The outcome of patients on dialysis with upper urinary tract transitional cell carcinoma

PURPOSE: Transitional cell carcinoma is the most common upper urinary tract cancer in Taiwanese patients on dialysis. It is a unique finding compared with Western countries. Unfortunately, the long-term outcomes of patients with upper urinary tract transitional cell carcinoma on dialysis are largely unknown. This study presents clinical outcome of patients on dialysis with upper urinary tract transitional cell carcinoma. MATERIALS AND METHODS: We retrospectively reviewed the medical records of all patients with upper urinary tract transitional cell carcinoma who had end stage renal disease and underwent dialysis. Traditional prognostic factors including age, sex, tumor grade, stage and tumor location were analyzed with respect to disease recurrence and survival. RESULTS: A total of 73 patients were included in this study. The major complaints were painless gross hematuria and urethral bloody discharge. Disease relapsed in 40 (54.8%) patients at average time of 15 months (2 to 92). Univariate analysis failed to identify significant prognostic factors for recurrence. The average duration between primary and contralateral metachronous upper urinary tract transitional cell carcinoma recurrence was 36 months (range 5 to 96). Patients on dialysis with upper urinary tract transitional cell carcinoma who had previous or concurrent bladder tumor, or who had a history of recurrent bladder tumor, had high contralateral upper urinary tract transitional cell carcinoma recurrence. (p = 0.038) The statistically significant prognostic factor for disease-free survival was pT stage (p = 0.041). CONCLUSIONS: Patients on dialysis with painless gross hematuria or bloody urethral discharge must undergo detail urinary system evaluation. Since patients with upper urinary tract transitional cell carcinoma on dialysis have a high recurrence rate and metachronous or even multiple, early synchronous tumor characteristics that may be missed by imaging, total urinary tract exenteration is a recommended therapeutic option.     

Prognostic variables in patients with transitional cell carcinoma of the renal pelvis and proximal ureter

Recent technological advances in urological endoscopic surgery of the renal pelvis and proximal ureter via ureteroscopy or percutaneous nephroscopy have made it possible to consider parenchymal-sparing procedures in patients with transitional cell carcinoma. To define the role of these procedures in the management of renal pelvic or proximal ureteral transitional cell carcinoma we analyzed retrospectively 31 patients who underwent nephroureterectomy for transitional cell carcinoma of the renal pelvis and/or proximal ureter. High grade upper urinary tract transitional cell carcinoma and a history of metachronous or synchronous bladder transitional cell carcinoma were independent adverse prognostic factors. However, patients with low grade upper urinary tract transitional cell carcinoma and no evidence of a urothelial field change had a 100 per cent 5-year survival rate. It would appear that parenchymal-sparing endoscopic techniques should be regarded with caution in patients with either high grade transitional cell carcinoma of the renal pelvis and proximal ureter or a history of bladder cancer.     

Squamous carcinoma of urinary bladder

The clinical course of 56 patients with squamous cell carcinoma of the urinary bladder and poorly differentiated transitional cell carcinoma with squamous metaplasia were compared. Survival was evaluated to compare treatments and biologic potentials of these neoplasms. Squamous cell carcinoma of the urinary bladder behaves as poorly differentiated transitional cell carcinoma with squamous metaplasia, and survival is significantly poorer than in poorly differentiated transitional cell carcinoma. While survivals are limited, only radical, surgical extirpation can be associated with significant patient salvage.     

Serum concentration of laminin in transitional cell carcinoma

The concentration of laminin in the serum was determined for 45 patients with urinary tract transitional cell carcinoma, and the clinical significance of the findings was considered. The difference between the serum laminin concentrations in the control group and the transitional cell carcinoma patient group was not statistically significant, but the serum laminin level was highest in the transitional cell carcinoma patients with metastatic foci. In many of the patients who had metastatic foci and showed clearly progressive disease, the serum laminin concentration was found to increase with the passage of time. When the transitional cell carcinoma tissues were stained by the fluorescent antibody technique, there was little distribution of laminin in the tumor tissues, contrary to our earlier-reported findings regarding the staining of laminin in renal cell carcinoma tissues. In renal cell carcinoma patients, the serum concentration of laminin had been found to be high even when there were no metastatic foci, and consideration of this fact strongly suggests the possibility that the mechanism for laminin synthesis in urinary tract transitional cell carcinoma is different from that in renal cell carcinoma. It was surmised that the serum laminin concentration has potential for use as a diagnostic indicator of metastasis in patients with urinary tract transitional cell carcinoma.     

核基质蛋白22检测在膀胱癌筛查中的应用

目的：探讨检测核基质蛋白22(NMP22)在膀胱癌筛查中的应用价值。方法：检测129例血尿患者的尿NMP22，并分为膀胱癌组和非肿瘤组进行比较。结果：膀胱癌组患者尿NMP22值高于非肿瘤组(P＜0．01)。结论：尿NMP22检测具有较高的敏感性和特异性，在膀胱癌筛查中可以选择应用。     

核基质蛋白22在上尿路移行细胞癌诊断中的作用

目的　探讨核基质蛋白 2 2 (NMP 2 2 )在上尿路移行细胞癌诊断中的作用。　方法　对2 4例肾盂癌及输尿管癌患者和 2 0例良性泌尿系疾病患者尿中NMP 2 2浓度及尿细胞学进行检测 ,计算诊断敏感性和特异性。　结果　 2 4例TCC患者尿液标本尿细胞学阳性 14例 ,NMP 2 2阳性 2 1例 ;2 0例良性泌尿系疾病患者尿液标本细胞学阳性 1例 ,NMP 2 2阳性 4例 ,NMP 2 2的诊断敏感性和特异性分别为 87.5 %和 80 .0 % ,尿细胞学为 5 8.3%和 95 .0 % ,比较二者敏感性差别有显著性意义。　结论　NMP 2 2可能成为检测上尿路移行细胞癌的良好辅助手段     

Clinical evaluation of urinary and serum carcinoembryonic antigen in bladder cancer.

Urinary carcinoembryonic antigen-like activity was increased (more than 1.5 ng. per ml.) in 61 per cent of patients with transitional cell carcinoma of the bladder. The frequency of abnormal carcinoembryonic antigen values correlated with the extent and the grade of the tumor. However, urinary tract infection can produce abnormal carcinoembryonic antigen values in non-cancer patients. The use of urinary carcinoembryonic antigen measurement and urine cytologic examination for diagnosis of transitional cell carcinoma gave a better diagnostic yield than did use of either test alone. In transitional cell carcinoma patients with abnormal preoperative urinary carcinoembryonic antigen values, postoperative urinary carcinoembryonic antigen values were useful for determining completeness of tumor resection. However, with total cystectomy and creation of an ileal conduit or ureterosigmoidostomy, urinary carcinoembryonic antigen values increased markedly postoperatively. Serum carcinoembryonic antigen values were of little value in the diagnosis of transitional cell carcinoma.     

SSX2基因mRNA在泌尿系统肿瘤组织中的表达

目的探讨肿瘤特异性SSX2基因mRNA在肾细胞癌及尿路移行细胞癌组织中的表达.方法采用逆转录聚合酶链反应方法,检测26例肾细胞癌患者、27例尿路移行细胞癌患者的癌组织,及15例患者相应的癌旁组织中SSX2基因mRNA的表达.结果 26例肾癌患者癌组织中,18例(69%)SSX2 基因mRNA表达阳性;27例尿路移行细胞癌组织中,22例(81%)SSX2 基因mRNA表达阳性.癌旁组织均不表达.在肿瘤不同分期之间及不同分级之间SSX2 基因mRNA的表达差异均无统计学意义(P均＞0.05).结论 SSX2基因mRNA在肾癌及尿路移行细胞癌组织中高表达.     

Lymphocyte antibody interaction in cytotoxicity against human transitional cell carcinoma.

The interaction of antibodies and lymphocytes in their immune reaction against human transitional cell carcinomas was studied using the in vitro microcytotoxicity assay. A non-complement dependent, IgG antibody was detected in the serum of occasional transitional cell carcinoma patients, which induced cytotoxicity against transitional cell carcinoma target cells by lymphocytes from donors with and without transitional cell carcinoma. The observation that lymphocytes from transitional cell carcinoma donors were more sensitive to activation by this anti-transitional cell carcinoma, lymphocyte dependent antibody is compatible with the hypothesis that the surface of lymphocytes from some transitional cell carcinoma donors is coated in vivo with an anti-transitional cell carcinoma lymphocyte dependent antibody and that this antibody may be a significant factor in immunity to transitional cell carcinomas of the urinary tract.     

尿核基质蛋白22在膀胱癌术后复发监测中的应用

目的:探讨尿核基质蛋白22(NMP22)检测在膀胱癌术后复发监测中的应用价值.方法:采用ELISA法检测93例膀胱癌术后患者尿NMP22值,并分为复发组和未复发组进行比较.结果:复发组患者尿NMP22值高于未复发组(P＜ 0.01),以6 IU/L为最适临界值,敏感性 95.1%,特异性 69.2%,阳性预测值 70.9%,阴性预测值 94.7%.结论:尿NMP22检测可作为膀胱癌术后复发的常规监测方法,以6 IU/L为临界值是较适宜的.     

Percutaneous Treatment of Transitional Cell Carcinoma of the Upper Urinary Tract

Background We evaluated the long-term effect of percutaneous resection in 2 Japanese patients with transitional cell carcinoma of the renal pelvis, and reviewed the medical literature on similar patients, to determine the appropriate indications for percutaneous treatment of transitional cell carcinoma in the upper urinary tract.
Results Indications for endoscopic resection in the 2 patients were renal insufficiency and unsuitability for major open surgery. The patients had no recurrence during follow-up. Seven previous reports described percutaneous resection of upper urinary tract transitional cell carcinoma in 82 patients. Although 72.6% of the patients were successfully treated by percutaneous resection, half of the patients with grade 3 carcinoma developed recurrence.
Conclusion These results, together with those of the 7 published reports, suggest that percutaneous resection should be limited to selected patients with low-grade transitional cell carcinoma.     

Different treatment strategies for end stage renal disease in patients with transitional cell carcinoma

PURPOSE: Transitional cell carcinoma is the most common urinary tract cancer in Taiwanese patients on dialysis. It is a unique finding compared within Western countries. Due to this geographic difference and a higher recurrence rate a more extensive operation and aggressive followup protocols should be refined for these patients on dialysis. MATERIALS AND METHODS: We retrospectively reviewed the medical records of all patients with transitional cell carcinoma who had end stage renal disease and underwent hemodialysis. Records were reviewed for hemodialysis duration, initial tumor location, tumor grade, stage, operative method, operative complication and final surgical status. Tumor grade and stage was determined by the WHO and proposed Jewett systems. Six patient groups were classified according to final surgical status for comparative analysis. RESULTS: A total of 30 patients were included in this study. Painless gross hematuria and urethral bloody discharge were the most common complaints. Tumor in 25 of the 30 cases was high grade and all were early stage. Of the patients 11 (36.7%) had undergone bilateral nephroureterectomy and radical cystectomy in as a 1 or multiple step procedure. Six patients (20%) had undergone bilateral nephroureterectomy at 1 or 2 sequential operations. Seven of the 13 patients (53.8%) in whom low urinary tract transitional cell carcinoma was initially treated with transurethral resection unfortunately had recurrent transitional cell carcinoma of the upper urinary tract. Ten of the 14 patients (71.4%) with upper urinary tract transitional cell carcinoma who underwent nephroureterectomy and bladder cuff excision had subsequent transitional cell carcinoma within the bladder. CONCLUSIONS: Patients with transitional cell carcinoma on dialysis had a higher recurrence rate in the upper urinary tract than patients not on dialysis. Most cases were at an early stage but with high grade tumor behavior. In 11 patients (36.7%) total exenteration of the urinary tract except the urethra was eventually done. The final bilateral nephroureterectomy rate was 56.7%. Since the rate of total exenteration and bilateral nephrectomy was abnormally high at such a short followup, 1-step bilateral nephroureterectomy and radical cystectomy are a recommended treatment for patients with transitional cell carcinoma on dialysis.     

Familial Transitional Cell Carcinoma Among the Population of Iceland

PurposeSeveral case reports have described familial aggregation of transitional cell carcinoma of the urinary tract but to our knowledge only 1 epidemiological study specifically addressed the issue of familial bladder cancer. We evaluated the extent of familial aggregation of transitional cell carcinoma among the population of Iceland.Materials and MethodsThe first to third degree relatives of 190 patients with bladder, ureter or renal pelvis transitional cell carcinoma diagnosed between 1983 and 1992 in Iceland were identified through the Icelandic Cancer Family Resource. The records of these 12,328 relatives were subsequently linked to the 1965 to 1994 cancer registry. The observed occurrence of transitional cell carcinoma of the urinary tract was compared to the expected occurrence based on age, gender and calendar specific incidence rates. Observed-to-expected ratios and 95% confidence intervals were calculated.ResultsIn 41 of the 190 pedigrees at least 1 relative had transitional cell carcinoma of the urinary tract. Of the probands 38 had only 1 and 3 had 2 affected relatives. The prevalence of family history of transitional cell carcinoma was 3% in first degree and 10% in first or second degree relatives. The risk of transitional cell carcinoma among all relatives was slightly elevated (observed-to-expected ratio 1.24, 95% confidence interval 0.90 to 1.67). The observed-to-expected ratio was greater among second and third degree relatives than among first degree relatives.ConclusionsThe risk of transitional cell carcinoma among relatives of patients is somewhat increased. However, the greater risk for more distant relatives argues against the existence of a hereditary subtype of bladder transitional cell carcinoma, at least in the founder population of Iceland.     

核基质蛋白22在膀胱移行上皮癌诊断中的价值(附48例报告)

目的:评价患者尿中核基质蛋白22(NMP 22)在泌尿系上皮肿瘤诊断中的意义。方法:采用ELISA法测定48例膀胱移行上皮肿瘤患者尿中NMP 22的值,并与尿脱落细胞学检查进行比较。结果:48例膀胱移行上皮肿瘤患者尿NMP 22的中位值为19.53 IU/L。以10 IU/L为临界值,NMP 22诊断膀胱移行上皮肿瘤的敏感性为86.96％,特异性为50％;尿脱落细胞学检查的敏感性为17.39％,特异性为100％。尿NMP 22在肿瘤的分期、分级间的差别无显著性意义(P>0.05)。结论:尿NMP 22检测比尿脱落细胞学检查更敏感,可以作为血尿患者和既往膀胱肿瘤患者的首选筛选方法。     

肾细胞癌及尿路移行细胞癌组织中黑色素瘤抗原基因mRNA的表达

目的　评价肿瘤特异性黑色素瘤抗原 (MAGE) 1、 3基因作为肾细胞癌及尿路移行细胞癌组织中的免疫学检测和免疫治疗、基因治疗分子标志物的可行性。　方法　肾细胞癌组织标本 18例 ,尿路移行细胞癌组织标本 2 6例 ,相应的癌旁组织 10例 ,采用RT PCR方法对MAGE 1、MAGE 3基因进行测定。　结果　 18例肾癌组织中MAGE 1mRNA阳性表达 10例 (5 6 % ) ,MAGE 3mRNA阳性表达11例 (6 1% ) ,MAGE 1及MAGE 3同时表达 8例 (44 % ) ;2 6例尿路移行细胞癌组织中MAGE 1mRNA阳性表达 16例 (6 2 % ) ,MAGE 3mRNA阳性表达 15例 (5 8% ) ,MAGE 1及MAGE 3同时表达 12例 (46 % )。癌旁组织 10例均不表达MAGE 1及MAGE 3。　结论　MAGE 1、MAGE 3基因有可能作为肾癌及尿路移行细胞癌组织免疫学检测的分子标志物 ,并且具有作为免疫治疗、基因治疗特异性靶位的潜在价值。     

A case of primary transitional cell carcinoma of the prostate]

We report a rare case of primary transitional cell carcinoma of the prostate. A 66-year-old man was referred to our hospital with the chief complaints of pollakisuria and residual urine sensation on January 21, 1998. Under a preoperative diagnosis of benign prostatic hyperplasia, transurethral resection of the prostate was performed. Histopathological examination revealed grade 3 transitional cell carcinoma. Then the transrectal needle biopsy of the prostate and random biopsy of the urinary bladder were performed. Since no metastatic tumors or tumor cells were detected in either the prostate or urinary bladder or any other organs, this patient was diagnosed with primary transitional cell carcinoma of the prostate. Three courses of adjuvant chemotherapy (M-VAC) were performed, and tumor recurrence was not recognized 9 months after the operation. This is the 35th case of primary transitional cell carcinoma of the prostate in the Japanese literature.     

IS SURVEILLANCE NECESSARY FOR INVERTED PAPILLOMA IN THE URINARY BLADDER AND URETHRA?

BACKGROUND: A case series of inverted papilloma of the urinary bladder and urethra is presented, together with a review of the literature with respect to multiplicity, recurrence rate and association with transitional cell carcinoma, and a discussion on surveillance of the lesion. METHODS: Cases of inverted papilloma of the lower urinary tract in a single centre were reviewed. Patient and tumour characteristics, recurrence and associated transitional cell carcinoma are reported. RESULTS: Twenty patients were included (18 male, two female). The mean age was 60.8 years (range 35-78 years). All had solitary tumours ranging from 3 mm to 30 mm in size. Median cystoscopic follow up was 30 months (range 2-140 months). There was no recurrence. One patient was associated with subsequent transitional cell carcinoma 44 and 76 months later. Together with the present 20 cases, review of the English literature with respect to inverted papilloma of the lower urinary tract identified a total of 322 cases reported, with a recurrence rate of 3.85%. Moreover, 1.55%, 5.90% and 1.54% were associated with previous, simultaneous and subsequent transitional cell carcinoma, respectively. CONCLUSIONS: Recurrence is not uncommon and risk of subsequent transitional cell carcinoma is not rare, such that non-invasive surveillance with flexible cystoscopy is recommended for inverted papilloma of the lower urinary tract.     

Urinary Nuclear Matrix Protein as a Marker for Transitional Cell Carcinoma of the Urinary Tract

Purpose

The purpose of this trial was to evaluate an immunoassay for urinary nuclear matrix protein, NMP22,^* as an indicator for transitional cell carcinoma of the urinary tract.

Materials and Methods

Three groups of subjects participated in this trial of NMP22: 1--175 with transitional cell carcinoma, 2--117 with benign urinary tract conditions and 3--375 healthy volunteers. Each subject provided a single (3 voids) urine sample for analysis at the time of study entry. Each sample was assayed for the level of NMP22.

Results

In normal healthy volunteers and in subjects with benign conditions median NMP22 levels were 2.9 and 3.3 units per ml., respectively. Median urinary NMP22 levels in patients with transitional cell carcinoma were significantly greater than in comparison subjects. Patients with active transitional cell carcinoma had significantly greater median urinary NMP22 levels than those with no evidence of disease (6.04 versus 4.11 units per ml., p = 0.027, 1-tailed Mann-Whitney U test). We noted no effect of tumor grade, extent of disease or exposure to intravesical therapy on urinary NMP22 levels.

Conclusions

NMP22 is a promising urinary tumor marker for monitoring transitional cell carcinoma. Nuclear matrix proteins are a new class of tumor markers that represent the basis for the development of assays with increased efficacy for the detection and treatment of cancer.     

survivin与nmp22对诊断尿路上皮肿瘤价值的比较

目的 :评价尿脱落细胞中survivin的表达和尿nmp2 2的表达对诊断尿路上皮肿瘤的价值。 方法 :对4 8例尿路上皮肿瘤患者 ,在行膀胱镜检查或手术前留新鲜尿液分别行尿脱落细胞survivin、尿nmp2 2和尿脱落细胞检查 ,并分别比较各方法的敏感性、特异性。结果 :尿路上皮肿瘤患者尿脱落细胞涂片中survivin表达 4 8例中4 6例阳性 ,尿NMP2 2有 38例阳性 ,而尿脱落细胞学仅 15例阳性 ,survivin的敏感性高于nmp2 2及脱落细胞学 (P <0 .0 5及P <0 .0 1)。三者的特异性分别为 10 0 %、90 %和 10 0 % ,差异无统计学意义。结论 :检测尿脱落细胞中survivin的表达方法简单无创敏感性、特异性高对诊断尿路上皮肿瘤的价值优于尿nmp2 2。     

¿Cuál es el valor de la biopsia aleatoria en el seguimiento del carcinoma uroterial superficial de vejiga?

IntroductionTransitional cell carcinoma of the bladder represents a disease of entire urothelial tract. The follow up is very important to detect any lesion that might represent a progression or a local recurrence. Some authors recommend randomized biopsies as a routine workup, others recommend cystoscopies and urinary cytology as the main part of superficial bladder cancer follow up.Patients and MethodsForty nine patients with superficial bladder cancer were followed up during a ten-year period. Randomized biopsies and urinary cytology were harvested according to the international cancer protocol on bladder cancer.Results15 (1%) out of 1.489 randomized biopsies found to be positive to transitional cell carcinoma. Four out (10.5%) of 35 biopsies targeted to suspicious areas were positive to transitional cell carcinoma. 50 (17.4%) out of 288 cystoscopies with urinary cytology found to be positive to transitional cell carcinoma. Sensitivity and Specificity of biopsies (including randomized and targeted) were 31% and 85.2% respectively. Sensitivity and specificity of cystoscopies with urinary cytology were 48% and 86.5% respectively.ConclusionRandomized biopsies did not show to detect more local recurrence or progression when compared to the urinary cytology. Cystoscopies with urinary cytology have good sensitivity and specificity for detection of tumor recurrence during follow up of transitional cell carcinoma.