Subclassification of pT3 upper tract urothelial carcinoma: a multicenter retrospective study

Yamada, Yukio; Nakagawa, Tohru; Miyakawa, Jimpei; Kawai, Taketo; Taguchi, Satoru; Tabata, Mariko; Kaneko, Tomoyuki; Ishikawa, Akira; Miyazaki, Hideyo; Kondo, Yasushi; Matsumoto, Akihiko; Naito, Akira; Hikatsu, Masahiro; Fujii, Yoichi; Akiyama, Yoshiyuki; Yamada, Yuta; Sato, Yusuke; Nomiya, Akira; Yamada, Daisuke; Murata, Toshiki; Suzuki, Motofumi; Enomoto, Yutaka; Nishimatsu, Hiroaki; Takeuchi, Takumi; Tanaka, Yoshinori; Kume, Haruki

doi:10.1007/s00345-023-04300-7

Cited by 4 publications

(4 citation statements)

References 27 publications

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“…Furthermore, Park et al. introduced the pT3 subclassification defined by the presence of peripelvic/periureteral fat invasion, 9 which was supported by a recent study confirming its usefulness 12 . In our study, we adopted the definition proposed by Park et al., 9 and validated the results of the previous studies 9,12 using a relatively large cohort.…”

Section: Discussionsupporting

confidence: 79%

Prognostic significance of subclassifying pathological T3 upper tract urothelial carcinoma: Results from a multicenter cohort study

Suhara,

Urabe,

Yoshihara

et al. 2023

Int J of Urology

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ObjectiveThe population with pathological T3 (pT3) upper tract urothelial carcinoma (UTUC) is heterogeneous, thereby making prognostication challenging. We assessed the clinical ramifications of subclassifying pT3 UTUC after nephroureterectomy.MethodsWe conducted a retrospective analysis including 308 patients who underwent nephroureterectomy for pT3N0–1M0 UTUC. pT3 was subclassified into pT3a and pT3b based on invasion of the peripelvic and/or periureteral fat. Cox's proportional hazard models were utilized to determine the significant prognosticators of oncological outcomes, encompassing intravesical recurrence‐free survival, recurrence‐free survival (RFS), cancer‐specific survival (CSS), and overall survival.ResultsMultivariate analysis elucidated that pT3b status, pathological N1 status, and lymphovascular invasion status were independent risk factors for an unfavorable RFS and CSS. Although the RFS and CSS of patients with pT3b UTUC were superior to those in patients with pT4 UTUC, no significant disparities were detected between patients with pT3a and pT2.ConclusionOur findings demonstrate that pT3 UTUC with peripelvic/periureteral fat invasion is independently associated with metastasis and cancer‐specific death after nephroureterectomy. These findings provide patients and physicians with invaluable insight into the risk for disease progression in pT3 UTUC patients.

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Section: Discussionsupporting

confidence: 79%

Prognostic significance of subclassifying pathological T3 upper tract urothelial carcinoma: Results from a multicenter cohort study

Suhara,

Urabe,

Yoshihara

et al. 2023

Int J of Urology

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“…The present study focuses on elevated C-reactive protein levels after radical surgery, which may reflect the presence of micrometastases [21]. Other studies demonstrated several prognostic factors including pathological lymph node metastasis [21], histological high grade [22], lymphovascular invasion [23,24], and hydronephrosis [17]. However, these were not determined as independent prognostic factors by multivariate analysis (Table 3).…”

Section: Cuaj -Original Researchmentioning

confidence: 84%

Prognostic model using postoperative normalization of C-reactive protein levels in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy

Teishima,

Hirata,

Toge

et al. 2023

CUAJ

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Introduction: To improve the prediction of outcomes in patients who will undergo radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), we investigated the preoperative prognostic factors and developed a risk classification model. Methods: A total of 144 patients who underwent RNU with history of neither neoadjuvant nor adjuvant chemotherapy between 2008 and 2022 were retrospectively reviewed. Associations between perioperative/clinicopathological factors and outcomes, including cancer-specific survival (CSS), were assessed. We specifically focused on preoperative serum C-reactive protein (CRP) and its postoperative normalization. Results: Non-normalization of postoperative serum CRP level and pathological T3 stage were identified as independent predictive factors of shorter CSS in univariate and multivariate analysis (p=0.0150 and 0.0037, hazard ratio: 3.628 and 4.470, respectively). We classified the patients into three groups using these factors and found that five-year CSS was 88, 42.5, and 0% in the low-risk group (0 factors), intermediate-risk group (one factor), and high-risk group (two factors), respectively (p<0.0001). Conclusions: Non-normalization of postoperative serum CRP level and pathological T stage were identified as independent postoperative prognostic factors in patients with UTUC who underwent RNU. These factors can stratify three prognostic groups and may help urologists in clinical decision-making for adjuvant therapy.

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“…The prognostic impact of T2 is very close to that of T3 as seen in our established nomogram, suggesting that the significance of preoperative differentiation between T2 and T3 may be limited, while preoperative identification of T4 is necessary. We also carried out a subgroup analysis in light of the possibility that pT3 renal pelvis carcinoma and pT3 ureteral carcinoma have different prognosis ( 34 , 35 ). Unfortunately, there was no statistically significant difference in OS between pT3 renal pelvis carcinoma, pT3 ureteral carcinoma, and pT2 UTUC ( Figure S1 ).…”

Section: Discussionmentioning

confidence: 99%

A dynamic nomogram integrated with blood inflammation markers for predicting overall survival in patients with upper tract urothelial carcinoma

Sun,

Zhang,

Chen

et al. 2023

Transl Androl Urol

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Background Upper tract urothelial carcinoma (UTUC) is a relatively rare disease with a poor prognosis. A growing body of evidence demonstrates that inflammation and the inflammatory microenvironment play a crucial role in tumorigenesis and tumor progression. Our aim was to evaluate the prognostic value of blood inflammation markers and develop a prediction model that incorporates inflammation markers in order to predict overall survival (OS) of UTUC. Methods We included 304 localized UTUC patients from two medical institutions who had undergone radical nephroureterectomy (RNU) (167 in the training cohort, 137 in the validation cohort). Univariate and multivariate Cox regression analyses were performed to screen the prognostic factors, and a nomogram and a web-based calculator were generated based on these predictors. The Harrell’s concordance index (C-index), the area under the receiver operating characteristic (ROC) curve, the calibration curve, and decision curve analysis (DCA) were used to evaluate the performance of the nomogram. Results Independent predictors incorporated in the nomogram were pathological stage, surgical margin, albumin-to-globulin ratio (AGR), and hemoglobin-to-red cell distribution width ratio (HRR). The c-index value was 0.726 in the training cohort and 0.761 in the validation cohort. The area under the ROC of the nomogram at 1-, 3- and 5-year in the training and validation sets were 0.765, 0.755, 0.763, and 0.791, 0.833, 0.802, respectively. Both the internal and external validation calibration plots showed a subtle distinction between the predicted and the actual probabilities. And it appears to provide incremental benefits for clinical decision-making in comparison to the American Joint Committee of Cancer (AJCC) staging system. Conclusions In patients with UTUC after RNU, lower preoperative AGR and HRR were independent predictors of inferior survival. In addition, we created a novel blood inflammation marker-based dynamic nomogram that may be useful for surgeons or oncologists in risk stratification and patient selection for more intensive therapy and closer follow-up.

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Subclassification of pT3 upper tract urothelial carcinoma: a multicenter retrospective study

Cited by 4 publications

References 27 publications

Prognostic significance of subclassifying pathological T3 upper tract urothelial carcinoma: Results from a multicenter cohort study

Prognostic significance of subclassifying pathological T3 upper tract urothelial carcinoma: Results from a multicenter cohort study

Prognostic model using postoperative normalization of C-reactive protein levels in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy

A dynamic nomogram integrated with blood inflammation markers for predicting overall survival in patients with upper tract urothelial carcinoma

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