TY - JOUR
T1 - Impact of Variant Histology on Oncological Outcomes in Upper Tract Urothelial Carcinoma
T2 - Results From the ROBUUST Collaborative Group
AU - Douglawi, Antoin
AU - Ghoreifi, Alireza
AU - Carbonara, Umberto
AU - Yip, Wesley
AU - Uzzo, Robert G.
AU - Margulis, Vitaly
AU - Ferro, Matteo
AU - Cobelli, Ottavio De
AU - Wu, Zhenjie
AU - Simone, Giuseppe
AU - Mastroianni, Riccardo
AU - Rha, Koon H.
AU - Eun, Daniel D.
AU - Reese, Adam C.
AU - Porter, James R.
AU - Derweesh, Ithaar
AU - Mehrazin, Reza
AU - Rosiello, Giuseppe
AU - Tellini, Riccardo
AU - Jamil, Marcus
AU - Kenigsberg, Alexander
AU - Farrow, Jason M.
AU - Schrock, William P.
AU - Cacciamani, Giovanni
AU - Srivastava, Abhishek
AU - Bhattu, Amit S.
AU - Mottrie, Alexandre
AU - Gonzalgo, Mark L.
AU - Sundaram, Chandru P.
AU - Abdollah, Firas
AU - Minervini, Andrea
AU - Autorino, Riccardo
AU - Djaladat, Hooman
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/10
Y1 - 2023/10
N2 - Introduction: Oncologic implications of variant histology (VH) have been extensively studied in bladder cancer; however, further investigation is needed in upper tract urothelial carcinoma (UTUC). Our study aims to evaluate the impact of VH on oncological outcomes in UTUC patients treated with radical nephroureterectomy (RNU). Methods: A retrospective analysis was performed on patients who underwent a robotic or laparoscopic RNU for UTUC using the ROBUUST database, a multi-institutional collaborative including 17 centers worldwide. Logistic regression was used to assess the effect of VH on urothelial recurrence (bladder, contralateral upper tract), metastasis, and survival following RNU. Results: A total of 687 patients were included in this study. Median (IQR) age was 71 (64-78) years and 470 (68%) had organ confined disease. VH was present in 70 (10.2%) patients. In a median follow-up of 16 months, the incidence of urothelial recurrence, metastasis, and mortality was 26.8%, 15.3%, and 11.8%, respectively. VH was associated with increased risk of metastasis (HR 4.3, P <.0001) and death (HR 2.0, P =.046). In multivariable analysis, VH was noted to be an independent risk factor for metastasis (HR 1.8, P =.03) but not for urothelial recurrence (HR 0.99, P =.97) or death (HR 1.4, P =.2). Conclusion: Variant histology can be found in 10% of patients with UTUC and is an independent risk factor for metastasis following RNU. Overall survival rates and the risk of urothelial recurrence in the bladder or contralateral kidney are not affected by the presence of VH.
AB - Introduction: Oncologic implications of variant histology (VH) have been extensively studied in bladder cancer; however, further investigation is needed in upper tract urothelial carcinoma (UTUC). Our study aims to evaluate the impact of VH on oncological outcomes in UTUC patients treated with radical nephroureterectomy (RNU). Methods: A retrospective analysis was performed on patients who underwent a robotic or laparoscopic RNU for UTUC using the ROBUUST database, a multi-institutional collaborative including 17 centers worldwide. Logistic regression was used to assess the effect of VH on urothelial recurrence (bladder, contralateral upper tract), metastasis, and survival following RNU. Results: A total of 687 patients were included in this study. Median (IQR) age was 71 (64-78) years and 470 (68%) had organ confined disease. VH was present in 70 (10.2%) patients. In a median follow-up of 16 months, the incidence of urothelial recurrence, metastasis, and mortality was 26.8%, 15.3%, and 11.8%, respectively. VH was associated with increased risk of metastasis (HR 4.3, P <.0001) and death (HR 2.0, P =.046). In multivariable analysis, VH was noted to be an independent risk factor for metastasis (HR 1.8, P =.03) but not for urothelial recurrence (HR 0.99, P =.97) or death (HR 1.4, P =.2). Conclusion: Variant histology can be found in 10% of patients with UTUC and is an independent risk factor for metastasis following RNU. Overall survival rates and the risk of urothelial recurrence in the bladder or contralateral kidney are not affected by the presence of VH.
KW - Laparoscopy
KW - Minimally invasive
KW - Nephroureterectomy
KW - Upper tract
KW - Urothelial carcinoma
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U2 - 10.1016/j.clgc.2023.05.011
DO - 10.1016/j.clgc.2023.05.011
M3 - Article
C2 - 37301663
AN - SCOPUS:85163401159
SN - 1558-7673
VL - 21
SP - 563
EP - 568
JO - Clinical Genitourinary Cancer
JF - Clinical Genitourinary Cancer
IS - 5
ER -