Hidehiro Iwata1,2, Naoto Sassa3,4, Masashi Kato4, Yota Murase1,2, Shuko Seko2, Hideji Kawanishi3,5, Ryohei Hattori5, Momokazu Gotoh4, Toyonori Tsuzuki6. 1. Department of Surgical Pathology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, 480-1195, Japan. 2. Department of Pathology, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myoken-Cho, Showa-Ku, Nagoya, 466-8650, Japan. 3. Department of Urology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, 480-1195, Japan. 4. Department of Urology, Nagoya University Graduate School of Medicine, Tsuruma-Cho, Showa-Ku, Nagoya, 466-0065, Japan. 5. Department of Urology, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Douge-Cho, Nakamura-Ku, Nagoya, 453-8511, Japan. 6. Department of Surgical Pathology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, 480-1195, Japan. tsuzuki@aichi-med-u.ac.jp.
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.
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.
Entities:
Keywords:
Intravesicular recurrence; Nephroureterectomy; Urine cytology; UroVysion; Urothelial carcinoma of the upper urinary tract
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