Size-focality-invasion in upper tract urothelial carcinoma (SFI-UTUC): A novel imaging-based score to predict survival outcomes.

Abstract

475 Background: Upper tract urothelial cell carcinoma (UTUC) is an uncommon malignancy with disparate outcomes. We developed a novel morphometric scoring system for prediction of oncologic and survival outcomes before nephroureterectomy (NU). Methods: Retrospective, multicenter analysis of UTUC patients who underwent NU after negative metastatic workup. Preoperative CT-urography was used to evaluate scores, based on 3 factors (Tumor Size, Focality, Invasion of architecture) with a score of 1-3 based on degree of each factor (total score 3-9). Primary outcome was overall survival (OS). Secondary outcomes were recurrence and recurrence free survival (RFS). Multivariable (MVA) and Kaplan-Meier (KMA) analyses were utilized. Results: We analyzed 244 patients (mean age 70.9, mean follow up 29.5 months). 61% with SFI-UTUC score 3-6 and 39% were score 7-9. No difference in age, gender, comorbid conditions, surgical approach, or complications between groups. Score 7-9 had a higher rate of pN+ disease (24.2% vs. 8.1%, p=0.002) but similar nuclear grade. All-cause mortality was higher for score 7-9 (47.4% vs. 28.9%, p=0.004). On MVA for all-cause mortality, age (OR 1.1), recurrence (OR 4.4) and score 7-9 (OR 2.0) were significant (p<0.05). KMA for OS demonstrated 5 year OS of 57.0% for score 3-6 and 34.1% for score 7-9 (p<0.01). KMA for RFS was significant for renal UTUC location with 5 year RFS of 72.3% for score 3-6 and 54.2% for score 7-9, (p<0.01). Conclusions: A novel scoring system for UTUC preoperative imaging may predict OS for tumors in renal and ureteral locations, as well as RFS for renal locations. Renal location. [Table: see text]