Ho Seok Chung1, Eu Chang Hwang1, Myung Soo Kim1, Seong Hyeon Yu1, Seung Il Jung1, Taek Won Kang1, Chan Choi2, Seock Hwan Choi3, Tae Gyun Kwon3, Joon Hwa Noh4, Myung Ki Kim5, Won Jin Cho6, Sung Gu Kang7, Seok Ho Kang7, Jun Cheon7, Ill Young Seo8, Hong Chung9, Hong Sup Kim9, Chan Ho Lee10, Ja Yoon Ku11, Hong Koo Ha11, Byung Hoon Kim12, Chang Wook Jeong13, Ja Hyeon Ku13, Cheol Kwak13, Dongdeuk Kwon14. 1. Department of Urology, Chonnam National University Medical School, Gwangju, Korea. 2. Department of Pathology, Chonnam National University Medical School, Gwangju, Korea. 3. Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea. 4. Department of Urology, Kwangju Christian Hospital, Gwangju, Korea. 5. Department of Urology, Chonbuk National University Medical School, Jeonju, Korea. 6. Department of Urology, Chosun University School of Medicine, Gwangju, Korea. 7. Department of Urology, Korea University College of Medicine, Seoul, Korea. 8. Department of Urology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea. 9. Department of Urology, Konkuk University School of Medicine, Chungju, Korea. 10. Department of Urology, Inje University School of Medicine, Busan, Korea. 11. Department of Urology, Pusan National University School of Medicine, Busan, Korea. 12. Department of Urology, Keimyung University School of Medicine, Daegu, Korea. 13. Department of Urology, Seoul National University College of Medicine, Seoul, Korea. 14. Department of Urology, Chonnam National University Medical School, Gwangju, Korea. Electronic address: urokwon@gmail.com.
Abstract
PURPOSE: To determine the prognostic effect of upper tract urothelial carcinoma (UTUC) with variant histology (VH) after radical nephroureterectomy (RNU). PATIENTS AND METHODS: The data of 1173 patients who received RNU for UTUC without neoadjuvant chemotherapy in 11 institutions between 2002 and 2016 were retrospectively reviewed. A matched propensity score analysis was performed. Clinicopathologic variables, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were compared between patients with pure UTUC and patients with UTUC and VH. Univariate and multivariate Cox proportional regression models were used to determine the independent variables associated with oncologic outcomes. RESULTS: UTUC with VH was observed in 93 patients (7.9%). After propensity score matching, UTUC with VH showed no difference in clinicopathologic features compared to pure UTUC; however, it was associated with shorter RFS, CSS, and OS (log rank, P = .011, P = .002, P = .006, respectively). Additionally, the multivariate analysis revealed that VH was independently associated with a poor RFS [hazard ratio (HR) = 1.92; 95% confidence interval (CI), 1.27-2.89; P = .002], CSS (HR = 4.47; 95% CI, 1.99-10.1; P = .001), and OS (HR = 3.00; 95% CI, 1.55-5.78; P = .001). However, the Kaplan-Meier method revealed that differences in RFS, CSS, and OS were not significant in patients who received adjuvant chemotherapy (log rank, P = .562, P = .060, P = .153, respectively). CONCLUSION: UTUC with VH was independently associated with poor oncologic outcomes in patients with UTUC after RNU. Although patients with UTUC and VH had a poor prognosis compared to patients with pure UTUC, adjuvant chemotherapy would be helpful in improving the survival rates of these patients.
PURPOSE: To determine the prognostic effect of upper tract urothelial carcinoma (UTUC) with variant histology (VH) after radical nephroureterectomy (RNU). PATIENTS AND METHODS: The data of 1173 patients who received RNU for UTUC without neoadjuvant chemotherapy in 11 institutions between 2002 and 2016 were retrospectively reviewed. A matched propensity score analysis was performed. Clinicopathologic variables, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were compared between patients with pure UTUC and patients with UTUC and VH. Univariate and multivariate Cox proportional regression models were used to determine the independent variables associated with oncologic outcomes. RESULTS: UTUC with VH was observed in 93 patients (7.9%). After propensity score matching, UTUC with VH showed no difference in clinicopathologic features compared to pure UTUC; however, it was associated with shorter RFS, CSS, and OS (log rank, P = .011, P = .002, P = .006, respectively). Additionally, the multivariate analysis revealed that VH was independently associated with a poor RFS [hazard ratio (HR) = 1.92; 95% confidence interval (CI), 1.27-2.89; P = .002], CSS (HR = 4.47; 95% CI, 1.99-10.1; P = .001), and OS (HR = 3.00; 95% CI, 1.55-5.78; P = .001). However, the Kaplan-Meier method revealed that differences in RFS, CSS, and OS were not significant in patients who received adjuvant chemotherapy (log rank, P = .562, P = .060, P = .153, respectively). CONCLUSION: UTUC with VH was independently associated with poor oncologic outcomes in patients with UTUC after RNU. Although patients with UTUC and VH had a poor prognosis compared to patients with pure UTUC, adjuvant chemotherapy would be helpful in improving the survival rates of these patients.