2193 PREOPERATIVE GRADING OF HYDRONEPHROSIS CAN IMPROVE THE ACCURACY OF WORSE PATHOLOGICAL PREDICTION IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA TREATED SURGICALLY

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology II1 Apr 20122193 PREOPERATIVE GRADING OF HYDRONEPHROSIS CAN IMPROVE THE ACCURACY OF WORSE PATHOLOGICAL PREDICTION IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA TREATED SURGICALLY Yujiro Ito, Eiji Kikuchi, Nobuyuki Tanaka, Hirotaka Akita, Masahiro Jinzaki, Shuji Mikami, Akira Miyajima, Ken Nakagawa, Sachio Kuribayashi, and Mototsugu Oya Yujiro ItoYujiro Ito Tokyo, Japan More articles by this author , Eiji KikuchiEiji Kikuchi Tokyo, Japan More articles by this author , Nobuyuki TanakaNobuyuki Tanaka Tokyo, Japan More articles by this author , Hirotaka AkitaHirotaka Akita Tokyo, Japan More articles by this author , Masahiro JinzakiMasahiro Jinzaki Tokyo, Japan More articles by this author , Shuji MikamiShuji Mikami Tokyo, Japan More articles by this author , Akira MiyajimaAkira Miyajima Tokyo, Japan More articles by this author , Ken NakagawaKen Nakagawa Tokyo, Japan More articles by this author , Sachio KuribayashiSachio Kuribayashi Tokyo, Japan More articles by this author , and Mototsugu OyaMototsugu Oya Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2367AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In patients with bladder tumors, the presence of hydronephrosis is associated with advanced disease and could be a predictor of poor outcome. However, there is limited information addressing whether a similar relationship exists for upper tract urothelial carcinoma (UTUC). We analyzed the impact of the grade of hydronephrosis whether it could predict worse pathological outcomes preoperatively in UTUC. METHODS We identified and retrospectively reviewed 91 patients who were evaluated by multidetector CT and/or MRI images preoperatively and treated by radical nephroureterectomy (RNU). Ipsilateral hydronephrosis was graded as 0 to 4 by two urological radiologists blinded to the clinical outcomes. All pathological specimens were re-reviewed by a dedicated genitourinary pathologist. The associations between the grade of hydronephrosis and pathological findings and patient outcomes were analyzed. RESULTS Of the 91 patients, the tumor was located in the renal pelvis in 35 and the ureter in 56 patients. Sixty-seven patients (73.6%) had ipsilateral hydronephrosis preoperatively, and their grade of hydronephrosis, 3 (3.3%) had grade1, 17 (18.7%) had grade2, 23 (25.3%) had grade3 and 24 (26.4%) had grade4. Using the defined cutoff line such as grade0,1 vs grade2,3,4, higher grade of hydronephrosis was significantly associated with pathological T stage (P<0.0001), the presence of lymphovascular invasion (LVI) (P=0.0014), and tumor grade 3 (P=0.0365) in surgical specimens. In multivariable analysis controlling preoperative indicators (patient age, gender, tumor location, tumor length, clinical T stage, urine cytology, and grade of hydronephrosis, a higher grade of hydronephrosis was independently predictors for pT3 or grater (P=0.0228, HR=4.98), positive LVI (P=0.0022, HR=6.37), and tumor grade3 (P=0.0311, HR=2.98) in surgical specimens, in addition to other prognostic indicators such as clinical T stage or urine cytology (as shown in Table). CONCLUSIONS The grade of preoperative hydronephrosis in image analysis could independently predict worse pathological features in UTUC. This information could help for selecting candidates for neoadjuvant chemotherapy as well as for making decisions concerning lymph node dissection. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e884 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yujiro Ito Tokyo, Japan More articles by this author Eiji Kikuchi Tokyo, Japan More articles by this author Nobuyuki Tanaka Tokyo, Japan More articles by this author Hirotaka Akita Tokyo, Japan More articles by this author Masahiro Jinzaki Tokyo, Japan More articles by this author Shuji Mikami Tokyo, Japan More articles by this author Akira Miyajima Tokyo, Japan More articles by this author Ken Nakagawa Tokyo, Japan More articles by this author Sachio Kuribayashi Tokyo, Japan More articles by this author Mototsugu Oya Tokyo, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...