AUA 2019: Perioperative and Oncologic Outcome of Upper Tract Urothelial Carcinoma with Variant Histology following Radical Nephroureterectomy

Chicago, IL (  Dr. Xu presented his moderated poster on- Perioperative and Oncologic Outcome of Upper Tract Urothelial Carcinoma with Variant Histology following Radical Nephroureterectomy. Upper tract urothelial carcinoma with variant histology (UTUC-VH) is not a well-known entity, and its prognostic implication is unknown. Dr. Xu and colleagues assessed the perioperative and oncologic outcome of patients with UTUC-VH and compared them to pure urothelial carcinoma (PUC) following radical nephroureterectomy (RNU) with lymph node dissection (LND). 

Through a prospectively maintained UTUC database, all patients undergoing RNU with intent to cure were identified. Tumors were divided into PUC or VH based on pathologic evaluation at resection. PUC and VH were compared in terms of primary outcomes of recurrence-free survival (RFS) and overall survival (OS). Perioperative outcomes, including 90-day complication and readmission rates, were also compared.

Dr. Xu then presented results of this study, Of 160 patients undergoing RNU from 2009-2018, 139 patients had PUC (87%), and 21 had VH (13%). The most common histologic variant was squamous (81%), followed by sarcomatoid (14%) and small cell/neuroendocrine (5%). Patients with VH presented with poorer ECOG status. On final pathology, patients with VH had a higher incidence of non-organ confined disease 71.4% vs. 37.2%, but similar pN+ (16.5% PUC vs. 14.29% VH). Neoadjuvant and adjuvant chemotherapy were used similarly between both groups. 90-day complications (38.1% VH vs 25.9% PUC) and readmission rates (14.29% VH vs 6.47% PUC) were comparable between groups. On univariate Cox regression, VH was associated with decreased OS (HR 3.07, 95% CI 1.11-8.49). There was no association between VH and RFS. On multivariable regression, VH failed to reach significance for RFS/OS.

AUA 2019 pathologic features for UTUC

Dr. Xu concluded his talk with a summary that variant histology of upper tract urothelial carcinoma present with higher pathological stage, but more extensive and multi-institutional studies are needed to confirm these findings as well as their effect on the oncologic outcome.

Presented by: Willem Xu, BA, Keck School of Medicine, University of Southern California, Los Angeles, California

Written by: Abhishek Srivastava, MD, Society of Urologic Oncology Fellow, Fox Chase Cancer Center, Fox Chase Cancer Center, Philadelphia, PA @shekabhishek at American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois
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