Stefania Zamboni1,2,3, Beat Foerster4,5,6, Mohammad Abufaraj4,7, Thomas Seisen8, Morgan Roupret9, Pierre Colin10, Alexandre De la Taille11, Carlo Di Bona1, Benoit Peyronnet12, Karim Bensalah13, Roman Herout14, Manfred Peter Wirth14, Vladimir Novotny14, Francesco Soria5, Piotr Chlosta15, Alessandro Antonelli2,3, Claudio Simeone2,3, Philipp Baumeister1, Agostino Mattei1, Francesco Montorsi16, Giuseppe Simone17, Michele Gallucci17, Kazumasa Matsumoto18, Pierre I Karakiewicz19, Alberto Briganti16, Evanguelos Xylinas20, Shahrokh F Shariat4,21,22, Marco Moschini1,4. 1. Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland. 2. Urology Unit, ASST Spedali Civili, Brescia, Italy. 3. Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy. 4. Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria. 5. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. 6. Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland. 7. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan. 8. Department of Urology, Pitié Salpêtrière Hospital, Sorbonne University, Paris, France. 9. Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpetrière, Paris, France. 10. Department of Urology, Générale de Santé, Hôpital Privé de La Louvière, Lille, France. 11. 79 Department of Urology, INSERM U955Eq07, Centre Hospitalier Universitaire Mondor Assistance Publique des Hôpitaux de Paris, Paris, France. 12. Department of Urology, Hopital Pontchaillou, CHU Rennes, Rennes, France. 13. Urology, Rennes University Hospital (France), Rennes, France. 14. Department of Urology, University Hospital Carl Gustav Carus, Dresden, Germany. 15. Department of Urology, Jagiellonian University, Krakow, Poland. 16. Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI Milan, Milan, Italy. 17. Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy. 18. Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan. 19. Department of Urology, University of Montreal, Montreal, QC, Canada. 20. Department of Urology Bichat Hospital, Paris Descartes University, Paris, France. 21. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 22. Department of Urology, Weill Cornell Medical College, New York, NY, USA.
Abstract
OBJECTIVE: To evaluate the incidence and survival outcomes of histological variants of upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). MATERIALS AND METHODS: We retrospectively analysed data from 1610 patients treated with RNU for clinically non-metastatic UTUC between 1990 and 2016 in several centres participating in the UTUC Collaboration. Histological variants were classified as micropapillary, squamous, sarcomatoid and other, including other rare variants (<10 cases for each). Multivariable competing risk analyses were conducted to assess the effect of variant histology on overall recurrence and cancer-specific mortality (CSM). RESULTS: Overall, 1460 patients (91%) had pure urothelial carcinoma (PUC), whereas 150 (9%) were diagnosed with a variant histology, including 89 (5.0%), 41 (2.0%), 10 (1.0%) and 10 (1.0%) cases of micropapillary, squamous, sarcomatoid and other tumours, respectively. Variant histology was associated with the presence of adverse pathological features compared with PUC, including non-organ-confined disease (59% vs 38%; P < 0.001), lymph node invasion (28% vs 24%; P = 0.02), high-grade disease (88% vs 71%; P < 0.001), tumour necrosis (28% vs 16%; P = 0.001) and positive surgical margins (15% vs 8%; P = 0.01). In competing risk analysis, micropapillary variant was the only factor associated with worse recurrence (sub-hazard ratio [SHR] 2.27, 95% confidence interval [CI] 1.25-4.79; P = 0.02) whereas sarcomatoid variant was associated with worse CSM (SHR 16.8, 95% CI 6.86-41.17; P < 0.001). CONCLUSION: We found that one out of 10 patients with UTUC treated with RNU had variant histology. Only micropapillary and sarcomatoid variants were associated with poorer oncological outcomes after adjusting for available confounding factors.
OBJECTIVE: To evaluate the incidence and survival outcomes of histological variants of upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). MATERIALS AND METHODS: We retrospectively analysed data from 1610 patients treated with RNU for clinically non-metastatic UTUC between 1990 and 2016 in several centres participating in the UTUC Collaboration. Histological variants were classified as micropapillary, squamous, sarcomatoid and other, including other rare variants (<10 cases for each). Multivariable competing risk analyses were conducted to assess the effect of variant histology on overall recurrence and cancer-specific mortality (CSM). RESULTS: Overall, 1460 patients (91%) had pure urothelial carcinoma (PUC), whereas 150 (9%) were diagnosed with a variant histology, including 89 (5.0%), 41 (2.0%), 10 (1.0%) and 10 (1.0%) cases of micropapillary, squamous, sarcomatoid and other tumours, respectively. Variant histology was associated with the presence of adverse pathological features compared with PUC, including non-organ-confined disease (59% vs 38%; P < 0.001), lymph node invasion (28% vs 24%; P = 0.02), high-grade disease (88% vs 71%; P < 0.001), tumour necrosis (28% vs 16%; P = 0.001) and positive surgical margins (15% vs 8%; P = 0.01). In competing risk analysis, micropapillary variant was the only factor associated with worse recurrence (sub-hazard ratio [SHR] 2.27, 95% confidence interval [CI] 1.25-4.79; P = 0.02) whereas sarcomatoid variant was associated with worse CSM (SHR 16.8, 95% CI 6.86-41.17; P < 0.001). CONCLUSION: We found that one out of 10 patients with UTUC treated with RNU had variant histology. Only micropapillary and sarcomatoid variants were associated with poorer oncological outcomes after adjusting for available confounding factors.
Authors: Z H Li; C R Xu; Y Liu; H Guan; M Zhang; X Y Che; Q Tang; Y B Huang; X S Li; L Q Hou Journal: Beijing Da Xue Xue Bao Yi Xue Ban Date: 2022-08-18
Authors: Victor M Schuettfort; Benjamin Pradere; Fahad Quhal; Hadi Mostafaei; Ekaterina Laukhtina; Keiichiro Mori; Reza Sari Motlagh; Michael Rink; David D'Andrea; Mohammad Abufaraj; Pierre I Karakiewicz; Shahrokh F Shariat Journal: Turk J Urol Date: 2020-10-09
Authors: Marco Moschini; Stefania Zamboni; Luca Afferi; Benjamin Pradere; Mohammad Abufaraj; Francesco Soria; David D'Andrea; Morgan Roupret; Alexandre De la Taille; Claudio Simeone; Agostino Mattei; Romain Mathieu; Karim Bensalah; Manfred Peter Wirth; Francesco Montorsi; Alberto Briganti; Andrea Gallina; Giuseppe Simone; Michele Gallucci; Carlo Di Bona; Giancarlo Marra; Andrea Mari; Ettore Di Trapani; Mario Alvarez Maestro; Wojciech Krajewski; Shahrokh F Shariat; Evanguelos Xylinas; Philipp Baumeister Journal: Arab J Urol Date: 2020-09-04