ASCO GU 2018: Size-focality-invasion in Upper Tract Urothelial Carcinoma - A Novel Imaging-Based Score To Predict Survival Outcomes

San Francisco, CA (UroToday.com) Upper tract urothelial cell carcinoma (UTUC) is an uncommon aggressive malignancy with disparate outcomes. The authors developed a novel morphometric scoring system for prediction of oncologic and survival outcomes before nephroureterectomy (NU).

Methods:

This was a 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) (Figure 1). Primary outcome was overall survival (OS). Secondary outcomes were recurrence and recurrence free survival (RFS). 

Results:

The authors analyzed 244 patients (mean age 70.9, mean follow up 29.5 months). 61% of the patients had SFI-UTUC score of 3-6 and 39% had a score of 7-9. No difference in age, gender, comorbid conditions, surgical approach, or complications between the groups were noted. Patients with a score of 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 patients with a score of 7-9 (47.4% vs. 28.9%, p=0.004). On multivariable analysis for all-cause mortality, age (OR 1.1), recurrence (OR 4.4) and score 7-9 (OR 2.0) were significant (p<0.05). Kaplan Meier graphs (KMG) demonstrated 5 year OS of 57.0% for patients with a score 3-6 and 34.1% for patients with a score of  7-9 (p<0.01). KMG 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:

This novel scoring system for UTUC preoperative imaging may predict OS for tumors in renal and ureteral locations, as well as RFS for renal locations. 


Figure 1 – SFI-UTUC scoring system for renal and ureteral UTUC tumors:
ASCOGU SFIUTUC 1



Presented by: Zachary Hamilton, MD Saint Louis University, St Louis, MO

Co Authors: Miki Haifler, Laura-Maria Krabbe, Stephen Ryan, Madhumitha Reddy, Sean Berquist, Timothy N Clinton, Aaron Bloch, Charles Field, Sunil Patel, Brittney Cotta, Vitaly Margulis, Robert Uzzo, Ithaar Derweesh; Saint Louis University, St Louis, MO; Fox Chase Cancer Center, Philadelphia, PA; UT Southwestern Medical Center, Dallas, TX; University of California San Diego, San Diego, CA

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA
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