Incidence and survival outcomes of upper urinary tract urothelial carcinoma (UTUC) patients diagnosed with variant histology treated with nephroureterectomy.

to evaluate incidence and survival outcomes of histologic variants in upper tract urothelial carcinoma (UTUC) patients treated with radical nephroureterectomy (RNU).

we retrospectively analyzed data from 1,610 patients treated with RNU for clinically non-metastatic UTUC between 1990 and 2016 in several center participating to the UTUC Collaboration. Histologic variants were classified as micropapillary, squamous, sarcomatoid and others, including other rare variants (less than 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).

Overall, 1,460 (91%) patients had pure urothelial carcinoma (PUC) whereas 150 (9%) were diagnosed with a variant histology including 89 (5.0%), 41 (2.0%), 10 (1.0%), 10 (1.0%) cases of micropapillary, squamous, sarcomatoid and other tumors, respectively. Variant histology was associated with presence of adverse pathological features compared to PUC, including non-organ-confined disease (59% vs 38%, p<0.001), LNI (28% vs 24%, p=0.02), high-grade disease (88% vs 71%, p<0.001), tumor necrosis (28% vs 16%, p=0.001) and positive surgical margins (15% vs 8%, p=0.01). At competing risk analysis, micropapillary variant was the only one 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, CI: 6.86-41.17, p<0.001).

we found that one out of ten 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. This article is protected by copyright. All rights reserved.

BJU international. 2019 Mar 25 [Epub ahead of print]

Stefania Zamboni, Beat Foerster, Mohammad Abufaraj, Thomas Seisen, Morgan Roupret, Pierre Colin, Alexandre De la Taille, Carlo Di Bona, Benoit Peyronnet, Karim Bensalah, Roman Herout, Manfred Peter Wirth, Vladimir Novotny, Francesco Soria, Piotr Chlosta, Alessandro Antonelli, Claudio Simeone, Philipp Baumeister, Agostino Mattei, Francesco Montorsi, Giuseppe Simone, Michele Gallucci, Kazumasa Matsumoto, Pierre I Karakiewicz, Alberto Briganti, Evanguelos Xylinas, Shahrokh F Shariat, Marco Moschini, Upper Tract Urothelial Carcinoma Collaboration Group , European Association of Urology - Young Academic Urologists (EAU-YAU), Urothelial carcinoma working group

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