Clinicopathologic characteristics and prognosis of upper tract urothelial carcinoma: an analysis of 368 radical nephroureterectomy specimens

Abstract

Objective: To evaluate the epidemiology, clinicopathological features and prognosis in upper tract urothelial carcinoma (UTUC) patients. Methods: All archival 368 UTUC cases that underwent radical nephroureterectomy between September 1999 and October 2014 were reviewed, and their clinicopathological features were analyzed. Follow-up time was 1-216 months, with a mean follow-up of 41 month. Results: One hundred and twenty-eight male and 240 female patients were included, with a mean age of 68 years ranging from 31 to 88 years. Tumor locations were classified in detail as follows: 148 renal pelvic tumors, 155 ureteral tumors, 58 renal pelvic and ureteral tumors, and 7 transitional tumors. Patients with history of renal transplantation (14.7%, 54/368) were more likely to develop UTUC before the age of 65 (P<0.01), with bilateral tract involved (P<0.01) and multifocal distributed (P=0.004). Histological grade was significantly associated with T stage (P<0.01), lympho-vascular involvement (P=0.001), neural invasion (P=0.005), carcinoma in situ (P=0.001) and extensive necrosis (P=0.020), while high-grade UTUC predominantly occurred in female patients (P=0.010) and histological variants (P<0.01). T stage was positively correlated with tumor size (P<0.01), lympho-vascular involvement (P<0.01), neural invasion (P<0.01) and lymph node metastasis (P=0.001). Furthermore, among the 214 followed-up cases, 76 died of the disease. Histological grade (P=0.002, P=0.005), T stage (P<0.01, P<0.01), lympho-vascular involvement (P=0.001, P=0.008), neural invasion (P<0.01, P=0.001) and extensive necrosis (P=0.017, P=0.023) were significantly associated with shorter overall survival and cancer specific survival of UTUC patients, respectively. In multivariable analyses, T stage (P<0.01, P<0.01) and extensive necrosis (P=0.004, P=0.014) were independent predictive factors of both overall survival and cancer specific survival, while neural invasion (P=0.007) and lymph node metastasis (P=0.007) were independent predictors of the overall survival. Conclusions: Chinese UTUC reveals its unique epidemiology. UTUC more commonly occurs in women and has a similar incidence between the renal pelvic and ureteral carcinoma. Patients with history of renal transplantation are prone to detect UTUC through physical examination rather than hematuria. Histological grade, T stage, lympho-vascular involvement, neural invasion and extensive necrosis are predictors of survival in UTUC patients, while advanced-stage and extensive necrosis are independent predictors of poor outcome.