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390 Miyake et al. | Journal of Clinical and Translational Research 2023; 9(6): 381-391
(208 out of 603 patients with UTUC) [31]. Discordance between Uro-Oncology Collaborative Group framework. Informed consent
the clinical TN category and pathological TN category was not was obtained from the participants or bereaved families through
avoidable in this study design. The retrospective study design has posters and/or websites using opt-out method.
an inherent potential for selection bias, and the decision criteria
for the implementation of NAC, chemotherapy regimen, timing of Consent for Publication
changing the treatment, and interval of radiographic evaluation were Not applicable.
dependent on the institutional protocol and physician’s discretion.
The cohort was derived from multiple institutions, which may have Availability of Data
introduced inconsistencies in surgical skills, clinical interpretation,
and pathological diagnoses. The treatment strategy, modality, The data underlying this article will be shared on reasonable
especially approval of gemcitabine plus platinum combination request to the corresponding author.
chemotherapy and advent of ICIs, and surgical skill change over References
time may have influenced outcomes. We did not include NAC-
induced histological changes in the analysis, because only one [1] Miyake M, Iida K, Nishimura N, Inoue T, Matsumoto H,
patient with MIBC showed downgrading from high-grade UC in Matsuyama H, et al. Site-specific risk stratification models
the transurethral resection specimens to low-grade UC in the radical for postoperative recurrence and survival prediction in
surgery specimen. Lastly, statistical power may be limited due to patients with upper tract urothelial carcinoma undergoing
the small number of patients and events in some subgroups. radical nephroureterectomy: Better stratification for
We suggest that it is vital to select NAC-treated patients with adjuvant therapy. Eur Urol Open Sci 2022;41:95-104.
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for adjuvant nivolumab. The transurethral resection specimens survival in transitional cell carcinoma of the upper urinary
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Not only assessment of tumor immune microenvironment upper urinary tract cancer after radical nephroureterectomy
including the extent of pro-tumoral inflammation and anti-tumoral in Taiwanese patients. Eur Urol 2008;54:1127-34.
inflammation but also molecular subtyping would be helpful to
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Routine clinical testing of immune checkpoint molecules, for Kikuchi E, et al. Outcomes of radical nephroureterectomy:
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such as CK5/6 and CK20 should be considered for making [5] Birtle A, Johnson M, Chester J, Jones R, Dolling D,
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Acknowledgments Eiben C. Neoadjuvant chemotherapy before nephroureterectomy
in high-risk upper tract urothelial cancer: A Systematic review
Clinicopathological statistics are based on the results of and meta-analysis. Cancers (Basel) 2022;14:4841.
contributions from several institutions in Western Japan. We thank [7] Witjes JA, Bruins HM, Carrión A, Cathomas R, Compérat E,
many urologists who are not listed as co-authors. Efstathiou JA, et al. European association of urology
Funding guidelines on muscle-invasive and metastatic bladder
cancer: Summary of the 2023 guidelines. Eur Urol
This research has received no external funding. 2023;S0302-2838(23)03073-7.
[8] Flaig TW, Spiess PE, Abern M, Agarwal N, Bangs R, Boorjian
Conflicts of Interest SA, et al. NCCN Guidelines® insights: Bladder cancer,

Nothing to declare. version 2.2022. J Natl Compr Canc Netw 2022;20:866-78.
[9] Matsumoto H, Shiraishi K, Azuma H, Inoue K, Uemura H,
Ethics Approval and Consent to Participate Eto M, et al. Clinical practice guidelines for bladder
This retrospective multicenter study was approved by the cancer 2019 update by the Japanese urological association:
Ethics Committee of each participating institute (reference ID: Summary of the revision. Int J Urol 2020;27:702-9.
1298, 1958, 2891, H30-048, and 2018-036) of the Nishinihon [10] Yin M, Joshi M, Meijer RP, Glantz M, Holder S,
DOI: http://dx.doi.org/10.18053/jctres.09.202306.23-00106