Ureteroscopic management of upper tract urothelial carcinoma (UTUC) in patients with Lynch Syndrome (hereditary nonpolyposis colorectal cancer syndrome). (1st March 2013)

• Record Type: Journal Article
• Authors: Hubosky, Scott G.; Boman, Bruce M.; Charles, Sarah; Bibbo, Marluce; Bagley, Demetrius H.
• Is Part Of: BJU international. Volume 112:Number 6(2013:Sep.)
• Page Start: 813
• Page End: 819
• Publication Date: 2013-03-01
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12008
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12008-sec-0001" sec-type="section"> <title>Objectives</title> <p> <list id="bju12008-list-0001" list-type="bullet"> <list-item> <p>To report our experience with ureteroscopic laser ablation of upper tract urothelial carcinoma (UTUC) in patients with Lynch Syndrome (LS), as defined by a documented germline mutation in the <italic>MSH‐2</italic> gene.</p> </list-item> <list-item> <p>To increase awareness among urologists about UTUC in this unique patient population and refer to genetic counselling when appropriate.</p> </list-item> </list> </p> </sec> <sec id="bju12008-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju12008-list-0002" list-type="bullet"> <list-item> <p>Demographic, clinical and pathological data on 13 consecutive patients with UTUC and documented <italic>MSH‐2</italic> mutation comprising 15 involved renal units were retrospectively collected.</p> </list-item> <list-item> <p>Ureteroscopic evaluations involved biopsy and laser treatment with combination holmium/neodymium yttrium aluminum garnet (YAG) lasers.</p> </list-item> <list-item> <p>Tumours were graded from 1 to 3 according to the 1973 World Health Organisation classification by a single pathologist evaluating cell block preparations.</p> </list-item> </list> </p> </sec> <sec id="bju12008-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju12008-list-0003" list-type="bullet"> <list-item> <p>The mean patient age at initial presentation was 56.5 years, with six of 13 patients having metachronous bilateral UT disease.</p> </list-item> <list-item> <p>The mean follow‐up was 59 months with a mean number of surveillances of 12.</p> </list-item> <list-item> <p>Of 15 affected renal units, 10/15 (67%) of initial tumours involved the ureter with mean lesion size of 17.5 mm, while five of 15 (33%) involved the intrarenal collecting system with mean lesion size of 25 mm.</p> </list-item> <list-item> <p>Ureteroscopy cleared 13/15 (87%) lesions and four of those 13 (31%) needed staged procedures. Renal preservation rate was 14/15 (93%) with one nephroureterectomy and one segmental ureterectomy performed.</p> </list-item> <list-item> <p>One patient developed metastatic UTUC after 40 months surveillance. No patient presented with bladder tumours but seven of the 13 (54%) developed them within 10 months of the initial ureteroscopy.</p> </list-item> </list> </p> </sec> <sec id="bju12008-sec-0004" sec-type="section"> <title>Conclusions</title> <p> <list id="bju12008-list-0004" list-type="bullet"> <list-item> <p>Patients with LS who develop UTUC present at younger ages and appear to be more likely to have bilateral UT disease over their lifetimes vs sporadic UTUC patients.</p> </list-item> <list-item> <p>Ureteroscopic laser ablation offers a good renal preservation rate with reasonable cancer control in patients willing to undergo endoscopic surveillance.</p> </list-item> <list-item> <p>Development of new bladder tumours is common.</p> </list-item> </list> </p> </sec> </abstract>