Comparison of clinicopathologic characteristics, epigenetic biomarkers and prognosis between renal pelvic and ureteral tumors in upper tract urothelial carcinoma

Dong Fang,Liqun Zhou,Lei Zhang,Zhenpeng Cao,Xuesong Li,Nirmish Singla,Shiming He,Gengyan Xiong

doi:10.1186/s12894-018-0334-7

Abstract

BackgroundThere's no consensus about the difference between renal pelvic and ureteral tumors in terms of clinical features, pathological outcomes, epigenetic biomarkers and prognosis.MethodsThe data of 341 patients with renal pelvic tumors and 271 patients with ureteral tumors who underwent radical nephroureterectomy between 1999 and 2011 were retrospectively reviewed. The clinicopathologic features, gene promoters methylation status and oncologic outcomes were compared. Regression analysis was performed to identify oncologic prognosticators.ResultsPatients with ureteral tumors were relatively older (p = 0.002), and had higher likelihood of pre-operative renal insufficiency (p < 0.001), hypertension (p = 0.038) and hydronephrosis (P < 0.001), while in patients with renal pelvic tumors gross hematuria was more prevalent (p < 0.001). Renal pelvic tumors tended to exhibit non-organ-confined disease (p = 0.004) and larger tumor diameter (p = 0.001), while ureteral tumors had a higher likelihood of exhibiting high grade (p < 0.001) and sessile architecture (p = 0.023). Hypermethylated gene promoters were significantly more prevalent in renal pelvic tumors (p < 0.001), specifically for TMEFF2, GDF15, RASSF1A, SALL3 and ABCC6 (all p < 0.05). Tumor location failed to independently predict cancer-specific survival, overall survival, intravesical or contralateral recurrence (all p > 0.05), while gene methylation status was demonstrated to be an independent prognostic factor.ConclusionRenal pelvic tumors and ureteral tumors exhibited significant differences in clinicopathologic characteristics and epigenetic biomarkers. Gene promoter methylation might be an important mechanism in explaining distinct tumor patterns and behaviors in UTUC.

Highlights

There's no consensus about the difference between renal pelvic and ureteral tumors in terms of clinical features, pathological outcomes, epigenetic biomarkers and prognosis
Upper tract urothelial carcinoma refers to renal pelvic and ureteral tumors [2], with radical nephroureterectomy (RNU) and excision of the bladder cuff as the standard treatment [3]. Since both ureteral tumors and renal pelvic tumors originate from the urothelium, they have been traditionally classified as a single entity (UTUC) and managed in a relatively similar fashion, barring nephron-sparing approaches for more distally located tumors
In the present study based on a large cohort of Chinese Upper tract urothelial carcinomas (UTUC) patients, we investigated the difference between renal pelvic and ureteral tumors in terms of clinical features, pathological outcomes, epigenetic biomarkers and prognosis

Summary

Introduction

There's no consensus about the difference between renal pelvic and ureteral tumors in terms of clinical features, pathological outcomes, epigenetic biomarkers and prognosis. Upper tract urothelial carcinoma refers to renal pelvic and ureteral tumors [2], with radical nephroureterectomy (RNU) and excision of the bladder cuff as the standard treatment [3]. Since both ureteral tumors and renal pelvic tumors originate from the urothelium, they have been traditionally classified as a single entity (UTUC) and managed in a relatively similar fashion, barring nephron-sparing approaches for more distally located tumors. In the present study based on a large cohort of Chinese UTUC patients, we investigated the difference between renal pelvic and ureteral tumors in terms of clinical features, pathological outcomes, epigenetic biomarkers and prognosis

Methods

Results

Conclusion