Subclassification of pT3 upper tract urothelial carcinoma: a multicenter retrospective study.

The prognosis of patients with pT3 upper tract urothelial carcinoma (UTUC) varies. The current study aimed to further classify patients with pT3 UTUC into different survival outcome groups based on tumor location and site of invasion.

This retrospective study included 323 patients with pT3 UTUC who underwent nephroureterectomy at 11 hospitals in Japan. Histological and clinical data were obtained via a chart review. Univariate and multivariate Cox proportional hazards analyses showed the effect of different variables on recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS).

The median age of the patients was 72 years. Patients with pT3 UTUCs were divided into two groups: those with renal parenchymal invasion only (pT3a, n = 95) and those with peripelvic or periureteral fat invasion (pT3b, n = 228). pT3b UTUC was significantly associated with hydronephrosis, low preoperative estimated glomerular filtration rate (eGFR), histological nodal metastasis, nuclear grade 3, lymphovascular invasion (LVI), carcinoma in situ, and positive surgical margin. Based on the univariate analyses, patients with pT3b UTUC had a significantly lower 5-year RFS (42.4% vs. 70.1%, p < 0.0001), 5-year CSS (54.3% vs. 80.0%, p = 0.0002), and 5-year OS (47.8% vs. 76.8%, p < 0.0001) than those with pT3a UTUC. According to the multivariate analyses, nodal metastasis, LVI, adjuvant chemotherapy, preoperative eGFR, nuclear grade (RFS only), surgical margin (RFS only), and Charlson comorbidity index (OS only), but not pT3b stage, were associated with survival.

Compared with pT3a UTUC, pT3b UTUC was significantly associated with worse histological features, consequently resulting in unsatisfactory survival outcomes.

World journal of urology. 2023 Feb 04 [Epub ahead of print]

Yukio Yamada, Tohru Nakagawa, Jimpei Miyakawa, Taketo Kawai, Satoru Taguchi, Mariko Tabata, Tomoyuki Kaneko, Akira Ishikawa, Hideyo Miyazaki, Yasushi Kondo, Akihiko Matsumoto, Akihiro Naito, Masahiro Hikatsu, Yoichi Fujii, Yoshiyuki Akiyama, Yuta Yamada, Yusuke Sato, Akira Nomiya, Daisuke Yamada, Taro Murata, Motofumi Suzuki, Yutaka Enomoto, Hiroaki Nishimatsu, Takumi Takeuchi, Yoshinori Tanaka, Haruki Kume

Department of Urology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-Ku, Tokyo, 173-8605, Japan., Department of Urology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-Ku, Tokyo, 173-8605, Japan. ., Department of Urology, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan., Department of Urology, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan., Department of Urology, Center Hospital of the National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan., Department of Urology, Tokyo Metropolitan Bokutoh Hospital, Sumida, Tokyo, Japan., Department of Urology, Yaizu City Hospital, Yaizu, Shizuoka, Japan., Department of Urology, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan., Department of Urology, Musashino Red Cross Hospital, Musashino, Tokyo, Japan., Department of Urology, Tokyo Teishin Hospital, Chiyoda, Tokyo, Japan., Department of Urology, Mitsui Memorial Hospital, Chiyoda, Tokyo, Japan., Department of Urology, The Fraternity Memorial Hospital, Sumida, Tokyo, Japan.