Accurate preoperative staging of upper tract urothelial carcinoma is often difficult. Therefore, we aimed to investigate the preoperative factors associated with pathological upstaging in patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy and to develop a risk-scoring system to assess pathological upstaging.
This retrospective study enrolled 386 patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy at Tottori University Hospital and affiliated hospitals between January 2015 and December 2021. Patients with clinical tumor stage 4, clinical node +, and those who received neoadjuvant chemotherapy were excluded from the study. The association between preoperative patient factors and pathological upstaging was analyzed. Statistical analyses included the t-test, chi-squared test, and logistic regression analysis.
Of the 386 patients, 32 were excluded. Finally, 354 patients were included in this study, of whom 87 (24.6%) were pathologically upstaged. Hydronephrosis, positive urine cytology result, and maximum tumor diameter <30 mm were associated with upstaging. We developed a risk scoring system in which the score was the sum of the number of applicable items for three factors: hydronephrosis, positive urine cytology result, and maximum tumor size <30 mm. The probabilities of ureteral cancer upstaging were 0%, 8.3%, 29.5%, and 50.0% for scores of 0, 1, 2, and 3, respectively.
Hydronephrosis, urine cytology, and maximum tumor diameter were associated with pathological upstaging. Our risk-scoring system may be useful in predicting pathological upstaging, especially in patients with ureteral cancer.
International journal of urology : official journal of the Japanese Urological Association. 2025 Jan 17 [Epub ahead of print]
Hiroshi Yamane, Shuichi Morizane, Noriya Yamaguchi, Sumiyo Toji, Katsuya Hikita, Masashi Honda, Kuniyasu Muraoka, Hirofumi Oono, Tadahiro Isoyama, Koji Ono, Takehiro Sejima, Atsushi Takenaka
Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan., Department of Urology, Sanin Rosai Hospital, Yonago, Tottori, Japan., Department of Urology, Tottori Prefectural Central Hospital, Tottori, Tottori, Japan., Department of Urology, Matsue Red Cross Hospital, Matsue, Simane, Japan., Department of Urology, Yonago Medical Center, Yonago, Tottori, Japan., Department of Urology, Tottori Red Cross Hospital, Tottori, Tottori, Japan., Department of Urology, Matsue City Hospital, Matsue, Shimane, Japan.