Preoperative Hydronephrosis, Ureteroscopic Biopsy Grade and Urinary Cytology Can Improve Prediction of Advanced Upper Tract Urothelial Carcinoma
- 17 May 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 184 (1), 69-73
- https://doi.org/10.1016/j.juro.2010.03.030
Abstract
We evaluated the value of hydronephrosis, ureteroscopic biopsy grade and urinary cytology to predict advanced upper tract urothelial carcinoma. We reviewed the charts of 469 patients with upper tract urothelial carcinoma treated with radical nephroureterectomy or distal ureterectomy. Complete data on hydronephrosis (present vs absent), ureteroscopic grade (high vs low) and urinary cytology (positive vs negative) were available in 172 patients. The outcome was muscle invasive (pT2-pT4) or nonorgan confined (pT3 or greater, or lymph node metastasis) upper tract urothelial carcinoma. Of the patients 92 (54%) had hydronephrosis, 74 (43%) had high grade disease on ureteroscopic biopsy and 137 (80%) had positive cytology. On univariate analysis hydronephrosis (p <0.001), high ureteroscopic grade (p <0.001) and positive cytology (p = 0.03) were associated with muscle invasive and nonorgan confined disease. On multivariate analysis adjusting for tumor site, gender and age hydronephrosis and high ureteroscopic grade were associated with muscle invasive carcinoma (HR 12.0 and 4.5, respectively, each p <0.001) but cytology was not (HR 2.3, p = 0.17). However, all 3 variables were independently associated with nonorgan confined disease (HR 5.1, p <0.001; HR 3.9, p <0.001; and HR 3.1, p = 0.035, respectively). Combining these 3 tests incrementally improved the prediction of upper tract urothelial carcinoma stage. Abnormality of all 3 tests had 89% and 73% positive predictive value for muscle invasive and nonorgan confined upper tract urothelial carcinoma, respectively, but when all tests were normal, the negative predictive value was 100%. Preoperative evaluation for hydronephrosis, ureteroscopic grade and cytology can identify patients at risk for advanced upper tract urothelial carcinoma. Such knowledge may impact surgery choice and extent as well as the need for perioperative chemotherapy regimens.Keywords
This publication has 18 references indexed in Scilit:
- Outcomes of radical nephroureterectomy: A series from the Upper Tract Urothelial Carcinoma CollaborationCancer, 2009
- Elective endoscopic management of transitional cell carcinoma first diagnosed in the upper urinary tractBJU International, 2008
- Prognostic Value of Lymph Node Dissection in Patients with Muscle-Invasive Transitional Cell Carcinoma of the Upper Urinary TractEuropean Urology, 2008
- Independent predictors of cancer‐specific survival in transitional cell carcinoma of the upper urinary tractCancer, 2007
- Endourologic Management of Patients with Upper-Tract Transitional-Cell Carcinoma: Long-Term Follow-up in a Single CenterJournal of Endourology, 2007
- Endoscopic treatment of upper tract transitional cell carcinomaUrologic Oncology, 2005
- Neoadjuvant Chemotherapy plus Cystectomy Compared with Cystectomy Alone for Locally Advanced Bladder CancerThe New England Journal of Medicine, 2003
- Limitations of computed tomography in the preoperative staging of upper tract urothelial carcinomaUrology, 2000
- URETEROSCOPIC MANAGEMENT OF UPPER TRACT TRANSITIONAL CELL CARCINOMA IN PATIENTS WITH NORMAL CONTRALATERAL KIDNEYSJournal of Urology, 2000
- URETEROSCOPIC BIOPSY OF UPPER TRACT UROTHELIAL CARCINOMA: IMPROVED DIAGNOSTIC ACCURACY AND HISTOPATHOLOGICAL CONSIDERATIONS USING A MULTI-BIOPSY APPROACHJournal of Urology, 2000