Evaluation of prognostic factors in upper tract urothelial carcinoma (UTUC).

Abstract

372 Background: UTUC is relatively rare (5-10% of UC). Limited data on prognostic factors is available. Methods: A retrospective study of UTUC patients (pts) who had surgery (1995-2014) at Cleveland Clinic (n = 454) was conducted. Univariable (UVA) and multivariable (MVA) analysis (proportional hazards) with a stepwise selection algorithm (p = .10 and .05, as criteria for entry and retention in the model) was used to identify independent predictors of recurrence-free survival (RFS) and overall survival (OS). Results: 192 pts with invasive high grade UTUC were identified; median age at resection was 72; 69% men. 72% of pts had laparoscopic and 17% open nephrouretectomy, 23% had +ve margins (including bladder/ureter cuff), 22% had multifocal tumor. Median tumor size 3.5 cm (0.2-12); 70% had tumors < 5 cm; 65% pT3, 8% pT4 stage; among pts with lymph node (LN) dissection, 25% had +ve LN. All but 3 pts (2 sarcomatoid, 1 small cell) had primarily UC; 28% mixed UC histology; 40% CIS, 54% confirmed lymphovascular invasion (LVI); 10 neoadjuvant, 14 confirmed adjuvant therapy). Among 116 pts with RFS data available 59% had disease recurrence; 8% died with no known recurrence. Estimated median RFS was 13.1 months (m) (95%CI 8.6-18.6). In UVA, age, positive margins, tumor size, smoking history, pT stage, LVI, primary site impacted RFS. In MVA, margin status (p = .04), age (p = .04), pT stage (p = .05) were independently associated with RFS. Among 175 pts with OS data available, 38% died with estimated median OS 44.6 m (95%CI 24.1-107.4); median follow-up was 13.8 m (0.1-185.7) in pts alive at last follow up. In UVA, LVI, tumor size, age, pT stage, tumor location, ECOG PS impacted OS. In MVA, tumor size (p = .002), CIS (p = .004), tumor location (p = .04), LVI (p = .04) independently predicted OS. Using these factors, 3 prognostic groups were identified for each outcome (see table). Conclusions: Clinic-pathological parameters can be prognostic in UTUC; further validation is needed. [Table: see text]