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[PMID]:29385365
[Au] Autor:So C; Siddiqui MM
[Ad] Endereço:University of Maryland, Baltimore, MD msiddiqui@som.umaryland.edu.
[Ti] Título:Urothelial Carcinoma.
[So] Source:N Engl J Med;378(5):e8, 2018 Feb 01.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Carcinoma Papilar/patologia
Neoplasias Ureterais/patologia
[Mh] Termos MeSH secundário: Idoso
Carcinoma Papilar/complicações
Feminino
Hematúria/etiologia
Seres Humanos
Histeroscopia
Ureter/patologia
Neoplasias Ureterais/complicações
Urotélio/patologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMicm1709216


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[PMID]:29406055
[Au] Autor:Arora HC; Fascelli M; Zhang JH; Isharwal S; Campbell SC
[Ad] Endereço:Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA.
[Ti] Título:Kidney, Ureteral, and Bladder Cancer: A Primer for the Internist.
[So] Source:Med Clin North Am;102(2):231-249, 2018 Mar.
[Is] ISSN:1557-9859
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Malignancies of the urinary tract (kidney, ureter, and bladder) are distinct clinical entities. Hematuria is a unifying common presenting symptom for these malignancies. Surgical management of localized disease continues to be the mainstay of treatment, and early detection is important in the prognosis of disease. Patients often require life-long follow-up and assessment for recurrence.
[Mh] Termos MeSH primário: Carcinoma de Células Renais/diagnóstico
Carcinoma de Células de Transição/diagnóstico
Hematúria/etiologia
Neoplasias Renais/diagnóstico
Neoplasias Ureterais/diagnóstico
Neoplasias da Bexiga Urinária/diagnóstico
[Mh] Termos MeSH secundário: Carcinoma de Células Renais/complicações
Carcinoma de Células de Transição/complicações
Cistoscopia
Seres Humanos
Medicina Interna
Neoplasias Renais/complicações
Neoplasias Renais/diagnóstico por imagem
Imagem por Ressonância Magnética
Encaminhamento e Consulta
Tomografia Computadorizada por Raios X
Neoplasias Ureterais/complicações
Neoplasias Ureterais/diagnóstico por imagem
Neoplasias da Bexiga Urinária/complicações
Neoplasias da Bexiga Urinária/diagnóstico por imagem
Urologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180207
[St] Status:MEDLINE


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[PMID]:27778491
[Au] Autor:Raheem AA; Alatawi A; Kim DK; Sheikh A; Rha KH
[Ad] Endereço:Department of Urology, Tanta University Medical School, Egypt.
[Ti] Título:Feasibility of Robot - assisted Segmental Ureterectomy and Ureteroureterostomy in Patient with High Medical Comorbidity.
[So] Source:Int Braz J Urol;43(4):779-780, 2017 Jul-Aug.
[Is] ISSN:1677-6119
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION AND OBJECTIVES: Nephroureterectomy remains the gold standard treatment option for upper tract tumors. However, segmental ureterectomy may be another option in patients with single kidney, borderline renal function or high medical comorbidities. The aim of this video is to assess the feasibility of robotic surgery as a minimally invasive technique in treatment of a high comorbid patient with ureteric tumor. MATERIALS AND METHODS: Eighty-year old male patient, with a medical history of chronic hypertensive and uncontrolled Diabetes Mellitus, was referred to our department for treatment of ureteric tumor. Patient underwent robot-assisted radical prostatectomy 5 years ago. Patient's Charlson comorbidity index score was 9. Computed tomography showed a 2.5cm right ureteral luminal filling enhancing lesion at lower part of upper 1/3 ureter. We performed diagnostic flexible cystoscopy under local anesthesia to exclude associated lower urinary tract carcinoma, and bladder wash was negative for malignancy. Under general anesthesia patient underwent diagnostic flexible ureteroscopy to confirm mass location, and a retrograde pyelography to rule out additional tumors on the right collecting system. Then, the patient was placed in the full lateral flank position without Table flexion. Ports placement were inserted as follow: a "12mm" optical trocar at pararectal line superior and lateral to umbilicus, two "8mm" robotic trocars cranial and caudal to optical trocar (8cm distance), a "8mm" robotic trocar towards anterior superior ischial spine, and a "12mm" assistant trocar was inserted between umbilicus and pubic bone. The surgical steps are shown in the video. RESULTS: The procedure was performed easily. The total operative time and consol time were 100 and 60 minutes, respectively. Blood loss was 50ml. No reported intraoperative or postoperative complications. Notably, we took full precautions in case of intraoperative failure to complete the procedure successfully, nephroureterectomy was our second option. Postoperative serum creatinine was 1.2mg/dL and length of hospital stay was 2 days. The frozen biopsy showed that the tumor was resected with safe proximal and distal surgical margins. Final histopathology revealed high grade (G3) urothelial carcinoma (pT3), measures (1.3x1.2x0.2cm), associated with carcinoma in situ. CONCLUSION: We affirm that robotic segmental ureterectomy and ureteroureterostomy could be offered safely as a minimally invasive treatment for patients with ureteric tumors and high-risk medical comorbidities. It provides excellent perioperative outcomes and early oncological safety with regard to surgical margins.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos Robóticos/métodos
Neoplasias Ureterais/diagnóstico
Procedimentos Cirúrgicos Urológicos/métodos
[Mh] Termos MeSH secundário: Idoso de 80 Anos ou mais
Comorbidade
Seres Humanos
Masculino
Resultado do Tratamento
Ureter/cirurgia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; VIDEO-AUDIO MEDIA
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171221
[Lr] Data última revisão:
171221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1590/S1677-5538.IBJU.2016.0026


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[PMID]:28830196
[Au] Autor:Sung Tae H; Deuk Jae S; Kyung Sook Y; Ki Choon S; Na Yeon H; Beom Jin P; Min Ju K; Sung Bum C
[Ad] Endereço:1 Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
[Ti] Título:Prediction of high-grade ureteral urothelial carcinoma on CT urography.
[So] Source:Br J Radiol;90(1078):20170159, 2017 Oct.
[Is] ISSN:1748-880X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate the correlation between CT urography (CTU) findings and histological grade of ureteral urothelial carcinoma (UUC), and to identify predictors of high-grade UUC. METHODS: CTU images of 73 patients with pathologically proven UUC via nephroureterectomy were independently reviewed by two radiologists for tumour size, tumour location, hydronephrosis grade, periureteral infiltration, presence of enlarged retroperitoneal lymph nodes and tumour enhancement value. Interobserver agreement was assessed with kappa statistics. Histological grade was classified as either low or high according to the WHO 2004 classification system and pathologic T stage was assessed according to the TNM staging system. Binary logistic regression, Spearman correlation analysis and receiver operating characteristic curves were used to evaluate relationships between CTU findings and histological grade. RESULTS: 58 patients had high-grade UUCs and 15 had low-grade UUCs. Among CTU features, only hydronephrosis grade was significantly correlated with high tumour grade for both readers (p < 0.001). Multivariate logistic regression revealed that hydronephrosis of Grade 3 or higher was a significantly independent predictor of high-grade UUC for both readers (p ≤ 0.004). Interobserver agreement was excellent for hydronephrosis grade (к = 0.862). With the cut-off value of hydronephrosis Grade 3, the sensitivity, specificity and area under the curve for predicting high-grade UUC were, respectively, 88%, 79% and 0.830 for reader 1 and 86%, 80% and 0.763 for reader 2. CONCLUSION: Hydronephrosis of Grade 3 or higher on CTU may be predictive of high-grade UUC. Advances in knowledge: Radical surgery should be considered for UUC causing hydronephrosis of Grade 3 or higher on CTU, even in small tumours without periureteral infiltration.
[Mh] Termos MeSH primário: Carcinoma de Células de Transição/diagnóstico por imagem
Carcinoma de Células de Transição/patologia
Tomografia Computadorizada por Raios X
Neoplasias Ureterais/diagnóstico por imagem
Neoplasias Ureterais/patologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Meia-Idade
Gradação de Tumores
Valor Preditivo dos Testes
Estudos Retrospectivos
Urografia/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171011
[Lr] Data última revisão:
171011
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170824
[St] Status:MEDLINE
[do] DOI:10.1259/bjr.20170159


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[PMID]:28732671
[Au] Autor:van den Heijkant F; Vermeer TA; Vrijhof EJEJ; Nieuwenhuijzen GAP; Koldewijn EL; Rutten HJT
[Ad] Endereço:Department of Urology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands. Electronic address: fleurvdheijkant@gmail.com.
[Ti] Título:Psoas hitch ureteral reimplantation after surgery for locally advanced and locally recurrent colorectal cancer: Complications and oncological outcome.
[So] Source:Eur J Surg Oncol;43(10):1869-1875, 2017 Oct.
[Is] ISSN:1532-2157
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The most important prognostic factor for oncological outcome of rectal cancer is radical surgical resection. In patients with locally advanced T4 rectal cancer (LARC) or locally recurrent rectal cancer (LRRC) (partial) resection of the urinary tract is frequently required to achieve radical resection. The psoas bladder hitch (PBH) technique is the first choice for reconstruction of the ureter after partial resection and this bladder-preserving technique should not influence the oncological outcome. METHODS: Demographic and clinical data were collected prospectively for all patients operated on for LARC or LRRC between 1996 and 2014 who also underwent a psoas hitch ureter reconstruction. Urological complications and oncological outcome were assessed. RESULTS: The sample comprised 70 patients, 30 with LARC and 40 with LRRC. The mean age was 62 years (range: 39-86). Postoperative complications occurred in 38.6% of patients, the most frequent were urinary leakage (22.9%), ureteral stricture with hydronephrosis (8.6%) and urosepsis (4.3%). Surgical re-intervention was required in 4 cases (5.7%), resulting in permanent loss of bladder function and construction of a ureter-ileo-cutaneostomy in 3 cases (4.3%). Oncological outcome was not influenced by postoperative complications. CONCLUSION: The rate of complications associated with the PBH procedure was higher in our sample than in previous samples with benign conditions, but most complications were temporary and did not require surgical intervention. We conclude that the bladder-sparing PBH technique of ureter reconstruction is feasible in locally advanced and recurrent rectal cancer with invasion of the urinary tract after pelvic radiotherapy.
[Mh] Termos MeSH primário: Neoplasias Colorretais/cirurgia
Músculos Psoas/transplante
Procedimentos Cirúrgicos Reconstrutivos/métodos
Ureter/cirurgia
Neoplasias Ureterais/cirurgia
Bexiga Urinária/cirurgia
Procedimentos Cirúrgicos Urológicos/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Anastomose Cirúrgica/métodos
Neoplasias Colorretais/diagnóstico
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Invasividade Neoplásica
Recidiva Local de Neoplasia
Complicações Pós-Operatórias
Reimplante
Estudos Retrospectivos
Resultado do Tratamento
Neoplasias Ureterais/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170723
[St] Status:MEDLINE


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[PMID]:28621055
[Au] Autor:Marchioni M; Primiceri G; Cindolo L; Hampton LJ; Grob MB; Guruli G; Schips L; Shariat SF; Autorino R
[Ad] Endereço:Department of Urology, SS Annunziata Hospital, 'G. D'Annunzio' University of Chieti, Chieti, Italy.
[Ti] Título:Impact of diagnostic ureteroscopy on intravesical recurrence in patients undergoing radical nephroureterectomy for upper tract urothelial cancer: a systematic review and meta-analysis.
[So] Source:BJU Int;120(3):313-319, 2017 Sep.
[Is] ISSN:1464-410X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Aim of this study was to analyse the association between the use of diagnostic ureteroscopy (URS) and the development of intravesical recurrence (IVR) in patients undergoing radical nephroureterectomy (RNU) for high-risk upper tract urothelial carcinoma. A systematic review of the published data was performed up to December 2016, using multiple search engines to identify eligible studies. A formal meta-analysis was conducted of studies comparing patients who underwent URS before RNU with those who did not. Hazard ratios (HRs), with their 95% confidence intervals (CIs), from each study were used to calculate pooled HRs. Pooled estimates were calculated using a fixed-effects or random-effects model according to heterogeneity. Statistical analyses were performed using RevMan, version 5. Seven studies were included in the systematic review, but only six of these were deemed fully eligible for meta-analysis. Among the 2 382 patients included in the meta-analysis, 765 underwent diagnostic URS prior to RNU. All examined studies were retrospective, and the majority examined Asian populations. The IVR rate ranged from 39.2% to 60.7% and from 16.7% to 46% in patients with and without prior URS, respectively. In the pooled analysis, a statistically significant association was found between performance of URS prior to RNU and IVR (HR 1.56, 95% CI 1.33-1.88; P < 0.001). There was no heterogeneity in the observed outcomes, according to the I statistic of 2% (P = 0.40). Within the intrinsic limitations of this type of analysis, these findings suggest a significant association between the use of diagnostic URS and higher risk of developing IVR after RNU. Further research in this area should be encouraged to further investigate the possible causality behind this association and it potential clinical implications.
[Mh] Termos MeSH primário: Nefrectomia
Neoplasias Ureterais
Ureteroscopia
Neoplasias da Bexiga Urinária/epidemiologia
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Masculino
Resultado do Tratamento
Neoplasias Ureterais/diagnóstico
Neoplasias Ureterais/epidemiologia
Neoplasias Ureterais/patologia
Neoplasias Ureterais/cirurgia
Ureteroscopia/efeitos adversos
Ureteroscopia/mortalidade
Ureteroscopia/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170831
[Lr] Data última revisão:
170831
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170617
[St] Status:MEDLINE
[do] DOI:10.1111/bju.13935


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[PMID]:28534209
[Au] Autor:Sun P; Xue C; Li LR; Shao C; An X; Thomas R; Yang W; Deng YF; Jiang WQ; Shi YX
[Ad] Endereço:State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
[Ti] Título:The renal safety and efficacy of combined gemcitabine plus cisplatin and gemcitabine plus carboplatin chemotherapy in Chinese patients with a solitary kidney after nephroureterectomy.
[So] Source:Cancer Chemother Pharmacol;80(1):37-44, 2017 Jul.
[Is] ISSN:1432-0843
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The renal safety of cisplatin-based chemotherapy has not been investigated in patients with urothelial carcinoma of the upper urinary tract (UUT-UC) who retain a solitary kidney after nephroureterectomy. This study aimed to assess and compare the renal safety and efficacy of gemcitabine-cisplatin (GP) and gemcitabine-carboplatin (GC) in these patients. METHODS: The medical records of patients diagnosed with urothelial carcinoma at the Sun Yat-Sen University Cancer Center between January 2005 and December 2015 were retrospectively reviewed. The creatinine clearance (CrCl) and estimated glomerular filtration rate (eGFR) were used to assess renal function and were calculated using different formulas. RESULTS: A total of 71 patients were enrolled in this study; 48 patients were on GP, and 23 were on GC. The renal function indicators (CrCl and eGFR) were all significantly lower after GP chemotherapy than at baseline, a phenomenon that was not observed in the GC group. Severe nephrotoxicities (SNTs) were reported in 12 patients on GP (25%) and zero on GC. SNT risk factors included a more than 20% decrease in eGFR after one GP cycle and the presence of diabetes (all p < 0.05). Among patients treated with first-line palliative chemotherapy (n = 32), GC (n = 13) patients had an ORR of 46.2%, which was not significantly different from GP patients (36.8%, n = 19), whereas GC patients tended to have a shorter OS than GP patients (9.2 vs. 29 months, p = 0.200). CONCLUSIONS: Our results confirm that GP has an adverse impact on the renal function of patients with UUT-UC who retain a solitary kidney, but it can be safely administered to the majority of these patients without inducing SNT. In specific patients, GC is an alternative to GP that has comparable efficacy and favourable renal toxicity.
[Mh] Termos MeSH primário: Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem
Carcinoma de Células de Transição/tratamento farmacológico
Neoplasias Renais/terapia
Nefrectomia/métodos
Neoplasias Ureterais/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos
Grupo com Ancestrais do Continente Asiático
Carboplatina/administração & dosagem
Carcinoma de Células de Transição/patologia
Cisplatino/administração & dosagem
Creatinina/metabolismo
Desoxicitidina/administração & dosagem
Desoxicitidina/análogos & derivados
Feminino
Taxa de Filtração Glomerular
Seres Humanos
Rim/efeitos dos fármacos
Rim/patologia
Neoplasias Renais/patologia
Masculino
Meia-Idade
Estudos Retrospectivos
Fatores de Risco
Neoplasias Ureterais/patologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0W860991D6 (Deoxycytidine); AYI8EX34EU (Creatinine); B76N6SBZ8R (gemcitabine); BG3F62OND5 (Carboplatin); Q20Q21Q62J (Cisplatin)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170717
[Lr] Data última revisão:
170717
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170524
[St] Status:MEDLINE
[do] DOI:10.1007/s00280-017-3316-7


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[PMID]:28480774
[Au] Autor:Raman JD; Park R
[Ad] Endereço:a Division of Urology , Penn State Health Milton S. Hershey Medical Center , Hershey , PA , USA.
[Ti] Título:Endoscopic management of upper-tract urothelial carcinoma.
[So] Source:Expert Rev Anticancer Ther;17(6):545-554, 2017 Jun.
[Is] ISSN:1744-8328
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Radical nephroureterectomy with an ipsilateral bladder cuff is the referent standard for management of muscle-invasive, high-grade, or bulky upper-tract urothelial carcinoma (UTUC). Nonetheless, certain patients with UTUC have imperative or elective indications for kidney preservation thereby lending to more conservative strategies for management of this disease. Areas covered: A review of the PubMED and Medline databases was performed to identify original scientific and review articles discussing retrograde ureteroscopic or percutaneous antegrade resection of UTUC tumors published between 1995 and 2016. Comparative studies with radical nephroureterectomy were also included. Expert commentary: Endoscopic ablative treatments via retrograde or antegrade approaches may appropriately treat small, solitary, and low risk UTUC tumors. Recurrences in the ipsilateral upper-tract and bladder distal to the original tumor can occur following nephron-sparing treatments and therefore a vigilant surveillance program with a compliant patient is essential when pursuing this treatment approach.
[Mh] Termos MeSH primário: Carcinoma de Células de Transição/cirurgia
Endoscopia/métodos
Neoplasias Urológicas/cirurgia
[Mh] Termos MeSH secundário: Carcinoma de Células de Transição/patologia
Seres Humanos
Neoplasias Renais/patologia
Neoplasias Renais/cirurgia
Recidiva Local de Neoplasia
Nefrectomia/métodos
Tratamentos com Preservação do Órgão/métodos
Neoplasias Ureterais/patologia
Neoplasias Ureterais/cirurgia
Neoplasias Urológicas/patologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170605
[Lr] Data última revisão:
170605
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170509
[St] Status:MEDLINE
[do] DOI:10.1080/14737140.2017.1326823


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[PMID]:28418183
[Au] Autor:Chappidi MR; Kates M; Tosoian JJ; Johnson MH; Hahn NM; Bivalacqua TJ; Pierorazio PM
[Ad] Endereço:James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
[Ti] Título:Evaluation of gender-based disparities in time from initial haematuria presentation to upper tract urothelial carcinoma diagnosis: analysis of a nationwide insurance claims database.
[So] Source:BJU Int;120(3):377-386, 2017 Sep.
[Is] ISSN:1464-410X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To investigate the length of time from initial haematuria presentation to upper tract urothelial carcinoma (UTUC) diagnosis and the effect of gender on this duration. PATIENTS AND METHODS: Patients with haematuria claims in the year prior to UTUC diagnosis were identified from the MarketScan database (2010-2014). Delayed diagnosis was defined as >90 days from haematuria presentation to UTUC diagnosis. Multivariable Poisson regression models were used to determine factors associated with delayed UTUC diagnosis. RESULTS: Among 1 326 patients with UTUC, 469 (35.4%) experienced delayed diagnosis. Men (n = 866) had a longer median interval from haematuria to diagnosis than women (60 vs 49 days; P = 0.04). In the multivariable model, male gender (relative risk [RR] 1.13, 95% confidence interval [CI] 0.95-1.34) was not associated with delayed diagnosis, while urinary tract infection (UTI; RR 1.52, 95% CI 1.32-1.76), nephrolithiasis (RR 1.23, 95% CI 1.06-1.44), new (RR 1.37, 95% CI 1.12-1.66) and recurrent prostate-related diagnoses (RR 1.61, 95% CI 1.23-2.10) were. For men presenting to non-urologists, UTI (RR 1.44, 95% CI 1.22-1.71), nephrolithiasis (RR 1.25 95% CI 1.05-1.49), new (RR 1.41, 95% CI 1.12-1.78) and recurrent prostate-related diagnoses (RR 1.94, 95% CI 1.45-2.58) were associated with delayed diagnosis; however, for men presenting to urologists, nephrolithiasis (RR 1.08 95% CI 0.78-1.49), new (RR 1.15, 95% CI 0.79-1.68) and recurrent prostate-related diagnoses (RR 1.17, 95% CI 0.69-1.97) were not associated with delayed diagnosis, while UTI diagnosis (RR 1.74, 95% CI 1.31-2.31) was still associated with delayed diagnosis. CONCLUSION: A UTUC diagnosis was made >90 days after haematuria presentation in approximately one-third of patients. Men experienced a longer median interval from haematuria to UTUC diagnosis compared with women, but male gender was not an independent predictor of delayed diagnosis. Benign diagnoses during haematuria evaluation were strongly associated with delayed diagnosis, especially among patients initially seen by non-urologists. Future interventions should focus on development of non-invasive techniques to improve clinical risk stratification of patients presenting with haematuria and to educate practitioners, especially non-urologists, with regard to the importance of a thoughtful haematuria evaluation and the common mimickers of UTUC, to help reduce delays in diagnosis.
[Mh] Termos MeSH primário: Bases de Dados Factuais
Hematúria
Formulário de Reclamação de Seguro/estatística & dados numéricos
Neoplasias Ureterais
[Mh] Termos MeSH secundário: Estudos de Coortes
Diagnóstico Tardio
Feminino
Hematúria/diagnóstico
Hematúria/epidemiologia
Hematúria/etiologia
Seres Humanos
Neoplasias Renais/complicações
Neoplasias Renais/diagnóstico
Neoplasias Renais/epidemiologia
Masculino
Meia-Idade
Distribuição por Sexo
Neoplasias Ureterais/complicações
Neoplasias Ureterais/diagnóstico
Neoplasias Ureterais/epidemiologia
Neoplasias da Bexiga Urinária/complicações
Neoplasias da Bexiga Urinária/diagnóstico
Neoplasias da Bexiga Urinária/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170831
[Lr] Data última revisão:
170831
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170419
[St] Status:MEDLINE
[do] DOI:10.1111/bju.13878


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[PMID]:28409437
[Au] Autor:Zhang B; Yu W; Feng X; Zhao Z; Fan Y; Meng Y; Hu S; Cui Y; He Q; Zhang H; Li D; He Z; Zhou L; Jin J; Han W
[Ad] Endereço:Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xi Shi Ku St., West District, Beijing, People's Republic of China.
[Ti] Título:Prognostic significance of PD-L1 expression on tumor cells and tumor-infiltrating mononuclear cells in upper tract urothelial carcinoma.
[So] Source:Med Oncol;34(5):94, 2017 May.
[Is] ISSN:1559-131X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Immunotherapy targeting the programmed death-1 (PD-1) receptor/PD-1 ligand (PD-L1) pathway has shown promising results in several malignancies. However, the prognostic significance of PD-L1 expression remains unknown in patients with upper tract urothelial carcinoma (UTUC). This study aimed to evaluate PD-L1 expression and its association with clinicopathological characteristics and oncological outcomes in UTUC patients. PD-L1 expression on tumor cells and tumor-infiltrating mononuclear cells (TIMCs), and E-cadherin and N-cadherin expression on tumor cells were assessed by immunohistochemistry in a cohort of 162 patients with UTUC. Associations of PD-L1 expression on tumor cells and TIMCs with clinicopathological characteristics and cancer-specific survival (CSS) were evaluated. Out of 162 patients, 20 (12.3%) and 35 (21.6%) had positive PD-L1 expression on tumor cells and TIMCs, respectively. Decreased E-cadherin expression was associated with PD-L1 positivity on tumor cells (P = 0.048) and PD-L1 negativity on TIMCs (P = 0.033). PD-L1 expression on tumor cells was higher in patients with preoperative chronic kidney disease (CKD) stage 4-5 than in those with no CKD or CKD stage 1-3 (P = 0.011). PD-L1 was differentially expressed in tumor cells and TIMCs in UTUC. Multivariate analyses revealed that PD-L1 expression on tumor cells independently predicted shorter CSS (P = 0.012), whereas PD-L1 expression on TIMCs independently predicted longer CSS (P = 0.034).
[Mh] Termos MeSH primário: Antígeno B7-H1/biossíntese
Carcinoma de Células de Transição/metabolismo
Linfócitos do Interstício Tumoral/metabolismo
Neoplasias Ureterais/metabolismo
[Mh] Termos MeSH secundário: Idoso
Carcinoma de Células de Transição/patologia
Estudos de Coortes
Feminino
Seres Humanos
Imuno-Histoquímica
Linfócitos do Interstício Tumoral/patologia
Masculino
Estadiamento de Neoplasias
Estudos Retrospectivos
Neoplasias Ureterais/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (B7-H1 Antigen); 0 (CD274 protein, human)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170415
[St] Status:MEDLINE
[do] DOI:10.1007/s12032-017-0941-2



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