Shu-Yu Wu

Yao-Chou Tsai

Frontiers in Surgery

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TYPE EditorialPUBLISHED 17 August 2023| DOI 10.3389/fsurg.2023.1228589EDITED AND REWIEWED BYFrancesco Giovinazzo,Agostino Gemelli University Polyclinic (IRCCS),Italy*CORRESPONDENCEYao-Chou Tsaitsai1970523@yahoo.com.twRECEIVED 25 May 2023ACCEPTED 21 July 2023PUBLISHED 17 August 2023CITATIONWu S-Y and Tsai Y-C (2023) Editorial: Urothelialcarcinoma of renal pelvis and ureter, prognosisand recent advances.Front. Surg. 10:1228589.doi: 10.3389/fsurg.2023.1228589COPYRIGHT© 2023 Wu and Tsai. This is an open-accessarticle distributed under the terms of theCreative Commons Attribution License (CC BY).The use, distribution or reproduction in otherforums is permitted, provided the originalauthor(s) and the copyright owner(s) arecredited and that the original publication in thisjournal is cited, in accordance with acceptedacademic practice. No use, distribution orreproduction is permitted which does notcomply with these terms.Frontiers in SurgeryEditorial: Urothelial carcinoma ofrenal pelvis and ureter, prognosisand recent advancesShu-Yu Wu1,2 and Yao-Chou Tsai1,2*1Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City,Taiwan, 2School of Medicine, Buddhist Tzu Chi University, Hualien, TaiwanKEYWORDSUTUC (renal pelvis & ureter), radical nephrectomy, radical nephroureterectomy (RNU),elderly, urothelial cancer (UC)Editorial on the Research TopicUrothelial carcinoma of renal pelvis and ureter, prognosis and recentadvancesIntroductionUrothelial carcinoma of the renal pelvis and ureter is a prevalent malignancy primarilyaffecting the elderly population (1). Its incidence has been on the rise in recent years (2).With evolving knowledge of the disease, significant advancements in prognosis predictionand treatment strategies have emerged. This editorial article aims to discuss thecontributions of recent studies in this special issue regarding UTUC, shedding light onprognosis and introducing novel approaches to improve patient outcomes.Insights into mortality patterns and therapeutic strategiesA comprehensive analysis exploring the causes of death among upper tract urothelialcarcinoma (UTUC) survivors has provided valuable insights into mortality patterns. Byutilizing the National Cancer Institute’s Surveillance, Epidemiology, and End Results(SEER) database, a large cohort of UTUC patients was examined (Zhanghuang et al.).The study revealed that non-UTUC deaths accounted for the majority of mortality amongpatients with localized disease. This highlights the importance of considering non-cancercauses in the management of UTUC survivors. Moreover, UTUC was found to be theleading cause of death in patients with regional and distant stages, emphasizing the needfor improved therapeutic strategies targeting advanced disease while considering theincreased risk of death from non-cancer causes (2).Significance of surgical methods and precision interventionA propensity score-matched study assessed the impact of surgical methods on overallsurvival (OS) and cancer-specific survival (CSS) in renal pelvic urothelial carcinoma01 frontiersin.orgWu and Tsai 10.3389/fsurg.2023.1228589(RPUC) patients. Using data from the SEER database, the studycompared radical nephroureterectomy (NU) and inadvertentradical nephrectomy (RN). The results underscored thesignificance of accurate diagnosis and appropriate surgicalintervention in RPUC patients. The study concluded that RNcould lead to worse oncological outcomes compared to NU,emphasizing the importance of precise surgical planningand execution.Differentiating radical nephroureterectomyand inadvertent radical nephrectomyAnother study emphasized the importance of distinguishingbetween radical nephroureterectomy (NU) and inadvertentradical nephrectomy (RN) in patients with renal pelvis urothelialcarcinoma (RPUC). A retrospective analysis of data from theSEER database revealed that patients who underwent RNexperienced worse overall survival (OS) compared to those whoreceived NU. Furthermore, the study highlighted that thenegative impact of RN on OS was more significant in patientswith tumors larger than 4.2 cm (Wu et al.).Exploring surgical approaches andpredictive factorsA study utilizing data from the Taiwan nationwide upperurinary tract urothelial carcinoma (UTUC) collaborationdatabase evaluated the outcomes of transperitoneal hand-assistedlaparoscopic nephroureterectomy (TP-HALNU) andtransperitoneal pure laparoscopic nephroureterectomy (TP-LNU)(Kuo et al.). While no significant differences were observed insurgical outcomes between the two approaches, the studyidentified various predictive factors associated with adverseoncological outcomes. Age over 70, positive lymph nodemetastasis, upper ureter tumor location, and male sex wereidentified as potential risk factors. Additionally, higher surgicalvolume showed trends toward favorable outcomes in terms ofoverall survival and cancer-specific survival.Role of nephroureterectomy in stage IVUTUCA multicenter retrospective cohort study addressed the role ofnephroureterectomy (NU) in stage IV upper tract urothelialcarcinoma (UTUC) (Lin et al.). The findings indicate thatpatients who received chemotherapy (CT) combined with NUFrontiers in Surgery 02exhibited improved overall survival (OS) compared to those whoreceived CT alone. This benefit was observed in bothnonmetastatic and metastatic UTUC. The study emphasizes thepotential advantages of NU in prolonging survival outcomes forpatients with advanced-stage UTUC.ConclusionCollectively, these studies contribute to our understanding ofurothelial carcinoma of the renal pelvis and ureter, highlightingthe significance of accurate diagnosis and appropriate surgicalmanagement. Inadvertent radical nephrectomy (RN) was shownto have a negative impact on overall survival (OS), particularly inpatients with larger tumors. Furthermore, while the choicebetween surgical approaches may not significantly influenceoutcomes, other factors such as patient age, lymph nodemetastasis, tumor location, and surgical volume should beconsidered for prognostic evaluation. Finally, the role ofnephroureterectomy (NU) in stage IV UTUC demonstratespotential benefits in terms of overall survival (OS) for bothnonmetastatic and metastatic cases. These findings underscorethe importance of precise diagnosis and treatment amongpatients with UTUC.Author contributionsConceptulizatoin, writing and review: Y-CT. Data collection:S-YW. All authors contributed to the article and approved thesubmitted version.Conflict of interestThe authors declare that the research was conducted in theabsence of any commercial or financial relationships that couldbe construed as a potential conflict of interest.Publisher’s noteAll claims expressed in this article are solely those of theauthors and do not necessarily represent those of their affiliatedorganizations, or those of the publisher, the editors and thereviewers. Any product that may be evaluated in this article, orclaim that may be made by its manufacturer, is not guaranteedor endorsed by the publisher.References1. Yeh HC, Chang CH, Fang JK, Chen IHA, Lin JT, Hong JH, et al. The value ofpreoperative local symptoms in prognosis of upper tract urothelial carcinoma afterradical nephroureterectomy: a retrospective, multicenter cohort study. Front Oncol.2022;12:872849. doi: 10.3389/fonc.2022.8728492. Chen IA, Chang CH, Huang CP, Wu WJ, Li CC, Chen CH, et al. Factorspredicting oncological outcomes of radical nephroureterectomy for upper tracturothelial carcinoma in Taiwan. Front Oncol. 2021;11:766576. doi: 10.3389/fonc.2021.766576frontiersin.org

Editorial: Urothelial carcinoma of renal pelvis and ureter, prognosis and recent advances

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Editorial: Urothelial carcinoma of renal pelvis and ureter, prognosis and recent advances

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