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

San Francisco, CA ( 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).


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). 


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).


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:

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