Tract Urothelial Carcinoma Research Articles

Reply to Editorial Comment on "Socioeconomic Disparities in Upper Tract Urothelial Carcinoma (UTUC) Management: A Regional Cohort Study"

Reply to Editorial Comment on "Socioeconomic Disparities in Upper Tract Urothelial Carcinoma (UTUC) Management: A Regional Cohort Study"

Segmental ureterectomy was associated with increased local recurrence for upper tract urothelial carcinoma compared to radical nephroureterectomy

Segmental ureterectomy was associated with increased local recurrence for upper tract urothelial carcinoma compared to radical nephroureterectomy

Oncologic Outcomes of Endoscopic Management of Upper Tract Urothelial Carcinoma: A Systematic Review and Pooled Analysis from the EAU-YAU Urothelial Working Group.

Data about the mid- and long-term oncologic outcomes of endoscopic kidney-sparing surgery (eKSS) for upper tract urothelial carcinoma (UTUC) are scarce. Therefore, we aimed to summarize the current evidence on the oncologic outcomes of eKSS for UTUC. A literature search was conducted to identify reports published until May 2024. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The outcomes were the following: recurrence-free (RFS), intravesical recurrence-free (IV-RFS), progression-free (PFS), cancer-specific (CSS), and overall (OS) survival. We found 56 studies (n=52 retrospective) that met our inclusion criteria (n=2862 patients). The 1-, 2-, 5-, and 10-yr OS rates were 96%, 87%, 80%, and 42%, respectively. The 1-, 2-, 5-, and 10-yr CSS rates were 97%, 89%, 82%, and 69%, respectively. RFS rates at 1, 2, and 5 yr were 69%, 55%, and 45%, respectively. IV-RFS rates at 1, 2, and 5 yr were 80%, 65%, and 64%, respectively. PFS rates at 2 and 5 yr were 75% and 69%, respectively. In low-grade UTUC, OS rates at 2 and 5 yr were 93% and 77%, respectively. The 2- and 5-yr CSS rates were 98% and 88%, respectively. At 2 yr, RFS, IV-RFS, and PFS were 52%, 54%, and 94%, respectively. For high-grade UTUC, only three studies reported data on 2-yr RFS, which was 34%. The main limitation is the heterogeneity found across the studies. Local recurrence, bladder recurrence, and progression of UTUC occur mainly within 2 yr after eKSS. After 5-yr follow-up, OS and CSS drop, while the risk of local recurrence is non-negligible.

The impact of diabetes and antidiabetics on uro-oncological disease outcomes: A single center experience.

To determine the impact of diabetes and antidiabetic medications on referral and pathological outcomes in uro-oncology cases. We report preliminary results from a single center study. We retrospectively collected data from 781 patients treated between 2018 and 2023 for radical prostatectomy (RP) for prostate cancer (PCa), radical cystectomy (RC) for bladder cancer (BCa), radical nephroureterectomy (RNU) for upper tract urothelial carcinoma, partial nephrectomy (PN) and radical nephrectomy (RN) for renal cell cancer (RCC). A total of 617 (79%) patients were non-diabetics and 164 (21%) were diabetics. Patient data were assessed for differences between diabetics and non-diabetics. All diabetic patients had a significantly higher BMI than non-diabetic patients (p<0.05 for PCa and p=0.006 for RC respectively). In diabetic patients with PCa, a lower proportion of ISUP grade 3 and 5 PCa was seen (p=0.047). In diabetic RCC patients on anti-diabetic medication, there was a significantly higher incidence of recurrence rates after RN (p=0.015). Penile cancer was diagnosed in diabetic patients at an older age (p=0.019). Significantly, higher BMI was observed for RP and RC in diabetic patients, as well as for RCC after RN. Diabetics showed a significantly higher occurrence of recurrence for RCC after RN.

Intravesical Instillation of Chemotherapy Before Radical Surgery for Upper Urinary Tract Urothelial Carcinoma: The REBACARE Trial.

Intravesical instillation of chemotherapy (IIC) after radical surgery for upper urinary tract urothelial carcinoma (UTUC) reduces the risk of intravesical recurrence (IVR). However, compliance is low because of possible extravesical leakage after bladder cuff excision. The aim of this study was to evaluate the efficacy of preoperative IIC in reducing the risk of IVR. In this prospective, single-arm, multi-institutional, phase 2 clinical trial, 190 chemonaïve patients with primary UTUC without prior or concurrent bladder cancer received a single intravesical instillation of mitomycin C for 1-2hr within 3 h before surgery. The primary endpoint was the 2-yr histologically confirmed IVR rate, with a target reduction of >40% (from 33.2% according to literature data to <20%). A historical cohort of 247 patients with UTUC who did not receive perioperative IIC served as the reference. Secondary endpoints included compliance, toxicity, and IVR-free survival, which was analyzed via multivariable Cox regression and stratified by previous diagnostic ureteroscopy (d-URS). The 2-yr IVR rate was 24% (95% confidence interval [CI] 18-31%) on intention-to-treat analysis and 23% (95% CI 13-32%) on per-protocol analysis. Multivariable analysis revealed that d-URS was associated with higher IVR risk. In the REBACARE cohort, patients without d-URS had threefold lower IVR risk (hazard ratio 0.33, 95% CI 0.12-0.87) in comparison to the reference cohort. Compliance with preoperative instillation was 96% and no grade >2 toxicity occurred. Preoperative IIC with mitomycin C was feasible and well tolerated and significantly reduced IVR risk for patients without d-URS. These findings suggest that preoperative IIC is a viable strategy for this subset of UTUC patients and that d-URS should be performed judiciously.

Durability of response of UGN-101: Longitudinal follow up of multicenter study.

UGN-101, a reverse thermal mitomycin gel for upper tract instillation, recently became the first FDA approved treatment for upper tract urothelial carcinoma (UTUC). However, the durability of UGN-101 treatment has not been well described. Here we present long term outcomes from our multi-institutional cohort for patients who initially responded to treatment. We identified patients from a multi-institutional database with UTUC who had a negative endoscopic evaluation following either adjuvant or chemoablative UGN-101 induction. Recurrence and progression data for those patients was reviewed. Kaplan-Meier survival analysis was performed, stratified by relevant clinical features. We identified 56 renal units that met the inclusion criteria of which 93% had low-grade disease while 4 cases had high-grade UTUC. With a median follow-up of 23.5 months, 21.4% of renal units experienced a recurrence, with 65% of renal units recurrence-free at 36 months. Three patients experienced eventual progression of disease leading to mortality, however only 1 of these patients had presumed low-grade UTUC and did not undergo nephroureterectomy on recurrence due to solitary kidney. UGN-101 treatment has excellent durability in patients who initially respond to the treatment. Further study is needed to better understand the long term outcomes of this novel therapy and also the risks/benefits of maintenance therapy in this setting. Caution should be used in patients with high-grade disease who appear to be at higher risk of relapse and death despite initial response.

Response to neoadjuvant chemotherapy leads to better survival outcomes in upper tract urothelial carcinoma.

To evaluate the benefit of neoadjuvant chemotherapy (NAC) for patients with high-risk upper tract urothelial carcinoma (UTUC) using a large, well-curated multi-institutional database. This study was a multi-institutional retrospective analysis conducted by the UTUC Collaborative Network (UCAN), combining data from 2276 patients with UTUC who underwent radical nephroureterectomy at seven high-volume tertiary care centres in the United States. The UCAN data were analysed to evaluate the impact of response to NAC on survival outcomes in patients with UTUC. A total of 378 patients in the UCAN database underwent NAC. On final surgical pathology, 101 patients (26.8%) had ≤ypT1N0 disease and were defined as NAC treatment responders. Patients who responded to NAC had significantly longer overall survival (OS) and progression-free survival (PFS) compared to non-responders. At 5 years post-surgery, 81.5% of responders were alive compared to 59.8% of non-responders. The median OS and PFS times among non-responders were 7.0 years (95% confidence interval [CI] 5.6-9.7) and 6.0 years (95% CI 4.6-9.3) respectively, while the median OS and PFS were not reached among responders. Limitations of this study include its retrospective design, heterogeneity in chemotherapy regimens, and the absence of clearly defined patient selection criteria for treatment. These data suggest that NAC can play a pivotal role in the treatment of well-selected UTUC patients who respond positively. Non-responders had clearly inferior outcomes. More work is needed to find predictors of response which can improve patient selection.

Risk scoring system for evaluating pathological upstaging after radical nephroureterectomy for upper tract urothelial carcinoma: A multicenter study in Japan.

Accurate preoperative staging of upper tract urothelial carcinoma is often difficult. Therefore, we aimed to investigate the preoperative factors associated with pathological upstaging in patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy and to develop a risk-scoring system to assess pathological upstaging. This retrospective study enrolled 386 patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy at Tottori University Hospital and affiliated hospitals between January 2015 and December 2021. Patients with clinical tumor stage 4, clinical node +, and those who received neoadjuvant chemotherapy were excluded from the study. The association between preoperative patient factors and pathological upstaging was analyzed. Statistical analyses included the t-test, chi-squared test, and logistic regression analysis. Of the 386 patients, 32 were excluded. Finally, 354 patients were included in this study, of whom 87 (24.6%) were pathologically upstaged. Hydronephrosis, positive urine cytology result, and maximum tumor diameter <30 mm were associated with upstaging. We developed a risk scoring system in which the score was the sum of the number of applicable items for three factors: hydronephrosis, positive urine cytology result, and maximum tumor size <30 mm. The probabilities of ureteral cancer upstaging were 0%, 8.3%, 29.5%, and 50.0% for scores of 0, 1, 2, and 3, respectively. Hydronephrosis, urine cytology, and maximum tumor diameter were associated with pathological upstaging. Our risk-scoring system may be useful in predicting pathological upstaging, especially in patients with ureteral cancer.

Hematuria in the ER patient: optimizing detection of upper tract urothelial cancer - A pictorial essay.

Upper tract urothelial carcinoma (UTUC) is a rare and challenging subset of the more frequently encountered urothelial carcinomas (UCs), comprising roughly 5-7% of all UCs and less than 10% of all renal tumors. Hematuria is a common presenting symptom in the emergency setting, often prompting imaging to rule out serious etiologies, with UTUC especially posing as a diagnostic challenge. These UTUC lesions of the kidney and ureter are often small, mimicking other pathologies, and are more aggressive than typical UC of the bladder, emphasizing the importance of timely and accurate diagnosis. Multidetector computed tomography urography (CTU) is the standard imaging modality for diagnosis, tumor staging, and surgical planning. Various postprocessing techniques like multiplanar reconstructions, maximal intensity projection (MIP) images, and 3D volumetric rendering technique (VRT) are crucial for accurate detection. In addition, 3D cinematic rendering (CR) is a novel technique that employs advanced illumination models, producing images with realistic shadows and increased surface detail, outperforming traditional VRT. We willreview the distinctive imaging features between UTUC and infiltrating mimicking lesions on CTU in patients who presented with hematuria, in conjunction with advanced postprocessing techniques,ultimately improving diagnostic confidence and preoperative planning in the emergency context.

Optimization of dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin therapy for Japanese patients with urothelial carcinoma.

Dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd-MVAC) regimen has been established as a systemic chemotherapy for patients with urothelial carcinoma. However, it is rarely used in Japan owing to the challenges associated with managing the related adverse events. This study aimed to optimize the dd-MVAC protocol for Japanese patients. Criteria were developed to adjust the doses of anticancer drugs used in dd-MVAC. In this regimen, the initial cycle of methotrexate and cisplatin was administered at 75% of the full dose. Patients who did not experience significant toxicities during the first cycle subsequently received the full dose starting from the second cycle. Additionally, the doses of methotrexate and cisplatin were adjusted according to the Cockcroft-Gault creatinine clearance. Based on these criteria, patients with urothelial carcinoma underwent dd-MVAC between August 2018 and May 2023, and all patients were scheduled to undergo six cycles. A total of 86 patients received dd-MVAC, with 36, 15, and 35 patients receiving it as neoadjuvant, adjuvant, and salvage chemotherapy, respectively. Fifty-nine patients (68.6%) completed the six scheduled cycles. Grade≥3 toxicities of Common Terminology Criteria for Adverse Events were observed in 76 (88.4%) patients; however, most were manageable. In the neoadjuvant cohort, the pathological complete response rate was 52.2% among patients with clinical N0 lower tract urothelial carcinoma. High levels of alkaline phosphatase at the initiation of treatment were correlated with failure to complete six cycles of dd-MVAC. Adjusting the dd-MVAC regimen based on renal function and significant adverse events may result in a high completion rate of scheduled treatments in Japanese patients with urothelial carcinoma.

Non-Caucasian Race/Ethnicity Predisposes to Unfavorable Stage and Grade at Upper Tract Urothelial Carcinoma Diagnosis.

To test whether race/ethnicity affects stage or grade distribution at upper tract urothelial carcinoma (UTUC) diagnosis. Within the Surveillance, Epidemiology, and End Results (SEER) database 2004-2020, UTUC patients were identified. Multivariable logistic regression models tested for the association between race/ethnicity and stage as well as grade at diagnosis according to renal pelvis vs. ureteral origin. Stage at presentation was defined as (i) metastatic stage (TanyNanyM1) and (ii) advanced stage (locoregional or metastatic (T3-4N0-2M0-1)). Of 14,384 UTUC patients, 8926 (62%) were renal pelvis. Of renal pelvis UTUC patients, 7064 (79%) were Caucasian, 797 (9%) Hispanic, 623 (7%) Asian Pacific Islander (API), and 442 (5%) African American (AA). Relative to Caucasians, API (odd ratio (OR) 1.85, 95% confidence interval (CI) 1.44-2.37, p < 0.001) and AA (OR 1.37, 95% CI 1.02-1.83, p = 0.03) patients more frequently harbored metastatic stage. APIs also more frequently harbored advanced (OR 1.33, 95% CI 1.11-1.60, p = 0.002) stage and high (OR 1.33, 95% CI 1.07-1.67, p = 0.01) grade. Of 5458 (38%) ureteral UTUC patients, 4360 (80%) were Caucasian, 362 (7%) Hispanic, 509 (9%) API, and 227 (4%) AA. Relative to Caucasians, Hispanic (OR 1.45, 95% CI 1.01-2.05, p = 0.03) patients more frequently harbored metastatic stage. APIs also more frequently harbored advanced stage (OR 1.22, 95% CI 1.02-1.47, p = 0.03) and high (OR 1.94, 95% CI 1.49-2.55, p < 0.001) grade. Race/ethnicity other than Caucasian, such as API and Hispanic, may predispose to higher odds of metastatic (TanyNanyM1) or advanced (T3-4N0-2M0-1) stages as well as to higher grade at initial diagnosis.

Diagnostic algorithm and key differential diagnoses of hematuria

The different causes of hematuria depend largely on age, gender and clinical context. Macrohematuria should always be investigated using cystoscopy and advanced imaging (CT/MRI with urographic phase). The most common differential diagnoses of macrohematuria include urinary tract infection, stones and urothelial carcinoma. A urological emergency is defined as macrohematuria with blood clot, urinary retention and new vegetative symptoms.

Benefit and Harms of Radical Nephroureterectomy as Part of a Multimodal Treatment Strategy for Upper Tract Urothelial Carcinoma Patients Presenting with Clinical Evidence of Regional Lymph Node Metastasis: A Systematic Review and Meta-analysis by the European Association of Urology Guidelines.

Given the uncertainty regarding the role of radical nephroureterectomy (RNU) as part of a multimodal treatment strategy for upper tract urothelial carcinoma (UTUC) patients with cN+ disease, we aimed to perform a systematic review and meta-analysis of the corresponding literature. Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we identified 17 observational comparative and noncomparative studies, published between January 2000 and September 2024, evaluating UTUC patients with cTanyN+M0 disease (P) who received RNU as part of a multimodal treatment strategy (I), as compared with any treatment strategy if applicable (C), to assess oncological or postoperative outcomes (O). Meta-analyses were further performed, as appropriate. Overall, 15 studies evaluated the effectiveness of adding chemotherapy to RNU in the perioperative setting without specifying the exact timing of delivery (n=1), in the induction setting (n=14), or in the adjuvant setting (n=5), while two studies evaluated the effectiveness of adding RNU to chemotherapy. Meta-analyses showed that the use of induction chemotherapy plus RNU versus RNU alone was associated with greater odds of pathological downstaging (risk ratio [RR]=3.06; 95% confidence interval [CI]=[2.48-3.77]; p<0.001; I2=0%; p=0.44) and pathological complete nodal response (RR=2.80; 95% CI=[2.03-3.86]; p<0.001; I2=0%; p=0.47) as well as prolonged overall survival (HR=0.52; 95% CI=[0.42-0.64]; p<0.001; I2=14%; p=0.33) without any significant impact on the risk of overall (RR=1.14; 95% CI=[0.79-1.64]; p=0.48; I2=0%; p=0.76) and major (RR=0.48; 95% CI=[0.18-1.24]; p=0.13; I2=0%; p=0.87) postoperative complications. In addition, the use of induction chemotherapy plus RNU versus RNU plus adjuvant chemotherapy (HR=0.58; 95% CI=[0.38-0.89]; p=0.01) or chemotherapy alone (HR=0.49; 95% CI=[0.32-0.76]; p=0.001; I2=46%; p=0.17) was associated with prolonged overall survival. Limitations include the observational design of all included studies. The use of RNU could provide the greatest oncological benefits without any significant harm in selected UTUC patients with fit general condition and resectable cN+ disease responding to induction chemotherapy. In this report, we looked at the outcomes of radical surgery in combination with systemic chemotherapy for upper tract urothelial carcinoma with clinical evidence of dissemination to the surrounding lymph nodes. We observed that the use of radical surgery was associated with the greatest oncological benefits without any increased risk of postoperative complications in patients with fit general condition and resectable disease responding to induction chemotherapy. We conclude that the use of induction chemotherapy plus radical surgery could be the best multimodal treatment strategy for these patients.

Incidence and mortality of upper tract urothelial carcinoma in Korea: A nationwide population-based study conducted from 2002 to 2020.

To describe the incidence and mortality of upper tract urothelial carcinoma (UTUC) from 2002-2020 using data from the Korean National Health Insurance Service, which contains data from the entire Korean population. Reimbursement records for 43,255 patients diagnosed with primary UTUC (according to the International Classification of Disease 10th revision code C65 and C66) between 2002-2020 were retrieved. The study period was split into four: period I (2002-2005), period II (2006-2010), period III (2011-2015), and period IV (2016-2020). Trends were quantified by calculating the annual percentage change (APC). Mortality data were obtained from the Statistics Korea. From 2002-2020, the incidence of UTUC in Korea increased gradually from 9.34 to 11.40 per 100,000 person-years. Although there was a male predominance, the male to female ratio did not change significantly over time; however, age at the time of diagnosis, the comorbidity index, and the proportion of patients undergoing open/laparoscopic surgery increased significantly over time. There was a modest improvement in 5-year survival (both all cause- and cancer-specific) over the study period. Multivariate analysis identified age at diagnosis, sex, the comorbidity index, and open/laparoscopic surgery as being associated with survival. Between 2002 and 2020, the incidence of UTUC in Korea showed a general upward trend; however, survival outcomes have improved. These representative datasets from the Korean population might provide crucial information that enables clinicians to better understand of the epidemiology of UTUC in Korea.

Editorial Comment for "Socioeconomic Disparities in Upper Tract Urothelial Carcinoma (UTUC) Management: A Regional Cohort Study".

Editorial Comment for "Socioeconomic Disparities in Upper Tract Urothelial Carcinoma (UTUC) Management: A Regional Cohort Study".

Statin therapy and upper tract urothelial carcinoma risk in hyperlipidemic patients with chronic kidney disease and end-stage kidney disease, a population-based 17-year follow-up study

Background The upper tract urothelial carcinoma (UTUC) risk associated with statin therapy in hyperlipidemic patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) remains obscure. Aim This retrospective cohort study investigated the UTUC risk for hyperlipidemic patients with CKD or ESKD associated with statin therapy. Methods From the national insurance claims data of Taiwan, we identified hyperlipidemic patients and established three pairs of statin users and non-users sub-cohorts matched by propensity scores: 401,490 pairs with normal kidney function, 37,734 pairs with CKD, and 6271 pairs with ESKD. Incidence rates and hazard ratio (HR) of UTUC were estimated, by the end of 2016, between statin and non-statin cohorts, and between hydrophilic statins users and lipophilic statins users. Time-dependent model estimated adjusted HR, and sub-distribution HR (sHR) accounting for the competing risk of deaths. Results The statin-users with ESKD were at increased UTUC risk (sHR 1.98; 95% confidence interval (CI), 1.28–3.06), significant for younger patients (40–64 years). The incidence was twofold greater in women than in men (31.8 versus 15.9 per 10,000 person-years). Receiving lipophilic statins was associated with increased UTUC risk in CKD and ESKD patients, while receiving hydrophilic statins was associated with increased UTUC risk in ESKD patients. Conclusions Patients with ESKD receiving statin were at an increased UTUC risk, significant for younger group (<65 y/o). The positive associations between UTUC and statin persisted in both genders with ESKD, and in therapy with either lipophilic statins or hydrophilic statins. Statin users with ESKD deserve attention for UTUC prevention.

Distribution and clinicopathological characteristics of G-CSF expression in tumor cells and stromal cells in upper tract urothelial carcinoma

Abstract Background Urothelial carcinoma (UC) is a common type of malignant disease; however, the diagnostic and prognostic markers of upper urinary tract urothelial cancer (UTUC) remain poorly understood because of its rarity. Methods To clarify the clinicopathological significance of granulocyte-colony stimulating factor (G-CSF) in UTUC, we analyzed the expression and distribution of G-CSF in 112 upper tract urothelial carcinoma (UTUC) samples with immunohistochemistry. Results In normal urothelium, G-CSF expression was weak or absent, whereas high expression of G-CSF was observed in UTUC tissues, both in tumor cells (TCs) and stromal cells (SCs). G-CSF expression in the TCs and SCs was associated with nodular/flat morphology, high grade, advanced T stage, and lymphovascular invasion in UTUC. G-CSF expression in SCs was associated with poor prognosis and was an independent prognostic factor. Public data showed that G-CSF expression was also associated with decreased progression-free survival and disease-specific survival. A prognostic model was constructed by incorporating the presence or absence of G-CSF expression along with clinicopathologic factors, which allowed for a more accurate prediction of poor prognosis. We further showed that G-CSF expression was associated with a high Ki-67 labeling index and with PD-L1, HER2, and p53 expression in UTUC. Conclusion G-CSF expression in TCs and SCs may play a crucial role in UTUC tumor progression. Notably, stromal G-CSF expression showed significant prognostic value, even when compared to major clinicopathological factors, suggesting that the evaluation of G-CSF expression may contribute to clinical decision-making in patients with UTUC.

Using apparent diffusion coefficient maps and radiomics to predict pathological grade in upper urinary tract urothelial carcinoma

BackgroundThe apparent diffusion coefficient (ADC) has been reported as a quantitative biomarker for assessing the aggressiveness of upper urinary tract urothelial carcinoma (UTUC), but it has typically been used only with mean ADC values. This study aims to develop a radiomics model using ADC maps to differentiate UTUC grades by incorporating texture features and to compare its performance with that of mean ADC values.MethodsA total of 215 patients with histopathologically confirmed UTUC were enrolled retrospectively and divided into training and test sets. The optimum cutoff value for the mean ADC was derived using the receiver operating characteristic (ROC) curve. Radiomics features based on ADC maps were extracted and screened, and then a radiomics model was constructed. Both mean ADC values and the radiomics model were tested on the training and test sets. ROC curve and DeLong test were used to assess the diagnostic performance.ResultsThe training set consisted of 151 patients (median age: 68.0, IQR: [63.0, 75.0] years; 80 males), whereas the test set consisted of 64 patients (median age: 68.0, IQR: [61.0, 72.3] years; 31 males). The ADC values were significantly lower in high-grade versus low-grade UTUC (1310 × 10− 6mm2/s vs. 1480 × 10− 6mm2/s, p < 0.001). The area under the curve (AUC) values of the mean ADC values in the training and test sets were 0.698 [95% confidence interval [CI]: 0.625–0.772] and 0.628 [95% CI: 0.474–0.782], respectively. Compared with the mean ADC values, the ADC-based radiomics model, which incorporates features such as log-sigma-1-0-mm-3D_glcm_ClusterProminence and wavelet-LLL_firstorder_10Percentile, obtained a significantly greater AUC in the training set (AUC: 1.000, 95% CI: 1.000–1.000, p < 0.001), and a trend towards statistical significance in the test set (AUC: 0.786, 95% CI: 0.651–0.921, p = 0.071).ConclusionsThe ADC-based radiomics model showed promising potential in predicting the pathological grade of UTUC, outperforming the mean ADC values in classification accuracy. Further studies with larger sample sizes and external validation are necessary to confirm its clinical utility and generalizability.Clinical trial numberNot applicable.

The Prognostic Importance of Expressions of FBLN2 and Microsatellit Instability (MSH2, MSH6, MLH1, PMS2) Immunhistochemical Biomarkers in Upper Urinary Tract Urothelial Cell Carcinomas

The Prognostic Importance of Expressions of FBLN2 and Microsatellit Instability (MSH2, MSH6, MLH1, PMS2) Immunhistochemical Biomarkers in Upper Urinary Tract Urothelial Cell Carcinomas

ASO Author Reflections: The Impact of Kidney-Sparing Surgery in Upper Tract Urothelial Carcinoma.

ASO Author Reflections: The Impact of Kidney-Sparing Surgery in Upper Tract Urothelial Carcinoma.