TY - JOUR
T1 - Urinary bladder recurrences following ureteroscopic biopsies of upper tract urothelial cancers
T2 - a multi-centre observational study with genomic assessment for clonality
AU - Anbarasan, Thineskrishna
AU - Nissar, Sheikh
AU - Turbitt, Julie
AU - Walls, Kathryn
AU - McLuckie, Sarah
AU - Clark, Caroline
AU - Bourdon, Jean-Christophe
AU - Tracey, Joel
AU - Bray, Susan
AU - Shamsuddin, Atlaf
AU - Alcorn, Jason
AU - Jain, Sunjay
AU - Hislop, Robert
AU - Biyani, Chandra Shekhar
AU - Nabi, Ghulam
N1 - Funding Information:
TA received funding from The Pathological Society of Great Britain and Ireland as part of the BMSc Intercalated Degree Award (ID2017 3748992).
Copyright:
© The Author(s) 2022.
PY - 2022/12/28
Y1 - 2022/12/28
N2 - Background and aims: Urinary bladder recurrences (UBRs) after radical nephroureterectomy (RNUx) are a known challenge in patients with upper-tract urothelial cancers (UTUCs). We aim to assess factors associated with UBR and clonal-relatedness with resected UTUC.Methods: Patients who underwent RNUx for UTUC between 1998 and 2015 in five institutions were identified. Clonal relatedness between primary UTUC and subsequent UBR in a sub-cohort was assessed using next-generation sequencing. A Kaplan–Meier curve was used to assess differences in UBR between two groups (with or without ureteroscopic biopsy).Results: Of 267 patients with complete records, 73 (27.3%) had UBR during follow-up. The five-year UBR-free survival in all patients was 64.7%. The five-year UBR-free-survival was inferior in patients who underwent URS biopsy compared with patients who did not undergo ureteroscopic biopsy (49.9% vs 76.4%, p < 0.001). History of bladder tumour (HR, 95% CI; 2.94, 1.73–5.00, p < 0.001), ureteroscopic biopsy (HR, 95% CI; 2.21, 1.38–3.53, p = 0.001) and preoperative urine cytology ≥C3 (HR, 95% CI; 2.06, 1.24–3.40, p = 0.005) were independently associated with UBR. Patients with ureteroscopic biopsy (n = 3/5) showed identical mutational changes for common genes (TP53 and FGFR3) between primary UTUC and subsequent UBR.Conclusions: Ureteroscopic biopsy of UTUC is a significant risk factor for UBR. Qualitative clonality assessment showed identical mutational signatures between primary UTUC and UBR.
AB - Background and aims: Urinary bladder recurrences (UBRs) after radical nephroureterectomy (RNUx) are a known challenge in patients with upper-tract urothelial cancers (UTUCs). We aim to assess factors associated with UBR and clonal-relatedness with resected UTUC.Methods: Patients who underwent RNUx for UTUC between 1998 and 2015 in five institutions were identified. Clonal relatedness between primary UTUC and subsequent UBR in a sub-cohort was assessed using next-generation sequencing. A Kaplan–Meier curve was used to assess differences in UBR between two groups (with or without ureteroscopic biopsy).Results: Of 267 patients with complete records, 73 (27.3%) had UBR during follow-up. The five-year UBR-free survival in all patients was 64.7%. The five-year UBR-free-survival was inferior in patients who underwent URS biopsy compared with patients who did not undergo ureteroscopic biopsy (49.9% vs 76.4%, p < 0.001). History of bladder tumour (HR, 95% CI; 2.94, 1.73–5.00, p < 0.001), ureteroscopic biopsy (HR, 95% CI; 2.21, 1.38–3.53, p = 0.001) and preoperative urine cytology ≥C3 (HR, 95% CI; 2.06, 1.24–3.40, p = 0.005) were independently associated with UBR. Patients with ureteroscopic biopsy (n = 3/5) showed identical mutational changes for common genes (TP53 and FGFR3) between primary UTUC and subsequent UBR.Conclusions: Ureteroscopic biopsy of UTUC is a significant risk factor for UBR. Qualitative clonality assessment showed identical mutational signatures between primary UTUC and UBR.
KW - Urothelial
KW - cancer
KW - ureteroscopy
KW - genetics
UR - http://www.scopus.com/inward/record.url?scp=85145185555&partnerID=8YFLogxK
U2 - 10.1177/00369330221134233
DO - 10.1177/00369330221134233
M3 - Article
C2 - 36576735
JO - Scottish Medical Journal
JF - Scottish Medical Journal
SN - 0036-9330
ER -
