Endoscopic management of upper tract urothelial carcinoma: Improved prediction of invasive cancer using a ureteroscopic scoring model. (September 2017)

• Record Type: Journal Article
• Authors: Jeon, Seong Soo; Sung, Hyun Hwan; Jeon, Hwang Gyun; Han, Deok Hyun; Jeong, Byong Chang; Seo, Seong Il; Lee, Hyun Moo; Choi, Han-Yong
• Is Part Of: Surgical oncology. Volume 26:Number 3(2017)
• Page Start: 252
• Page End: 256
• Publication Date: 2017-09
• Subjects: Upper tract urothelial carcinoma -- Ureteroscopy -- Predictive factor; Cancer -- Surgery -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Electronic journals; 616.994059
• DOI: 10.1016/j.suronc.2017.04.003
• Languages: English
• ISSNs: 0960-7404

Abstract

Abstract: Background: The aim of this study was to investigate clinical and ureteroscopic factors considered as important for the prediction of invasive upper tract urothelial carcinoma (UTUC) and establish a model using a new ureteroscopic scoring. Methods: We analyzed tumor depth and grade from ureteroscopic biopsies in 172 patients who underwent imaging studies, urine cytology, and radical nephroureterectomy. Invasive UTUC was defined as muscle-invasive or non-organ confined tumors. Ureteroscopic scoring was defined as sum of the risk factors, lamina propria invasion, or presence of a high-grade tumor. Results: In the multivariate analysis, lamina propria invasion was a significant factor associated with an increased risk of invasive UTUC. Positive urine cytology, hydronephrosis, and local invasion on imaging were also significant. Presence of a high-grade tumor was not significant due to interaction with lamina propria invasion (P < 0.001). In the ureteroscopic scoring model, the odds ratio of invasive UTUC was significantly related to the ureteroscopic scoring number (30.9% (56/81), 66.7% (14/42), and 83.7% (41/49) according to the sum of risk factors 0 to 2, respectively, (P < 0.001). Positive predictive value (PPV) for invasive UTUC was increased in relation to the number of risk factors including urine cytology, hydronephrosis, local invasion on imaging, and any abnormal ureteroscopic finding (lamina propria invasion or presence of high-grade tumors). The PPV gradually increased as follows: 6.3%, 33.3%, 52.1%, 81.6%, to 92.9% for 0 to 4 positive risk factors, respectively (P < 0.001). Conclusions: When lamina propria invasion and presence of a high-grade tumor were incorporated, our novel ureteroscopic scoring model was highly predictive of invasive UTUC. Highlights: Lamina propria invasion and presence of a high-grade tumor incorporated in a ureteropic biopsy, was highly predictive of invasive upper tract urothelial carcinoma (UTUC). Risk of invasive UTUC was 83.7% when a ureteroscopic biopsy shows high grade disease with lamina propria invasion exists. Use of this model could improve selection of UTUC patients for neoadjuvant chemotherapy and nephron sparing-surgery.