E et al. [15] Xylinas E et al. [30] Crivelli JJ et al. [31] Ehdaie B et al. [32] | |
Diabetes mellitus with poor glycemic control | Tai YS et al. [33] Gao X et al. [34] Duan W et al. [35] | |
Monocyte-to-lymphocyte ratio (MLR) | Liu J et al. [36] Zhang XK et al. [37] | |
Neutrophil-to-lymphocyte ratio (NLR) | Mathieu R et al. [38] De Larco JE et al. [39] Vartolomei MD et al. [40] Vartolomei MD et al. [41] | |
Tumor specific factors | Multifocality of upper urinary tract tumors | Milojevic B et al. [42] Chen CS et al. [43] Sheu ZL et al. [44] Chromecki TF et al. [45] |
Size of upper urinary tract tumor | Kauffman EC et al. [46] Shibing Y et al. [47] Espiritu PN et al. [48] Su X et al. [49] | |
Distal ureteral position | Tanaka N et al. [16] Xylinas E et al. [15] Seisen T et al. [29] Wu Y et al. [50] | |
Lymph node involvement | Arancibia MF et al. [51] Xylinas E et al. [15] Roscigno M et al. [52] Novara G et al. [53] Verhoest G et al. [54] Peyrottes A et al. [55] | |
Invasive pT staging | Seisen T et al. [29] Verhoest G et al. [54] Li YR et al. [56] | |
papillary structure of tumors | Remzi M et al. [57] Fritsche HM et al. [58] Ishioka J et al. [59] | |
Extensive tumor necrosis | Seisen T et al. [29] Zigeuner R et al. [60] Simone G et al. [61] Zhang L et al. [62] | |
Concomitant carcinoma in situ (CIS) | Wheat JC et al. [63] Roscigno M et al. [64] Otto W et al. [5] | |
Treatment specific factors | Incomplete excision | Kauffman EC et al. [46] Zou L et al. [65] Chung JH et al. [66] Seisen T et al. [29] |
Immature laparoscopic technique | Favaretto RL et al. [67] Piszczek R et al. [68] Seisen T et al. [29] Shigeta K et al. [69] | |
Surgery time | Yanagi M et al. [70] Shigeta K et al. [71] | |
Early ureteral ligation | Yamashita S et al. [72] Chen MK et al. [73] | |
Ureteroscopy | Sung HH et al. [74] Li YR et al. [56] Yoo S et al. [75] Loizzo D et al. [76] Ha JS et al. [77] | |
Molecular specific factors | E-calmodulin | E- Inoue K et al. [78] |
FOXO3A | Zhang G et al. [79] Li J et al. [80] | |
HER2 | Sasaki Y et al. [81] Soria F et al. [82] |
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Hu, X.; Xue, Y.; Zhu, G. Clinical Characteristics and Current Status of Treatment for Recurrent Bladder Cancer after Surgeries on Upper Tract Urothelial Carcinoma. Diagnostics 2023, 13, 1004. https://doi.org/10.3390/diagnostics13051004
Hu X, Xue Y, Zhu G. Clinical Characteristics and Current Status of Treatment for Recurrent Bladder Cancer after Surgeries on Upper Tract Urothelial Carcinoma. Diagnostics. 2023; 13(5):1004. https://doi.org/10.3390/diagnostics13051004
Chicago/Turabian StyleHu, **nfeng, Yufan Xue, and Guodong Zhu. 2023. "Clinical Characteristics and Current Status of Treatment for Recurrent Bladder Cancer after Surgeries on Upper Tract Urothelial Carcinoma" Diagnostics 13, no. 5: 1004. https://doi.org/10.3390/diagnostics13051004