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document
Intravesical seeding of upper urinary tract urothelial carcinoma cells during nephroureterectomy : an exploratory analysis from the THPMG trial . OBJECTIVE The Pirarubicin Monotherapy Study Group trial was a randomized Phase II study that evaluated the efficacy of intravesical instillation of pirarubicin in the prevention of bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma . This study conducted further analysis of the Pirarubicin Monotherapy Study Group cohort , focusing on intravesical seeding of cancer cells . METHODS Using the data from the Pirarubicin Monotherapy Study Group trial , bladder recurrence-free survival rates and factors associated with bladder recurrence in the control group were analyzed . RESULTS Of 36 patients in the control group , 14 with positive urine cytology had more frequent recurrence when compared with the 22 patients with negative cytology ( P = 0.004 ) . Based on the multivariate analysis in the control group , voided urine cytology was an independent predictive factor of bladder recurrence ( hazard ratio , 5.54 ; 95 % confidence interval 1.12-27.5 ; P = 0.036 ) . Of 72 patients in the Pirarubicin Monotherapy Study Group trial , 31 had positive urine cytology . Among the 31 patients , 17 patients who received pirarubicin instillation had fewer recurrences when compared with 14 patients who received control treatment ( P = 0.0001 ) . On multivariate analysis , pirarubicin instillation was an independent predictor of better recurrence-free survival rates in the patients with positive urine cytology ( hazard ratio , 0.02 ; 95 % confidence interval , 0.00-0.53 ; P = 0.018 ) . Of 21 patients with bladder recurrence , 17 had recurrent tumor around cystotomy or in the bladder neck compromised by the urethral catheter , supporting the notion that tumor cells seeded in the injured urothelium . CONCLUSIONS Intravesical instillation of pirarubicin immediately after nephroureterectomy significantly reduced the bladder recurrence rate in patients with positive voided urine cytology . The results suggest that intravesical seeding of upper urinary tract urothelial carcinoma occurs during nephroureterectomy .
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Intervention_Physical
Intravesical seeding of upper urinary tract urothelial carcinoma cells
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Intervention_Physical
nephroureterectomy
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Intervention_Pharmacological
pirarubicin
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Intervention_Physical
intravesical seeding of cancer cells
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Intervention_Control
control
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Intervention_Pharmacological
pirarubicin instillation
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Intervention_Pharmacological
Intravesical instillation of pirarubicin
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Intervention_Pharmacological
nephroureterectomy
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Outcome_Mortality
bladder recurrence-free survival rates
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Outcome_Physical
factors associated with bladder recurrence
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Outcome_Physical
positive urine cytology
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Outcome_Physical
recurrence
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Outcome_Physical
urine cytology .
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Outcome_Physical
recurrences
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Outcome_Mortality
recurrence-free survival rates
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Outcome_Physical
recurrent tumor around cystotomy or in the bladder neck
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Outcome_Physical
bladder recurrence rate
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Participant_Condition
nephroureterectomy
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Participant_Condition
upper urinary tract urothelial carcinoma
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Participant_Sample-size
36
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Participant_Sample-size
14
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Participant_Sample-size
22
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Participant_Sample-size
72
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Participant_Sample-size
31
61200
Participant_Sample-size
17
61201
Participant_Sample-size
14