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Caractérisation de l’évolution des tumeurs urothéliales de la voie excrétrice urinaire supérieure après néphrourétérectomie totale

Abstract : Although radical nephroureterectomy remains currently considered as the standard of care for upper tract urothelial carcinoma (UTUC), there is a high risk of postoperative recurrence, which can occur either within the bladder or the surgical field and/or distant sites. The aim of our study was to investigate and better characterize these events. With regards to intra-vesical recurrence, a systematic review and meta-analysis was conducted to identify all significant clinical and pathological predictors. Moreover, an additional cohort study suggested that, from a biological perspective, such an event could be related to the presence of the FGFR3 mutation detected from urinary DNA. With regards to locoregional and/or distant recurrence, a central pathology review of UTUC patients with pT3 disease showed that there may be a prognostic interest in stratifying these individuals based on the extent of local invasion (pT3a vs. pT3b) to propose a risk-adapted strategy for postoperative management. Nonetheless, an US hospital-based registry study revealed that all patients with pT3-T4 and/or pN+ UTUC could derive an overall survival benefit from adjuvant chemotherapy. Finally, a preliminary analysis from a large French cohort of UTUC patients established that the 2 mm TMA technique can be used to assess the prognostic interest of determining PDL1 expression on tumor cells with 28.8 antibody and PD-1 expression on TILs with NAT105 antibody, both at the 5% threshold for positivity.
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  • HAL Id : tel-02614224, version 1

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Thomas Seisen. Caractérisation de l’évolution des tumeurs urothéliales de la voie excrétrice urinaire supérieure après néphrourétérectomie totale. Urologie et Néphrologie. Sorbonne Université, 2018. Français. ⟨NNT : 2018SORUS486⟩. ⟨tel-02614224⟩

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