- 作者：Jamie C. Messer ; John D. Terrell ; Michael P. Herman ; Casey K. Ng ; Douglas S. Scherr ; Benjamin Scoll ; Stephen A. Boorjian ; Robert G. Uzzo ; Mark Wille ; Scott E. Eggener ; Steven M. Lucas ; Yair Lotan ; Shahrokh F. Shariat ; Jay D. Raman
- 关键词：Computed tomography (CT) ; Magnetic resonance imaging (MRI) ; Intravenous pyelogram (IVP) ; Renal ultrasonography (RUS) ; Transitional cell carcinoma (TCC) ; Renal pelvis ; Ureter
- 刊名：Urologic Oncology: Seminars and Original Investigations
- 出版年：2013
- 出版时间：August, 2013
- 年：2013
- 卷：31
- 期：6
- 页码：904-908
- 全文大小：159 K
Objective
The presence of hydronephrosis (HN) has been implicated as a predictor of poor outcomes for patients diagnosed with bladder cancer. Small, single institution preliminary reports suggest a similar negative relationship may exist for upper-tract urothelial carcinoma (UTUC). Herein, we attempt to validate the prognostic value of preoperative HN in a large, multi-institutional cohort of UTUC patients.Materials and methods
Data on 469 patients with localized UTUC from 5 tertiary referral centers who underwent a radical nephroureterectomy (91 % ) or distal ureterectomy (9 % ) without neoadjuvant chemotherapy were integrated into a relational database. Preoperative HN data, including presence vs. absence and high vs. low grade, were available in 408 patients. The association of HN with pathologic features was evaluated.
Results
A total of 254 men and 154 women with a median age of 69 years (IQR 15) were analyzed. Overall, 192 patients (47 % ) had ¡ÝpT2 disease, 145 (36 % ) had non-organ-confined (NOC) cancers (¡ÝpT3 and/or positive lymph nodes), and 298 (73 % ) had high grade UTUC on final pathology. Forty-six percent of patients had tumors in the renal pelvis, 27 % in the ureter, and 27 % in both locations. Preoperatively, 223 patients (55 % ) were noted to have ipsilateral HN (39 % low grade and 61 % high grade). Hydronephrosis was associated with ¡ÝpT2 stage (P < 0.001), NOC disease (P < 0.001), and high grade cancers (P = 0.04). On multivariate analysis adjusting for gender, age, and tumor location, HN was an independent predictor of muscle invasive (HR 7.4, P < 0.001), NOC (HR 5.5, P < 0.001), and high pathologic grade (HR 1.6, P = 0.03) UTUC disease.
Conclusion
The presence of preoperative HN was associated with advanced stage UTUC. This readily available imaging modality may improve preoperative risk stratification for UTUC patients thereby guiding use of endoscopic versus extirpative surgery as well as the need for neoadjuvant chemotherapy regimens.