Fluorescence in situ hybridization status of voided urine predicts invasive and high-grade upper tract urothelial carcinoma.

Xiaohong Su,Liqun Zhou,Yi Ding,Han Hao,Zhisong He,Lin Yao,Qian Zhang,Zheng Zhang,Cuijian Zhang,Yanqing Gong,Lin Cai,Kan Gong,Dong Fang,Xuesong Li

doi:10.18632/oncotarget.15344

Xiaohong Su, Liqun Zhou + Show 12 more

Open Access

https://doi.org/10.18632/oncotarget.15344

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Journal: Oncotarget	Publication Date: Feb 15, 2017
Citations: 11	License type: cc-by

Affiliation: Peking University First Hospital

Abstract

Here, we assessed the diagnostic accuracy of fluorescence in situ hybridization (FISH) for detecting aggressive upper tract urothelial carcinoma (UTUC). A total of 210 UTUC patients from a single hospital in China were enrolled in this retrospective study between 2012 and 2016. Patients were classified as FISH-positive or -negative based on FISH analysis of voided urine, and the clinicpathological characteristics of these two patient groups were compared. Patients with positive FISH results had more advanced tumor stages and higher tumor grades than those with negative results. The overall sensitivity of FISH for detecting advanced UTUC was 62.4% (131/210). The sensitivity and positive predictive values of positive FISH results were 76.5% and 59.5% for high-grade UTUC and 71.7% and 58.0% for muscle-invasive UTUC. These data suggest that voided urine FISH results accurately predict advanced UTUC and might help distinguish patients with aggressive disease from those who might benefit from conservative management.

Highlights

Upper tract urothelial carcinomas (UTUCs) are relatively rare compared to bladder cancer and account for approximately 5% to 10% of urothelial carcinomas [1]
Conservative management of low-risk UTUCs allows the renal unit to be preserved and spares the patient from morbidity associated with radical surgery [2]
Messer et al demonstrated in a multi-institutional study of 326 patients that urine cytology alone was unable to accurately predict muscle-invasive or high-grade disease in UTUC patients; positive urinary cytology had a sensitivity and PPV of only 56% and 54% for high-grade UTUC, and 62% and 44% for muscle-invasive UTUC, restricting analysis to patients with selective ureteral cytology improved the diagnostic accuracy [4]

Summary

Introduction

Upper tract urothelial carcinomas (UTUCs) are relatively rare compared to bladder cancer and account for approximately 5% to 10% of urothelial carcinomas [1]. Radical nephroureterectomy (RNU) with an ipsilateral bladder cuff excision, which is the gold-standard treatment for UTUC [2], can result in varying degrees of renal insufficiency. Conservative management of small, low-grade and non-invasive UTUC may help preserve renal function in select groups of patients [2], and accurate pre-oprative risk stratification of UTUC patients is crucial. Accurately determining the stage and grade of UTUC via urine cytology or preoperative imaging is difficult. Neither ureteroscopy nor urine cytology is sufficient for accurately predicting muscle invasion or the risk of high-grade disease in UTUC patients [3, 4]. Novel, more reliable methods are needed to identify low-risk patients before surgery

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Conclusion