Histopathologic Characteristics of Upper Tract Urothelial Carcinoma With an Emphasis on Their Effect on Cancer Survival: A Single-Institute Experience With 305 Patients With Long-Term Follow-Up

Elawdy, Mohamed Mohamed; Taha, Diaa‐Eldin; Elbaset, M. A.; Abouelkheir, Rasha T.; Osman, Yasser

doi:10.1016/j.clgc.2016.04.017

Cited by 22 publications

(20 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several pathological features are related to poor prognosis . In particular, variant histology is an important prognostic factor in patients with bladder cancer (BCa) and its presence is generally associated with adverse pathological features and worse survival outcomes compared to standard urothelial histology ; however, few data exist regarding the impact of histological variants in patients affected by UTUC treated with RNU .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Consequently, the available evidence in this context is relatively weak. Grade and stage have been shown to be the strongest prognostic factors [3, 5, 8], whereas the significance of tumour size and multifocality has been questioned [9, 47]. Direct staging is not possible, because endoscopic samples are very small, and deep biopsies are associated with the risk of perforation and tumour seeding [48].…”

Section: Discussionmentioning

confidence: 99%

“…Inasmuch as UTUC is a relatively rare disease, most recommendations for clinical decision-making are based on retrospective studies. Tumour stage and grade have proven to be the strongest prognostic factors [3, 8], and some studies have reported that size and multifocality are not as decisive [9].…”

Section: Introductionmentioning

confidence: 99%

Consultation on UTUC, Stockholm 2018 aspects of risk stratification: long-term results and follow-up

et al. 2019

View full text Add to dashboard Cite

PurposeTo summarize current knowledge on upper urinary tract carcinoma (UTUC) regarding risk stratification, long-term results, and follow-up.MethodsA scoping review approach was applied to search literature in Pubmed, Web of Science, and Embase. Consensus was reached through discussions at Consultation on UTUC, September 2018, Stockholm.ResultsTo optimize oncological outcome considering both cancer-specific survival (CSS) and overall survival (OS), it is essential to identify pre- and postoperative prognostic factors. In low-risk UTUC, kidney-sparing surgery (KSS) and radical nephroureterectomy (RNU) offer equivalent CSS, whereas RNU may result in poorer OS due to nephron loss. For more aggressive tumours, undergrading can lead to insufficient treatment. The strongest prognostic factors are tumour stage and grade. Determining grade is best achieved by ureterorenoscopy (URS) with focal samples, biopsy and cytology. Staging is more difficult but can be indirectly achieved by multiphase computed tomography urography (CTU) or tumour grade determined by cytology and histopathology. Patients treated with KSS should be monitored closely with regular follow-ups (URS and CTU).ConclusionKSS should be offered in low-risk UTUC when feasible, whereas RNU is the treatment of choice in organ-confined high-risk UTUC. Intravesical recurrence (IVR) is common after RNU, but a single postoperative dose of mitomycin instillation decreases IVR. Endourological management has high local and bladder recurrence rates; however, its effect on CSS or overall survival OS is unclear. RNU is associated with significant risk of chronic kidney disease. Careful selection of patients and risk stratification are mandatory, and patients should be followed according to strict protocols.

show abstract

“…Stratification into low- and high-risk tumors [2] may aid choice of treatment modality (i.e., radical or KSS), but it is a matter of debate what parameters are essential for prognostic assessment. Recent studies suggest that tumor size and multifocality do not affect prognosis and efficacy of KSS to the same degree as tumor stage and grade [4–6].…”

Section: Introductionmentioning

confidence: 99%

“…Stage and grade are the strongest prognostic factors recurring in the literature [2, 6, 8–10]. Stage is difficult to determine when examining small ureteroscopic biopsies [11] with conventional 2D microscopes [7, 8], but fortunately there is good correlation between stage and grade [9].…”

Section: Introductionmentioning

confidence: 99%

Volumetric imaging: a potential tool to stage upper tract urothelial carcinoma

et al. 2019

View full text Add to dashboard Cite

PurposeTo investigate whether volumetric imaging of tumor vasculature can be used to phenotypically characterize advanced upper tract urothelial carcinoma, and if this technique can distinguish aggressive invasive tumors from non-aggressive superficial ones.MethodsIn a pilot study, two TaG1 and two T3G3 formalin-fixed paraffin-embedded (FFPE) tumor samples were examined using the DIPCO pipeline (Tanaka et al. in Nature Biomed Eng 1(10):796–806. 10.1038/s41551-017-0139-0, 2017). Briefly, punch biopsies of FFPE tumors were deparaffinized, cleared, immunolabeled with the vessel marker CD34 and imaged with a light-sheet microscope. Thereafter, the three-dimensional (3D) vasculature of the tumors was analyzed and characterized using a specialized image processing software.ResultsWe found that T3G3 tumors had increased CD34 density kurtosis and skewness compared to TaG1 tumors. This suggests that analysis of the 3D vasculature can distinguish between high-grade invasive and low-grade superficial tumors.ConclusionsVolumetric imaging of tumor samples may represent novel methodology that can complement conventional histopathology. Volumetric imaging enabled us to differentiate between invasive and non-invasive upper tract urothelial carcinoma. The method is of particular interest in diagnostic work-up of patients with upper tract urothelial carcinoma as previous findings indicate that volumetric imaging of vascular patterns could be used to differentiate superficial and invasive urothelial carcinoma, irrespective of if the tumor sample was deep or superficial. However, further and more extensive studies are required before this method can be applied clinically.

show abstract

Histopathologic Characteristics of Upper Tract Urothelial Carcinoma With an Emphasis on Their Effect on Cancer Survival: A Single-Institute Experience With 305 Patients With Long-Term Follow-Up

Cited by 22 publications

References 22 publications

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

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

Consultation on UTUC, Stockholm 2018 aspects of risk stratification: long-term results and follow-up

Volumetric imaging: a potential tool to stage upper tract urothelial carcinoma

Contact Info

Product

Resources

About