Degree of hydronephrosis predicts adverse pathological features and worse oncologic outcomes in patients with high-grade urothelial carcinoma of the upper urinary tract

作者：Chung Paul H; Krabbe Laura Maria; Darwish Oussama M; Westerman Mary E; Bagrodia Aditya; Gayed Bishoy A; Haddad Ahmed Q; Kapur Payal; Sagalowsky Arthur I; Lotan Yair; Margulis Vitaly^*

来源：Urologic Oncology-Seminars and Original Investigations, 2014, 32(7): 981-988.

DOI：10.1016/j.urolonc.2014.02.018

• Upper tract urothelial carcinoma
• Hydronephrosis
• Nephroureterectomy
• Outcome
• Chemotherapy

Objective: To evaluate degree of hydronephrosis (HN) as a surrogate for adverse pathological features and oncologic outcomes in patients with high-grade (HG) and low-grade (LG) upper tract urothelial carcinomas (UTUCs). %26lt;br%26gt;Methods: We retrospectively reviewed 141 patients with localized UTUCs that underwent extirpative surgery at a tertiary referral center. Preoperative imaging was used to evaluate presence and degree of ipsilateral HN. We evaluated degree of HN (none/mild vs. moderate/severe), pathological findings, and oncologic outcomes. %26lt;br%26gt;Results: HG UTUC was present in 113 (80%) patients, muscle-invasive disease (%26gt;= pT2) in 49 (35%), and non organ-confined disease (%26gt;= pT3) in 41(29%). At a median follow-up of 34 months, 49 (35%) patients experienced intravesical recurrence, 28 (20%) developed local/systemic recurrence, and 24 (17%) died of UTUC. RN was graded as none/mild in 77 (55%) patients and moderate/severe in 64 (45%). In patients with HG UTUC, but not LG, degree of HN was associated with advanced pathological stage (P %26lt; 0.001), positive lymph nodes (P = 0.01), local/systemic recurrence-free survival (hazard ratio [HR] = 5.5, P = 0.02), and cancer-specific survival (HR = 5.2, P = 0.02). On multivariable analysis of preoperative factors, degree of HN in patients with HG UTUC was associated with muscle invasion (HR = 9.3; 95% CI: 3.08-28.32; P %26lt; 0.001), non organ-confined disease (HR = 4.5; 95% CI: 1.66-12.06; P = 0.003), local/systemic recurrence-free survival (RR = 2.5; 95% CI: 1.07-5.64; P = 0.04), and cancer-specific survival (HR = 2.6; 95% CI: 1.05-6.22; P = 0.04). %26lt;br%26gt;Conclusions: Degree of HN can serve as a surrogate for advanced disease and predict worse oncologic outcomes in HG UTUC. Degree of HN was not predictive of intravesical or local/systemic recurrence in LG UTUC.

• 出版日期2014-10