Incidence and survival outcomes in patients with upper urinary tract urothelial carcinoma diagnosed with variant histology and treated with nephroureterectomy

Upper Tract Urothelial Carcinoma Collaboration Group, the European Association of Urology - Young Academic Urologists (EAU-YAU), Urothelial carcinoma working group

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate the incidence and survival outcomes of histological variants of upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Materials and Methods: We retrospectively analysed data from 1610 patients treated with RNU for clinically non-metastatic UTUC between 1990 and 2016 in several centres participating in the UTUC Collaboration. Histological variants were classified as micropapillary, squamous, sarcomatoid and other, including other rare variants (<10 cases for each). Multivariable competing risk analyses were conducted to assess the effect of variant histology on overall recurrence and cancer-specific mortality (CSM). Results: Overall, 1460 patients (91%) had pure urothelial carcinoma (PUC), whereas 150 (9%) were diagnosed with a variant histology, including 89 (5.0%), 41 (2.0%), 10 (1.0%) and 10 (1.0%) cases of micropapillary, squamous, sarcomatoid and other tumours, respectively. Variant histology was associated with the presence of adverse pathological features compared with PUC, including non-organ-confined disease (59% vs 38%; P < 0.001), lymph node invasion (28% vs 24%; P = 0.02), high-grade disease (88% vs 71%; P < 0.001), tumour necrosis (28% vs 16%; P = 0.001) and positive surgical margins (15% vs 8%; P = 0.01). In competing risk analysis, micropapillary variant was the only factor associated with worse recurrence (sub-hazard ratio [SHR] 2.27, 95% confidence interval [CI] 1.25–4.79; P = 0.02) whereas sarcomatoid variant was associated with worse CSM (SHR 16.8, 95% CI 6.86–41.17; P < 0.001). Conclusion: We found that one out of 10 patients with UTUC treated with RNU had variant histology. Only micropapillary and sarcomatoid variants were associated with poorer oncological outcomes after adjusting for available confounding factors.

Original languageEnglish
Pages (from-to)738-745
Number of pages8
JournalBJU International
Volume124
Issue number5
DOIs
Publication statusPublished - Nov 1 2019

Fingerprint

Urinary Tract
Histology
Carcinoma
Survival
Incidence
Neoplasms
Confidence Intervals
Recurrence
Mortality
Necrosis
Lymph Nodes

Keywords

  • #utuc
  • micropapillary
  • radical nephroureterectomy
  • RNU
  • squamous
  • upper tract urothelial carcinoma
  • variant histology

ASJC Scopus subject areas

  • Urology

Cite this

Upper Tract Urothelial Carcinoma Collaboration Group, & the European Association of Urology - Young Academic Urologists (EAU-YAU), Urothelial carcinoma working group (2019). Incidence and survival outcomes in patients with upper urinary tract urothelial carcinoma diagnosed with variant histology and treated with nephroureterectomy. BJU International, 124(5), 738-745. https://doi.org/10.1111/bju.14751

Incidence and survival outcomes in patients with upper urinary tract urothelial carcinoma diagnosed with variant histology and treated with nephroureterectomy. / Upper Tract Urothelial Carcinoma Collaboration Group; the European Association of Urology - Young Academic Urologists (EAU-YAU), Urothelial carcinoma working group.

In: BJU International, Vol. 124, No. 5, 01.11.2019, p. 738-745.

Research output: Contribution to journalArticle

Upper Tract Urothelial Carcinoma Collaboration Group & the European Association of Urology - Young Academic Urologists (EAU-YAU), Urothelial carcinoma working group 2019, 'Incidence and survival outcomes in patients with upper urinary tract urothelial carcinoma diagnosed with variant histology and treated with nephroureterectomy', BJU International, vol. 124, no. 5, pp. 738-745. https://doi.org/10.1111/bju.14751
Upper Tract Urothelial Carcinoma Collaboration Group, the European Association of Urology - Young Academic Urologists (EAU-YAU), Urothelial carcinoma working group. Incidence and survival outcomes in patients with upper urinary tract urothelial carcinoma diagnosed with variant histology and treated with nephroureterectomy. BJU International. 2019 Nov 1;124(5):738-745. https://doi.org/10.1111/bju.14751
Upper Tract Urothelial Carcinoma Collaboration Group ; the European Association of Urology - Young Academic Urologists (EAU-YAU), Urothelial carcinoma working group. / Incidence and survival outcomes in patients with upper urinary tract urothelial carcinoma diagnosed with variant histology and treated with nephroureterectomy. In: BJU International. 2019 ; Vol. 124, No. 5. pp. 738-745.
@article{895b83101c654eabb39e1a799546fb21,
title = "Incidence and survival outcomes in patients with upper urinary tract urothelial carcinoma diagnosed with variant histology and treated with nephroureterectomy",
abstract = "Objective: To evaluate the incidence and survival outcomes of histological variants of upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Materials and Methods: We retrospectively analysed data from 1610 patients treated with RNU for clinically non-metastatic UTUC between 1990 and 2016 in several centres participating in the UTUC Collaboration. Histological variants were classified as micropapillary, squamous, sarcomatoid and other, including other rare variants (<10 cases for each). Multivariable competing risk analyses were conducted to assess the effect of variant histology on overall recurrence and cancer-specific mortality (CSM). Results: Overall, 1460 patients (91{\%}) had pure urothelial carcinoma (PUC), whereas 150 (9{\%}) were diagnosed with a variant histology, including 89 (5.0{\%}), 41 (2.0{\%}), 10 (1.0{\%}) and 10 (1.0{\%}) cases of micropapillary, squamous, sarcomatoid and other tumours, respectively. Variant histology was associated with the presence of adverse pathological features compared with PUC, including non-organ-confined disease (59{\%} vs 38{\%}; P < 0.001), lymph node invasion (28{\%} vs 24{\%}; P = 0.02), high-grade disease (88{\%} vs 71{\%}; P < 0.001), tumour necrosis (28{\%} vs 16{\%}; P = 0.001) and positive surgical margins (15{\%} vs 8{\%}; P = 0.01). In competing risk analysis, micropapillary variant was the only factor associated with worse recurrence (sub-hazard ratio [SHR] 2.27, 95{\%} confidence interval [CI] 1.25–4.79; P = 0.02) whereas sarcomatoid variant was associated with worse CSM (SHR 16.8, 95{\%} CI 6.86–41.17; P < 0.001). Conclusion: We found that one out of 10 patients with UTUC treated with RNU had variant histology. Only micropapillary and sarcomatoid variants were associated with poorer oncological outcomes after adjusting for available confounding factors.",
keywords = "#utuc, micropapillary, radical nephroureterectomy, RNU, squamous, upper tract urothelial carcinoma, variant histology",
author = "Stefania Zamboni and Beat Foerster and Mohammad Abufaraj and Thomas Seisen and Morgan Roupret and Pierre Colin and {De la Taille}, Alexandre and {Di Bona}, Carlo and Benoit Peyronnet and Karim Bensalah and Roman Herout and Wirth, {Manfred Peter} and Vladimir Novotny and Francesco Soria and Piotr Chlosta and Alessandro Antonelli and Claudio Simeone and Philipp Baumeister and Agostino Mattei and Francesco Montorsi and Giuseppe Simone and Michele Gallucci and Kazumasa Matsumoto and Karakiewicz, {Pierre I.} and Alberto Briganti and Evanguelos Xylinas and Shariat, {Shahrokh F.} and Marco Moschini and {Upper Tract Urothelial Carcinoma Collaboration Group} and {the European Association of Urology - Young Academic Urologists (EAU-YAU), Urothelial carcinoma working group}",
year = "2019",
month = "11",
day = "1",
doi = "10.1111/bju.14751",
language = "English",
volume = "124",
pages = "738--745",
journal = "BJU International",
issn = "1464-4096",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "5",

}

TY - JOUR

T1 - Incidence and survival outcomes in patients with upper urinary tract urothelial carcinoma diagnosed with variant histology and treated with nephroureterectomy

AU - Zamboni, Stefania

AU - Foerster, Beat

AU - Abufaraj, Mohammad

AU - Seisen, Thomas

AU - Roupret, Morgan

AU - Colin, Pierre

AU - De la Taille, Alexandre

AU - Di Bona, Carlo

AU - Peyronnet, Benoit

AU - Bensalah, Karim

AU - Herout, Roman

AU - Wirth, Manfred Peter

AU - Novotny, Vladimir

AU - Soria, Francesco

AU - Chlosta, Piotr

AU - Antonelli, Alessandro

AU - Simeone, Claudio

AU - Baumeister, Philipp

AU - Mattei, Agostino

AU - Montorsi, Francesco

AU - Simone, Giuseppe

AU - Gallucci, Michele

AU - Matsumoto, Kazumasa

AU - Karakiewicz, Pierre I.

AU - Briganti, Alberto

AU - Xylinas, Evanguelos

AU - Shariat, Shahrokh F.

AU - Moschini, Marco

AU - Upper Tract Urothelial Carcinoma Collaboration Group

AU - the European Association of Urology - Young Academic Urologists (EAU-YAU), Urothelial carcinoma working group

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Objective: To evaluate the incidence and survival outcomes of histological variants of upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Materials and Methods: We retrospectively analysed data from 1610 patients treated with RNU for clinically non-metastatic UTUC between 1990 and 2016 in several centres participating in the UTUC Collaboration. Histological variants were classified as micropapillary, squamous, sarcomatoid and other, including other rare variants (<10 cases for each). Multivariable competing risk analyses were conducted to assess the effect of variant histology on overall recurrence and cancer-specific mortality (CSM). Results: Overall, 1460 patients (91%) had pure urothelial carcinoma (PUC), whereas 150 (9%) were diagnosed with a variant histology, including 89 (5.0%), 41 (2.0%), 10 (1.0%) and 10 (1.0%) cases of micropapillary, squamous, sarcomatoid and other tumours, respectively. Variant histology was associated with the presence of adverse pathological features compared with PUC, including non-organ-confined disease (59% vs 38%; P < 0.001), lymph node invasion (28% vs 24%; P = 0.02), high-grade disease (88% vs 71%; P < 0.001), tumour necrosis (28% vs 16%; P = 0.001) and positive surgical margins (15% vs 8%; P = 0.01). In competing risk analysis, micropapillary variant was the only factor associated with worse recurrence (sub-hazard ratio [SHR] 2.27, 95% confidence interval [CI] 1.25–4.79; P = 0.02) whereas sarcomatoid variant was associated with worse CSM (SHR 16.8, 95% CI 6.86–41.17; P < 0.001). Conclusion: We found that one out of 10 patients with UTUC treated with RNU had variant histology. Only micropapillary and sarcomatoid variants were associated with poorer oncological outcomes after adjusting for available confounding factors.

AB - Objective: To evaluate the incidence and survival outcomes of histological variants of upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Materials and Methods: We retrospectively analysed data from 1610 patients treated with RNU for clinically non-metastatic UTUC between 1990 and 2016 in several centres participating in the UTUC Collaboration. Histological variants were classified as micropapillary, squamous, sarcomatoid and other, including other rare variants (<10 cases for each). Multivariable competing risk analyses were conducted to assess the effect of variant histology on overall recurrence and cancer-specific mortality (CSM). Results: Overall, 1460 patients (91%) had pure urothelial carcinoma (PUC), whereas 150 (9%) were diagnosed with a variant histology, including 89 (5.0%), 41 (2.0%), 10 (1.0%) and 10 (1.0%) cases of micropapillary, squamous, sarcomatoid and other tumours, respectively. Variant histology was associated with the presence of adverse pathological features compared with PUC, including non-organ-confined disease (59% vs 38%; P < 0.001), lymph node invasion (28% vs 24%; P = 0.02), high-grade disease (88% vs 71%; P < 0.001), tumour necrosis (28% vs 16%; P = 0.001) and positive surgical margins (15% vs 8%; P = 0.01). In competing risk analysis, micropapillary variant was the only factor associated with worse recurrence (sub-hazard ratio [SHR] 2.27, 95% confidence interval [CI] 1.25–4.79; P = 0.02) whereas sarcomatoid variant was associated with worse CSM (SHR 16.8, 95% CI 6.86–41.17; P < 0.001). Conclusion: We found that one out of 10 patients with UTUC treated with RNU had variant histology. Only micropapillary and sarcomatoid variants were associated with poorer oncological outcomes after adjusting for available confounding factors.

KW - #utuc

KW - micropapillary

KW - radical nephroureterectomy

KW - RNU

KW - squamous

KW - upper tract urothelial carcinoma

KW - variant histology

UR - http://www.scopus.com/inward/record.url?scp=85063986153&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85063986153&partnerID=8YFLogxK

U2 - 10.1111/bju.14751

DO - 10.1111/bju.14751

M3 - Article

C2 - 30908835

AN - SCOPUS:85063986153

VL - 124

SP - 738

EP - 745

JO - BJU International

JF - BJU International

SN - 1464-4096

IS - 5

ER -