Predicting invasiveness and disease-specific survival in upper tract urothelial carcinoma: identifying relevant clinical tumour characteristics

Camilla Malm,Bernhard Tribukait,Alexandra Grahn,Georg Jaremko,Marianne Brehmer

doi:10.1007/s00345-019-02760-4

Abstract

PurposeThe aim of this prospective study was to identify the tumour characteristics that are associated with invasiveness and those that are relevant for disease-specific survival (DSS) in upper tract urothelial carcinoma, UTUC.MethodsFrom a prospective consecutive cohort of patients with suspicion of UTUC, those who were diagnosed with UTUC using URS prior to rNU between 2005 and 2012 were included. Tumour characteristics were analysed for prediction of invasiveness and association with DSS. Stages were categorised as superficial (pTa-1 and CIS only) or invasive (≥ pT2). Tumours were graded according to WHO 1999 classification. DSS was analysed regarding possible association with stage, grade, size, multifocality, location, ploidy and rate of proliferation. Associations were tested using Fisher’s exact test, Pearson Chi-square or Cox’s regression. Kaplan–Meier survival curves were constructed.ResultsForty-five consecutive patients were included, and 43 of them were included in the final analyses because their rNU specimens were available for reassessment. The only tumour characteristics that were significantly associated with stage were tumour grade (P < 0.001), DNA ploidy (P = 0.045) and rate of proliferation (P = 0.004). No association with stage was noted for size, multifocality or location. Grade, stage and rate of proliferation were associated with DSS.ConclusionsGrade, DNA ploidy and S-phase fraction were the only tumour characteristics associated with stage in our study. However, DNA ploidy was not associated with DSS. The prognostic factors that we identified were tumour grade, stage, and S-phase fraction.

Highlights

Balancing preservation of renal function against optimisation of oncological treatment in patients with upper tract urothelial carcinoma (UTUC) is challenging, and the guidelines developed by the European Association of Urology (EAU) have addressed this issue by dividing UTUC into high- and low-risk disease [1]
A statistically significant association was found between ploidy and grade (P < 0.001) and rate of proliferation (S-phase) and grade (G1: 2.2% [95% confidence intervals (CIs) 1.1–3.3], G2: 6.5% [95% CI 3.8–9.3], G3: 10.0 [95% CI 7.6–12.5])
The only tumour characteristics that were significantly associated with stage, superficial or invasive (> T1) were tumour grade (P < 0.001), DNA ploidy (P = 0.045) and rate of proliferation (P = 0.002); that is, no association with stage was noted for tumour size, multifocality or location (Table 2)

Summary

Introduction

Balancing preservation of renal function against optimisation of oncological treatment in patients with upper tract urothelial carcinoma (UTUC) is challenging, and the guidelines developed by the European Association of Urology (EAU) have addressed this issue by dividing UTUC into high- and low-risk disease [1]. Considering diseasespecific survival (DSS), organ-sparing treatment may represent a good option in patients with low-risk UTUC [1, 4,5,6,7]. A reliable model for preoperative identification of stage and organ confinement is essential for choice of treatment modality. Preoperative prognostic models based on retrospective data have been proposed for identification of non-organ-confined UTUC [8, 9], and these approaches suggest that tumour grade and hydronephrosis on imaging are key factors predicting invasiveness. Radiological investigations should be combined with ureterorenoscopy (URS) and analysis of cytopathological samples [10, 12]

Methods

Results

Discussion

Conclusion