Biological and prognostic implications of biopsy upgrading for high-grade upper tract urothelial carcinoma at nephroureterectomy
Por:
Katayama S., Pradere B., Grossman N.C., Potretzke A.M., Boorjian S.A., Ghoreifi A., Daneshmand S., Djaladat H., Sfakianos J.P., Mari A., Khene, ZE, D'Andrea D., Hayakawa N., Breda A., Fontana M., Fujita K., Antonelli A., van Doeveren T., Steinbach C., Mori K., Laukhtina E., Roupret, M, Margulis V., Karakiewicz P.I., Araki M., Compérat E., Nasu Y., Shariat S.F.
Publicada:
1 ene 2023
Ahead of Print:
1 nov 2022
Resumen:
Objectives Technical limitations of ureteroscopic (URS) biopsy has been considered responsible for substantial upgrading rate in upper tract urothelial carcinoma (UTUC). However, the impact of tumor specific factors for upgrading remain uninvestigated. Methods Patients who underwent URS biopsy were included between 2005 and 2020 at 13 institutions. We assessed the prognostic impact of upgrading (low-grade on URS biopsy) versus same grade (high-grade on URS biopsy) for high-grade UTUC tumors on radical nephroureterectomy (RNU) specimens. Results This study included 371 patients, of whom 112 (30%) and 259 (70%) were biopsy-based low- and high-grade tumors, respectively. Median follow-up was 27.3 months. Patients with high-grade biopsy were more likely to harbor unfavorable pathologic features, such as lymphovascular invasion (p < 0.001) and positive lymph nodes (LNs; p < 0.001). On multivariable analyses adjusting for the established risk factors, high-grade biopsy was significantly associated with worse overall (hazard ratio [HR] 1.74; 95% confidence interval [CI], 1.10-2.75; p = 0.018), cancer-specific (HR 1.94; 95% CI, 1.07-3.52; p = 0.03), and recurrence-free survival (HR 1.80; 95% CI, 1.13-2.87; p = 0.013). In subgroup analyses of patients with pT2-T4 and/or positive LN, its significant association retained. Furthermore, high-grade biopsy in clinically non-muscle invasive disease significantly predicted upstaging to final pathologically advanced disease (>= pT2) compared to low-grade biopsy. Conclusions High tumor grade on URS biopsy is associated with features of biologically and clinically aggressive UTUC tumors. URS low-grade UTUC that becomes upgraded to high-grade might carry a better prognosis than high-grade UTUC on URS. Tumor specific factors are likely to be responsible for upgrading to high-grade on RNU.
Filiaciones:
Katayama S.:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Okayama Univ, Grad Sch Med Dent & Pharmaceut Sci, Dept Urol, Okayama, Japan
Pradere B.:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Grossman N.C.:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Univ Hosp Zurich, Dept Urol, Zurich, Switzerland
Potretzke A.M.:
Mayo Clin, Dept Urol, Rochester, MN USA
Boorjian S.A.:
Mayo Clin, Dept Urol, Rochester, MN USA
Ghoreifi A.:
Univ Southern Calif, Norris Comprehens Canc Ctr, Dept Urol, Los Angeles, CA 90007 USA
Daneshmand S.:
Univ Southern Calif, Norris Comprehens Canc Ctr, Dept Urol, Los Angeles, CA 90007 USA
Djaladat H.:
Univ Southern Calif, Norris Comprehens Canc Ctr, Dept Urol, Los Angeles, CA 90007 USA
Sfakianos J.P.:
Mt Sinai Hosp, Icahn Sch Med, Dept Urol, New York, NY 10029 USA
Mari A.:
Univ Florence, Careggi Hosp, Dept Urol, Florence, Italy
Khene, ZE:
CHU Rennes, Hosp Pontchaillou, Dept Urol, Rennes, France
D'Andrea D.:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Hayakawa N.:
St Marianna Univ, Sch Med, Dept Urol, Kawasaki, Kanagawa, Japan
Breda A.:
Autonoma Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
Fontana M.:
Autonoma Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
Fujita K.:
Osaka Univ, Grad Sch Med, Dept Urol, Osaka, Japan
Antonelli A.:
Univ Verona, Dept Surg Dent Pediat & Gynecol, Urol Unit AUOI Verona, Verona, Italy
van Doeveren T.:
Erasmus MC Canc Inst, Univ Med Ctr Rotterdam, Dept Urol, Rotterdam, Netherlands
Steinbach C.:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Mori K.:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Jikei Univ, Sch Med, Dept Urol, Tokyo, Japan
Laukhtina E.:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Sechenov Univ, Inst Urol & Reprod Hlth, Moscow, Russia
Roupret, M:
Sorbonne Univ, Pitie Salpetriere Hosp, AP HP, GRC Predict Oncouro 5,Urol, Paris, France
Margulis V.:
Univ Texas Southwestern Med Ctr Dallas, Dept Urol, Dallas, TX 75390 USA
Karakiewicz P.I.:
Univ Montreal, Hlth Ctr, Canc Prognost & Hlth Outcomes Unit, Montreal, PQ, Canada
Araki M.:
Okayama Univ, Grad Sch Med Dent & Pharmaceut Sci, Dept Urol, Okayama, Japan
Compérat E.:
Sorbonne Univ, Pitie Salpetriere Hosp, AP HP, GRC Predict Oncouro 5,Urol, Paris, France
Med Univ Vienna, Dept Pathol, Vienna, Austria
Nasu Y.:
Okayama Univ, Grad Sch Med Dent & Pharmaceut Sci, Dept Urol, Okayama, Japan
Shariat S.F.:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Sechenov Univ, Inst Urol & Reprod Hlth, Moscow, Russia
Univ Texas Southwestern Med Ctr Dallas, Dept Urol, Dallas, TX 75390 USA
Al Ahliyya Amman Univ, Hourani Ctr Appl Sci Res, Amman, Jordan
Weill Cornell Med Coll, Dept Urol, New York, NY USA
Charles Univ Prague, Fac Med 2, Dept Urol, Prague, Czech Republic
Karl Landsteiner Inst Urol & Androl, Vienna, Austria
Green Published, hybrid, All Open Access, Hybrid Gold, Green
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