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Urinary Bladder Neoplasms: HELP
Articles by Richard Zigeuner
Based on 11 articles published since 2009
(Why 11 articles?)
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Between 2009 and 2019, Richard Zigeuner wrote the following 11 articles about Urinary Bladder Neoplasms.
 
+ Citations + Abstracts
1 Guideline Indication for a Single Postoperative Instillation of Chemotherapy in Non-muscle-invasive Bladder Cancer: What Factors Should Be Considered? 2018

Babjuk, Marko / Burger, Maximilian / Compérat, Eva M / Gontero, Paolo / Mostafid, Hugh A / Palou, Joan / van Rhijn, Bas W G / Rouprêt, Morgan / Shariat, Shahrokh F / Sylvester, Richard / Zigeuner, Richard / Capoun, Otakar / Cohen, Daniel / Dominguez-Escrig, José L / Hernández, Virginia / Peyronnet, Benoit / Seisen, Thomas / Soukup, Viktor / Anonymous1751121. ·Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Praha, Czech Republic; Medical University of Vienna, Vienna General Hospital, Vienna, Austria. Electronic address: marek.babjuk@fnmotol.cz. · Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany. · Department of Pathology, Hôpital Tenon, AP-HP, Sorbonne University, Paris, France. · Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy. · Department of Urology, Royal Surrey County Hospital, Guildford, UK. · Department of Urology, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain. · Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. · Department of Urology, Hôpital La Pitié-Salpétrière, AP-HP, Sorbonne University, Paris, France. · Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Praha, Czech Republic; Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Weill Cornell Medical College, New York, NY, USA. · European Association of Urology Guidelines Office, Brussels, Belgium. · Department of Urology, Medical University of Graz, Graz, Austria. · Department of Urology, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic. · Department of Surgery and Cancer, Imperial College London, London, UK; Department of Urology, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK. · Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain. · Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain. · Service d'Urologie, CHU de Rennes, Rennes, France. ·Eur Urol Focus · Pubmed #30061076.

ABSTRACT: An early single instillation of intravesical chemotherapy (SICI) used immediately after transurethral resection of the bladder (TURB) can significantly reduce the recurrence rate in selected patients with non-muscle-invasive bladder cancer (NMIBC). SICI should be used in patients with low-risk and with selected intermediate-risk tumours, in particular for multiple primary small papillary tumours, single primary papillary tumours >3cm, and single recurrent papillary tumours recurring >1yr after the previous resection. The available data do not support any recommendation to reduce the role of SICI in patients after fluorescence cystoscopy-guided TURB or en bloc TURB. SICI can even provide some benefit in patients with intermediate-risk tumours subsequently treated with further instillations. During instillation, contraindications should be taken into account and safety measures should be applied. PATIENT SUMMARY: An early single instillation of intravesical chemotherapy immediately after transurethral resection of the bladder can significantly reduce the recurrence rate in selected patients with non-muscle-invasive bladder cancer. It should be used in patients with low-risk and selected intermediate-risk tumours.

2 Guideline European Association of Urology Guidelines on Upper Urinary Tract Urothelial Cell Carcinoma: 2015 Update. 2015

Rouprêt, Morgan / Babjuk, Marko / Compérat, Eva / Zigeuner, Richard / Sylvester, Richard J / Burger, Maximilian / Cowan, Nigel C / Böhle, Andreas / Van Rhijn, Bas W G / Kaasinen, Eero / Palou, Joan / Shariat, Shahrokh F. ·Department of Urology, Hospital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie, Institut Universitaire de Cancérologie, Paris, France. Electronic address: morgan.roupret@aphp.fr. · Department of Urology, Hospital Motol and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic. · Department of Pathology, Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie, Institut Universitaire de Cancérologie, Paris, France. · Department of Urology, Medizinische Universität Graz, Graz, Austria. · EAU Guidelines Office Board, European Association of Urology, The Netherlands. · Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany. · Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK. · Helios Agnes Karll Krankenhaus, Schwartau, Germany. · Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. · Department of Surgery, Hyvinkää Hospital, Hyvinkää, Finland. · Department of Urology, Universitat Autònoma de Barcelona-Fundació Puigvert, Barcelona, Spain. · Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Weill Medical College of Cornell University, New York, NY, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. ·Eur Urol · Pubmed #26188393.

ABSTRACT: CONTEXT: The European Association of Urology (EAU) guidelines panel on upper urinary tract urothelial cell carcinoma (UTUC) has prepared updated guidelines to aid clinicians in the current evidence-based management of UTUC and to incorporate recommendations into clinical practice. OBJECTIVE: To provide a brief overview of the EAU guidelines on UTUC as an aid to clinicians. EVIDENCE ACQUISITION: The recommendations provided in the current guidelines are based on a thorough review of available UTUC guidelines and articles identified following a systematic search of Medline. Data on urothelial malignancies and UTUC were searched using these keywords: urinary tract cancer; urothelial carcinomas; upper urinary tract, carcinoma; renal pelvis; ureter; bladder cancer; chemotherapy; nephroureterectomy; adjuvant treatment; instillation; neoadjuvant treatment; recurrence; risk factors; and survival. References were weighted by a panel of experts. EVIDENCE SYNTHESIS: Due to the rarity of UTUC, there are insufficient data to provide strong recommendations (ie, grade A). However, the results of recent multicentre studies are now available, and there is a growing interest in UTUC. The 2009 TNM classification is recommended. Recommendations are given for diagnosis and risk stratification as well as radical and conservative treatment, and prognostic factors are discussed. A single postoperative dose of intravesical mitomycin after nephroureterectomy reduces the risk of bladder tumour recurrence. Recommendations are also provided for patient follow-up after different therapeutic strategies. CONCLUSIONS: These guidelines contain information on the management of individual patients according to a current standardised approach. Urologists should take into account the specific clinical characteristics of each patient when determining the optimal treatment regimen, based on the proposed risk stratification of these tumours. PATIENT SUMMARY: Urothelial carcinoma of the upper urinary tract is rare, but because 60% of these tumours are invasive at diagnosis, an appropriate diagnosis is most important. A number of known risk factors exist.

3 Guideline EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013. 2013

Babjuk, Marko / Burger, Maximilian / Zigeuner, Richard / Shariat, Shahrokh F / van Rhijn, Bas W G / Compérat, Eva / Sylvester, Richard J / Kaasinen, Eero / Böhle, Andreas / Palou Redorta, Joan / Rouprêt, Morgan / Anonymous1300763. ·Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Prague, Czech Republic. marek.babjuk@lfmotol.cuni.cz ·Eur Urol · Pubmed #23827737.

ABSTRACT: CONTEXT: The first European Association of Urology (EAU) guidelines on bladder cancer were published in 2002 [1]. Since then, the guidelines have been continuously updated. OBJECTIVE: To present the 2013 EAU guidelines on non-muscle-invasive bladder cancer (NMIBC). EVIDENCE ACQUISITION: Literature published between 2010 and 2012 on the diagnosis and treatment of NMIBC was systematically reviewed. Previous guidelines were updated, and the levels of evidence and grades of recommendation were assigned. EVIDENCE SYNTHESIS: Tumours staged as Ta, T1, or carcinoma in situ (CIS) are grouped as NMIBC. Diagnosis depends on cystoscopy and histologic evaluation of the tissue obtained by transurethral resection (TUR) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TUR is essential for the patient's prognosis. Where the initial resection is incomplete, where there is no muscle in the specimen, or where a high-grade or T1 tumour is detected, a second TUR should be performed within 2-6 wk. The risks of both recurrence and progression may be estimated for individual patients using the EORTC scoring system and risk tables. The stratification of patients into low-, intermediate-, and high-risk groups is pivotal to recommending adjuvant treatment. For patients with a low-risk tumour, one immediate instillation of chemotherapy is recommended. Patients with an intermediate-risk tumour should receive one immediate instillation of chemotherapy followed by 1 yr of full-dose bacillus Calmette-Guérin (BCG) intravesical immunotherapy or by further instillations of chemotherapy for a maximum of 1 yr. In patients with high-risk tumours, full-dose intravesical BCG for 1-3 yr is indicated. In patients at highest risk of tumour progression, immediate radical cystectomy should be considered. Cystectomy is recommended in BCG-refractory tumours. The long version of the guidelines is available from the EAU Web site: http://www.uroweb.org/guidelines/. CONCLUSIONS: These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice. PATIENT SUMMARY: The EAU Panel on Non-muscle Invasive Bladder Cancer released an updated version of their guidelines. Current clinical studies support patient selection into different risk groups; low, intermediate and high risk. These risk groups indicate the likelihood of the development of a new (recurrent) cancer after initial treatment (endoscopic resection) or progression to more aggressive (muscle-invasive) bladder cancer and are most important for the decision to provide chemo- or immunotherapy (bladder installations). Surgical removal of the bladder (radical cystectomy) should only be considered in patients who have failed chemo- or immunotherapy, or who are in the highest risk group for progression.

4 Review Prognostic Performance and Reproducibility of the 1973 and 2004/2016 World Health Organization Grading Classification Systems in Non-muscle-invasive Bladder Cancer: A European Association of Urology Non-muscle Invasive Bladder Cancer Guidelines Panel Systematic Review. 2017

Soukup, Viktor / Čapoun, Otakar / Cohen, Daniel / Hernández, Virginia / Babjuk, Marek / Burger, Max / Compérat, Eva / Gontero, Paolo / Lam, Thomas / MacLennan, Steven / Mostafid, A Hugh / Palou, Joan / van Rhijn, Bas W G / Rouprêt, Morgan / Shariat, Shahrokh F / Sylvester, Richard / Yuan, Yuhong / Zigeuner, Richard. ·Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University in Praha, Praha, Czech Republic. Electronic address: viktor.soukup@seznam.cz. · Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University in Praha, Praha, Czech Republic. Electronic address: otakar.capoun@seznam.cz. · Department of Urology, Royal Free London NHS Foundation Trust, London, UK. · Department of Urology, Hospital Universitario Fundación de Alcorcón, Madrid, Spain. · Hospital Motol and Second Faculty of Medicine, Charles University, Department of Urology, Prague, Czech Republic. · Department of Urology, Caritas-St. Josef Medical Center, University of Regensburg, Germany. · Department of Pathology, Hôpitaux Universitaires de l'Est-Parisien HUEP, Assistance Publique Faculty of Medicine Pierre et Marie Curie, Institut Universitaire de Cancerologie GRC5, University Paris 6, Paris, France. · Department of Surgical Sciences, Urology, University of Turin, Turin, Italy. · Academic Urology Unit, University of Aberdeen, Scotland, UK; Department of Urology, Aberdeen Royal, 12 Infirmary, Aberdeen, Scotland. · Academic Urology Unit, University of Aberdeen, Scotland, UK. · Department of Urology, Royal Surrey County Hospital, Guildford, UK. · Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain. · Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. · Department of Urology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hopitaux de Paris, Faculty of Medicine Pierre et Marie Curie, Institut Universitaire de Cancérologie GRC5, University Paris 6, Paris, France. · Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria. · EAU Guidelines Office Board, European Association of Urology, The Netherlands. · Department of Medicine, Health Science Centre, McMaster University, Hamilton, Ontario, Canada. · Department of Urology, Medizinische Universität Graz, Graz, Austria. ·Eur Urol · Pubmed #28457661.

ABSTRACT: CONTEXT: Tumour grade is an important prognostic indicator in non-muscle-invasive bladder cancer (NMIBC). Histopathological classifications are limited by interobserver variability (reproducibility), which may have prognostic implications. European Association of Urology NMIBC guidelines suggest concurrent use of both 1973 and 2004/2016 World Health Organization (WHO) classifications. OBJECTIVE: To compare the prognostic performance and reproducibility of the 1973 and 2004/2016 WHO grading systems for NMIBC. EVIDENCE ACQUISITION: A systematic literature search was undertaken incorporating Medline, Embase, and the Cochrane Library. Studies were critically appraised for risk of bias (QUIPS). For prognosis, the primary outcome was progression to muscle-invasive or metastatic disease. Secondary outcomes were disease recurrence, and overall and cancer-specific survival. For reproducibility, the primary outcome was interobserver variability between pathologists. Secondary outcome was intraobserver variability (repeatability) by the same pathologist. EVIDENCE SYNTHESIS: Of 3593 articles identified, 20 were included in the prognostic review; three were eligible for the reproducibility review. Increasing tumour grade in both classifications was associated with higher disease progression and recurrence rates. Progression rates in grade 1 patients were similar to those in low-grade patients; progression rates in grade 3 patients were higher than those in high-grade patients. Survival data were limited. Reproducibility of the 2004/2016 system was marginally better than that of the 1973 system. Two studies on repeatability showed conflicting results. Most studies had a moderate to high risk of bias. CONCLUSIONS: Current grading classifications in NMIBC are suboptimal. The 1973 system identifies more aggressive tumours. Intra- and interobserver variability was slightly less in the 2004/2016 classification. We could not confirm that the 2004/2016 classification outperforms the 1973 classification in prediction of recurrence and progression. PATIENT SUMMARY: This article summarises the utility of two different grading systems for non-muscle-invasive bladder cancer. Both systems predict progression and recurrence, although pathologists vary in their reporting; suggestions for further improvements are made.

5 Review Bladder cancer in 2016: News in diagnosis, treatment, and risk group assessment. 2017

Zigeuner, Richard. ·Department of Urology, Medical University of Graz, Auenbruggerplatz 5/6, A-8036 Graz, Austria. ·Nat Rev Urol · Pubmed #28050015.

ABSTRACT: -- No abstract --

6 Review Lymphadenectomy at the time of nephroureterectomy for upper tract urothelial cancer. 2011

Roscigno, Marco / Brausi, Maurizio / Heidenreich, Axel / Lotan, Yair / Margulis, Vitaly / Shariat, Shahrokh F / Van Poppel, Hendrik / Zigeuner, Richard. ·Department of Urology, Ospedali Riuniti di Bergamo, Bergamo, Italy. roscigno.marco@gmail.com ·Eur Urol · Pubmed #21798659.

ABSTRACT: CONTEXT: The role of lymph node dissection (LND) in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial cancer (UTUC) is still controversial. OBJECTIVE: To analyze the impact of lymph node invasion on the outcome of patients, the staging, and the possible therapeutic role of LND in UTUC. EVIDENCE ACQUISITION: A Medline search was conducted to identify original articles, review articles, and editorials addressing the role of LND in UTUC. Keywords included upper tract urothelial neoplasms, lymphadenectomy, lymph node excision, lymphatic metastases, nephroureterectomy, imaging, and survival. EVIDENCE SYNTHESIS: Regional nodes are frequently involved in UTUC and represent the most common metastatic site. Regional nodal status is a significant predictor of patient outcomes, especially in invasive disease. Therefore, select patients treated with RNU at high risk for regional nodal metastases should undergo LND to improve disease staging, which would identify those who could benefit from adjuvant systemic therapy. Several retrospective studies suggested the potential therapeutic role of LND in UTUC. An accurate LND could remove some nodal micrometastases not identified on routine pathologic examination, thus improving local control and cancer-specific survival. Radical surgery and LND might be curative in a subpopulation with limited nodal disease, as described in bladder cancer. A clear knowledge of the limits of LND and a template of LND for UTUC are still needed. CONCLUSIONS: An extended LND can provide better disease staging and may be curative in patients with limited nodal disease. However, current evidence is based on retrospective studies, which limits the ability to standardize either the indication or the extent of LND. Prospective trials are required to determine the impact of LND on survival in patients with UTUC and identify patients for a risk-adapted approach such as close follow-up or adjuvant chemotherapy.

7 Article EAU Guidelines on Non-Muscle-invasive Urothelial Carcinoma of the Bladder: Update 2016. 2017

Babjuk, Marko / Böhle, Andreas / Burger, Maximilian / Capoun, Otakar / Cohen, Daniel / Compérat, Eva M / Hernández, Virginia / Kaasinen, Eero / Palou, Joan / Rouprêt, Morgan / van Rhijn, Bas W G / Shariat, Shahrokh F / Soukup, Viktor / Sylvester, Richard J / Zigeuner, Richard. ·Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Praha, Czech Republic. Electronic address: marek.babjuk@lfmotol.cuni.cz. · Department of Urology, HELIOS Agnes-Karll-Krankenhaus, Bad Schwartau, Germany. · Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany. · Department of Urology, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic. · Department of Surgery and Cancer, Imperial College London, UK; Department of Urology, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK. · Department of Pathology, Hôpital La Pitié-Salpétrière, UPMC, Paris, France. · Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain. · Department of Urology, Hyvinkää Hospital, Hyvinkää, Finland. · Department of Urology, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain. · AP-HP, Hôpital La Pitié-Salpétrière, Service d'Urologie, Paris, France; UPMC University Paris 06, GRC5, ONCOTYPE-Uro, Institut Universitaire de Cancérologie, Paris, France. · Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. · Medical University of Vienna, Vienna General Hospital, Vienna, Austria. · European Association of Urology Guidelines Office, Brussels, Belgium. · Department of Urology, Medical University of Graz, Graz, Austria. ·Eur Urol · Pubmed #27324428.

ABSTRACT: CONTEXT: The European Association of Urology (EAU) panel on Non-muscle-invasive Bladder Cancer (NMIBC) released an updated version of the guidelines on Non-muscle-invasive Bladder Cancer. OBJECTIVE: To present the 2016 EAU guidelines on NMIBC. EVIDENCE ACQUISITION: A broad and comprehensive scoping exercise covering all areas of the NMIBC guidelines published between April 1, 2014, and May 31, 2015, was performed. Databases covered by the search included Medline, Embase, and the Cochrane Libraries. Previous guidelines were updated, and levels of evidence and grades of recommendation were assigned. EVIDENCE SYNTHESIS: Tumours staged as TaT1 or carcinoma in situ (CIS) are grouped as NMIBC. Diagnosis depends on cystoscopy and histologic evaluation of the tissue obtained by transurethral resection of the bladder (TURB) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TURB is essential for the patient's prognosis. If the initial resection is incomplete, there is no muscle in the specimen, or a high-grade or T1 tumour is detected, a second TURB should be performed within 2-6 wk. The risks of both recurrence and progression may be estimated for individual patients using the European Organisation for Research and Treatment of Cancer (EORTC) scoring system and risk tables. The stratification of patients into low-, intermediate-, and high-risk groups is pivotal to recommending adjuvant treatment. For patients with a low-risk tumour and intermediate-risk patients at a lower risk of recurrence, one immediate instillation of chemotherapy is recommended. Patients with an intermediate-risk tumour should receive 1 yr of full-dose bacillus Calmette-Guérin (BCG) intravesical immunotherapy or instillations of chemotherapy for a maximum of 1 yr. In patients with high-risk tumours, full-dose intravesical BCG for 1-3 yr is indicated. In patients at highest risk of tumour progression, immediate radical cystectomy (RC) should be considered. RC is recommended in BCG-refractory tumours. The long version of the guidelines is available at the EAU Web site (www.uroweb.org/guidelines). CONCLUSIONS: These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice. PATIENT SUMMARY: The European Association of Urology has released updated guidelines on Non-muscle-invasive Bladder Cancer (NMIBC). Stratification of patients into low-, intermediate-, and high-risk groups is essential for decisions about adjuvant intravesical instillations. Risk tables can be used to estimate risks of recurrence and progression. Radical cystectomy should be considered only in case of failure of instillations or in NMIBC with the highest risk of progression.

8 Article Small cell carcinoma of the urinary bladder: a rare tumor with propensity for hepatic involvement. 2013

Schneider, Nora I / Zigeuner, Richard / Langner, Cord. ·Institute of Pathology, Medical University of Graz, Auenbruggerplatz, Graz, Austria. ·Am J Med Sci · Pubmed #22986616.

ABSTRACT: Small cell (neuroendocrine) carcinoma of the bladder is a rare entity, accounting for less than 1% of all bladder tumors. The authors report 2 new cases of the disease, both presenting with liver metastasis. In the first case, small cell carcinoma occurred in an 85-year-old woman as tumor recurrence of previous micropapillary carcinoma and urothelial carcinoma in situ, illustrating the common coexistence with conventional urothelial carcinoma. In the second case of a 58-year-old man, non-small cell tumor components were not observed. Accurate diagnosis of small cell carcinoma may be challenging. A panel of different antibodies, including neuron-specific enolase, chromogranin A, synaptophysin and CD56 (neural cell adhesion molecule) is recommended. In conclusion, small cell carcinoma represents a rare and aggressive form of bladder malignancy. As illustrated by the 2 cases and according to the literature review, the tumor shows a so far underrecognized propensity for hepatic involvement.

9 Article Concomitant carcinoma in situ is a feature of aggressive disease in patients with organ confined urothelial carcinoma following radical nephroureterectomy. 2012

Wheat, Jeffery C / Weizer, Alon Z / Wolf, J Stuart / Lotan, Yair / Remzi, Mesut / Margulis, Vitaly / Wood, Christopher G / Montorsi, Francesco / Roscigno, Marco / Kikuchi, Eiji / Zigeuner, Richard / Langner, Cord / Bolenz, Christian / Koppie, Theresa M / Raman, Jay D / Fernández, Mario / Karakiewizc, Pierre / Capitanio, Umberto / Bensalah, Karim / Patard, Jean-Jacques / Shariat, Shahrokh F. ·University of Michigan, Ann Arbor, MI 48109, USA. jefwheat@med.umich.edu ·Urol Oncol · Pubmed #20451416.

ABSTRACT: OBJECTIVE: Carcinoma in situ (CIS) is associated with increased risk of progression when found with high-grade non-muscle-invasive bladder cancer, yet its impact is less clear in the upper urinary tract. In the current study, we evaluated the impact of concomitant CIS on recurrence-free survival and cancer-specific survival following radical nephroureterectomy for upper tract urothelial carcinoma (UTUC). MATERIALS AND METHODS: A multi-institutional retrospective cohort of 1,387 patients undergoing radical nephroureterectomy was identified. Concomitant CIS was defined as the presence of CIS in association with another pathologic stage; patients with CIS alone were excluded from the analysis. The presence of concomitant CIS served as the exposure variable with disease recurrence and cancer-specific mortality as the outcomes. Organ-confined disease was defined as AJCC/UICC stage II or lower. RESULTS: Concomitant CIS was identified in 371 of 1,387 (26.7%) patients and was significantly more common in patients with a previous bladder cancer history, high grade, and high stage tumors. In a multivariable analysis, concomitant CIS was a predictor of disease recurrence (HR = 1.25, P = 0.04) and cancer specific mortality (HR = 1.34, P = 0.05) for patients with organ-confined UTUC, but not in the entire cohort. Other prognostic variables, such as grade, stage, lymphovascular invasion, and lymph node status, were associated with poorer overall and recurrence-free survival for all patients. CONCLUSION: The presence of concomitant CIS in patients with organ-confined UTUC is associated with a higher risk of recurrent disease and cancer-specific mortality. This information may be useful in refining surveillance protocols and in more appropriate selection of patients for adjuvant chemotherapy.

10 Article Prognostic effect of urinary bladder carcinoma in situ on clinical outcome of subsequent upper tract urothelial carcinoma. 2011

Youssef, Ramy F / Shariat, Shahrokh F / Lotan, Yair / Wood, Christopher G / Sagalowsky, Arthur I / Zigeuner, Richard / Langner, Cord / Montorsi, Francesco / Bolenz, Christian / Margulis, Vitaly. ·University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA. ·Urology · Pubmed #21167566.

ABSTRACT: OBJECTIVES: To evaluate the effect of a history of bladder carcinoma in situ (CIS) on relapse and survival after surgical management of metachronous upper tract urothelial carcinoma (UTUC). Urinary bladder CIS was previously reported to be among the independent risk factors for the development of UTUC. METHODS: Using a multi-institutional database of patients treated with radical nephroureterectomy (RNU) for UTUC, we compared the clinicopathologic parameters and clinical outcomes of patients with and without a history of bladder CIS. Multivariate Cox regression analysis was performed to determine the independent predictors of disease recurrence and cancer-specific mortality after RNU. RESULTS: The study included 1316 patients, 884 men and 432 women, with median follow-up of 36 months after RNU. The patients with a history of bladder CIS (n = 91) were more likely to have high-grade and sessile UTUC (P < .05). The 5 year disease-free survival and cancer-specific survival rate was 53% and 59% in those with a history of bladder CIS and 71% and 75% in those without a history of bladder CIS, respectively (P = .031 and P = .045, respectively). On multivariate Cox regression analysis, a history of bladder CIS was an independent predictor of disease recurrence and cancer-specific mortality after RNU (P = .006 and P = .045, respectively). CONCLUSIONS: The results of our study have shown that patients with a history of bladder CIS are more likely to develop aggressive UTUC and demonstrate a greater risk of recurrence and death from cancer after RNU. Our findings suggest the need for aggressive surveillance regimens and multimodal management strategies for patients who develop UTUC in the setting of previous bladder CIS.

11 Article Comparison of oncologic outcomes for open and laparoscopic nephroureterectomy: a multi-institutional analysis of 1249 cases. 2009

Capitanio, Umberto / Shariat, Shahrokh F / Isbarn, Hendrik / Weizer, Alon / Remzi, Mesut / Roscigno, Marco / Kikuchi, Eiji / Raman, Jay D / Bolenz, Christian / Bensalah, Karim / Koppie, Theresa M / Kassouf, Wassim / Fernández, Mario I / Ströbel, Philipp / Wheat, Jeffrey / Zigeuner, Richard / Langner, Cord / Waldert, Matthias / Oya, Mototsugu / Guo, Charles C / Ng, Casey / Montorsi, Francesco / Wood, Christopher G / Margulis, Vitaly / Karakiewicz, Pierre I. ·Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. ·Eur Urol · Pubmed #19361911.

ABSTRACT: BACKGROUND: Data regarding the oncologic efficacy of laparoscopic nephroureterectomy (LNU) compared to open nephroureterectomy (ONU) are scarce. OBJECTIVE: We compared recurrence and cause-specific mortality rates of ONU and LNU. DESIGN, SETTING, AND PARTICIPANTS: Thirteen centers from three continents contributed data on 1249 patients with nonmetastatic upper tract urothelial carcinoma (UTUC). MEASUREMENTS: Univariable and multivariable survival models tested the effect of procedure type (ONU [n=979] vs LNU [n=270]) on cancer recurrence and cancer-specific mortality. Covariables consisted of institution, age, Eastern Cooperative Oncology Group (ECOG) performance status score, pT stage, pN stage, tumor grade, lymphovascular invasion, tumor location, concomitant carcinoma in situ, ureteral cuff management, previous urothelial bladder cancer, and previous endoscopic treatment. RESULTS AND LIMITATIONS: Median follow-up for censored cases was 49 mo (mean: 62). Relative to ONU, LNU patients had more favorable pathologic stages (pT0/Ta/Tis: 38.1% vs 20.8%, p<0.001) and less lymphovascular invasion (14.8% vs 21.3%, p=0.02) and less frequently had tumors located in the ureter (64.5 vs 71.1%, p=0.04). In univariable recurrence and cancer-specific mortality models, ONU was associated with higher cancer recurrence and mortality rates compared to LNU (hazard ratio [HR]: 2.1 [p<0.001] and 2.0 [p=0.008], respectively). After adjustment for all covariates, ONU and LNU had no residual effect on cancer recurrence and mortality (p=0.1 for both). CONCLUSIONS: Short-term oncologic data on LNU are comparable to ONU. Since LNU was selectively performed in favorable-risk patients, we cannot state with certainty that ONU and LNU have the same oncologic efficacy in poor-risk patients. Long-term follow-up data and morbidity data are necessary before LNU can be considered as the standard of care in patients with muscle-invasive or high-grade UTUC.