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.

Impact of Surgical Wait Time on Survival in Patients With Upper Urinary Tract Urothelial Carcinoma With Hydronephrosis

“…A previous study found that the incidence of histologic variation in UTUC was approximately 10%. Micropapillary and sarcomatoid variations may lead to poor oncology outcomes ( 30 ). Another study also suggested that the micropapillary variation often predicts a poor biological behavior in invasive urothelial carcinoma of the bladder ( 31 ).…”

Use of F-18 FDG PET/CT Through Delayed Diuretic Imaging for Preoperative Evaluation of Upper Urinary Tract-Occupying Lesions

“…In our study 14 patients were confirmed only by ureteroscopy and biopsy, and they have limitations in upper tract disease. Previous studies showed that micropapillary and sarcomatoid variants were associated with poorer oncological outcomes, and molecular markers such as human epidermal growth factor receptor−2 (HER2) is considered to be a potential prognostic and therapeutic marker in patients with upper tract urothelial carcinoma ( 21 , 22 ). In our study, no patients with micropapillary and sarcomatoid variants were found.…”

Systemic Immune-Inflammation Index is a Promising Noninvasive Biomarker for Predicting the Survival of Urinary System Cancers: A Systematic Review and Meta-Analysis

“…[4] Meanwhile, the rest of the common malignancies of the urinary system, such as kidney, bladder, and upper urinary tract cancers, also pose a serious threat to human health. [5][6][7] Although surgical techniques and medical therapies (chemotherapy, radiotherapy, immunotherapy and so on) have been rapidly developed in the last ten years, the ve-year survival rate of patients with urinary system cancers is still not optimistic. [8,9] Therefore, especially useful new biomarkers that could be helpful for the diagnosis, evaluation and even improvement of prognosis in urinary system cancers should be identi ed in clinical practice.…”