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 - Data availability:
All data in this study in an anonymized format are available upon reasonable request.
Ethics approval and consent to participate.
The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Tayside Biorepository (TR459/SR1289) that has informed consent for genomic analysis of collected tissue. The Tayside Biorepository (TBR) holds approval from the Local Research Ethics Committee (LREC) to provide data and samples to researchers who satisfy the TBR Access Committee that their application is both ethically and scientifically appropriate. Informed consent was obtained from all subjects providing tissue samples to the Tayside Biorepository. Supplemental material for this article is available online
Copyright:
© The Author(s) 2022.
PY - 2023/2
Y1 - 2023/2
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
U2 - 10.1177/00369330221134233
DO - 10.1177/00369330221134233
M3 - Article
C2 - 36576735
SN - 0036-9330
VL - 68
SP - 4
EP - 13
JO - Scottish Medical Journal
JF - Scottish Medical Journal
IS - 1
ER -
