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Biological and prognostic implications of biopsy upgrading for high‐grade upper tract urothelial carcinoma at nephroureterectomy
OBJECTIVES: Technical limitations of ureteroscopic (URS) biopsy has been considered responsible for substantial upgrading rate in upper tract urothelial carcinoma (UTUC). However, the impact of tumor specific factors for upgrading remain uninvestigated. METHODS: Patients who underwent URS biopsy wer...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10098861/ https://www.ncbi.nlm.nih.gov/pubmed/36349904 http://dx.doi.org/10.1111/iju.15061 |
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author | Katayama, Satoshi Pradere, Benjamin Grossman, Nico C. Potretzke, Aaron M. Boorjian, Stephen A. Ghoreifi, Alireza Daneshmand, Sia Djaladat, Hooman Sfakianos, John P. Mari, Andrea Khene, Zine‐Eddine D'Andrea, David Hayakawa, Nozomi Breda, Alberto Fontana, Matteo Fujita, Kazutoshi Antonelli, Alessandro van Doeveren, Thomas Steinbach, Christina Mori, Keiichiro Laukhtina, Ekaterina Rouprêt, Morgan Margulis, Vitaly Karakiewicz, Pierre I. Araki, Motoo Compérat, Eva Nasu, Yasutomo Shariat, Shahrokh F. |
author_facet | Katayama, Satoshi Pradere, Benjamin Grossman, Nico C. Potretzke, Aaron M. Boorjian, Stephen A. Ghoreifi, Alireza Daneshmand, Sia Djaladat, Hooman Sfakianos, John P. Mari, Andrea Khene, Zine‐Eddine D'Andrea, David Hayakawa, Nozomi Breda, Alberto Fontana, Matteo Fujita, Kazutoshi Antonelli, Alessandro van Doeveren, Thomas Steinbach, Christina Mori, Keiichiro Laukhtina, Ekaterina Rouprêt, Morgan Margulis, Vitaly Karakiewicz, Pierre I. Araki, Motoo Compérat, Eva Nasu, Yasutomo Shariat, Shahrokh F. |
author_sort | Katayama, Satoshi |
collection | PubMed |
description | OBJECTIVES: Technical limitations of ureteroscopic (URS) biopsy has been considered responsible for substantial upgrading rate in upper tract urothelial carcinoma (UTUC). However, the impact of tumor specific factors for upgrading remain uninvestigated. METHODS: Patients who underwent URS biopsy were included between 2005 and 2020 at 13 institutions. We assessed the prognostic impact of upgrading (low‐grade on URS biopsy) versus same grade (high‐grade on URS biopsy) for high‐grade UTUC tumors on radical nephroureterectomy (RNU) specimens. RESULTS: This study included 371 patients, of whom 112 (30%) and 259 (70%) were biopsy‐based low‐ and high‐grade tumors, respectively. Median follow‐up was 27.3 months. Patients with high‐grade biopsy were more likely to harbor unfavorable pathologic features, such as lymphovascular invasion (p < 0.001) and positive lymph nodes (LNs; p < 0.001). On multivariable analyses adjusting for the established risk factors, high‐grade biopsy was significantly associated with worse overall (hazard ratio [HR] 1.74; 95% confidence interval [CI], 1.10–2.75; p = 0.018), cancer‐specific (HR 1.94; 95% CI, 1.07–3.52; p = 0.03), and recurrence‐free survival (HR 1.80; 95% CI, 1.13–2.87; p = 0.013). In subgroup analyses of patients with pT2‐T4 and/or positive LN, its significant association retained. Furthermore, high‐grade biopsy in clinically non‐muscle invasive disease significantly predicted upstaging to final pathologically advanced disease (≥pT2) compared to low‐grade biopsy. CONCLUSIONS: High tumor grade on URS biopsy is associated with features of biologically and clinically aggressive UTUC tumors. URS low‐grade UTUC that becomes upgraded to high‐grade might carry a better prognosis than high‐grade UTUC on URS. Tumor specific factors are likely to be responsible for upgrading to high‐grade on RNU. |
format | Online Article Text |
id | pubmed-10098861 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-100988612023-04-14 Biological and prognostic implications of biopsy upgrading for high‐grade upper tract urothelial carcinoma at nephroureterectomy Katayama, Satoshi Pradere, Benjamin Grossman, Nico C. Potretzke, Aaron M. Boorjian, Stephen A. Ghoreifi, Alireza Daneshmand, Sia Djaladat, Hooman Sfakianos, John P. Mari, Andrea Khene, Zine‐Eddine D'Andrea, David Hayakawa, Nozomi Breda, Alberto Fontana, Matteo Fujita, Kazutoshi Antonelli, Alessandro van Doeveren, Thomas Steinbach, Christina Mori, Keiichiro Laukhtina, Ekaterina Rouprêt, Morgan Margulis, Vitaly Karakiewicz, Pierre I. Araki, Motoo Compérat, Eva Nasu, Yasutomo Shariat, Shahrokh F. Int J Urol Original Articles: Clinical Investigation OBJECTIVES: Technical limitations of ureteroscopic (URS) biopsy has been considered responsible for substantial upgrading rate in upper tract urothelial carcinoma (UTUC). However, the impact of tumor specific factors for upgrading remain uninvestigated. METHODS: Patients who underwent URS biopsy were included between 2005 and 2020 at 13 institutions. We assessed the prognostic impact of upgrading (low‐grade on URS biopsy) versus same grade (high‐grade on URS biopsy) for high‐grade UTUC tumors on radical nephroureterectomy (RNU) specimens. RESULTS: This study included 371 patients, of whom 112 (30%) and 259 (70%) were biopsy‐based low‐ and high‐grade tumors, respectively. Median follow‐up was 27.3 months. Patients with high‐grade biopsy were more likely to harbor unfavorable pathologic features, such as lymphovascular invasion (p < 0.001) and positive lymph nodes (LNs; p < 0.001). On multivariable analyses adjusting for the established risk factors, high‐grade biopsy was significantly associated with worse overall (hazard ratio [HR] 1.74; 95% confidence interval [CI], 1.10–2.75; p = 0.018), cancer‐specific (HR 1.94; 95% CI, 1.07–3.52; p = 0.03), and recurrence‐free survival (HR 1.80; 95% CI, 1.13–2.87; p = 0.013). In subgroup analyses of patients with pT2‐T4 and/or positive LN, its significant association retained. Furthermore, high‐grade biopsy in clinically non‐muscle invasive disease significantly predicted upstaging to final pathologically advanced disease (≥pT2) compared to low‐grade biopsy. CONCLUSIONS: High tumor grade on URS biopsy is associated with features of biologically and clinically aggressive UTUC tumors. URS low‐grade UTUC that becomes upgraded to high‐grade might carry a better prognosis than high‐grade UTUC on URS. Tumor specific factors are likely to be responsible for upgrading to high‐grade on RNU. John Wiley and Sons Inc. 2022-11-09 2023-01 /pmc/articles/PMC10098861/ /pubmed/36349904 http://dx.doi.org/10.1111/iju.15061 Text en © 2022 The Authors. International Journal of Urology published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Urological Association. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Articles: Clinical Investigation Katayama, Satoshi Pradere, Benjamin Grossman, Nico C. Potretzke, Aaron M. Boorjian, Stephen A. Ghoreifi, Alireza Daneshmand, Sia Djaladat, Hooman Sfakianos, John P. Mari, Andrea Khene, Zine‐Eddine D'Andrea, David Hayakawa, Nozomi Breda, Alberto Fontana, Matteo Fujita, Kazutoshi Antonelli, Alessandro van Doeveren, Thomas Steinbach, Christina Mori, Keiichiro Laukhtina, Ekaterina Rouprêt, Morgan Margulis, Vitaly Karakiewicz, Pierre I. Araki, Motoo Compérat, Eva Nasu, Yasutomo Shariat, Shahrokh F. Biological and prognostic implications of biopsy upgrading for high‐grade upper tract urothelial carcinoma at nephroureterectomy |
title | Biological and prognostic implications of biopsy upgrading for high‐grade upper tract urothelial carcinoma at nephroureterectomy |
title_full | Biological and prognostic implications of biopsy upgrading for high‐grade upper tract urothelial carcinoma at nephroureterectomy |
title_fullStr | Biological and prognostic implications of biopsy upgrading for high‐grade upper tract urothelial carcinoma at nephroureterectomy |
title_full_unstemmed | Biological and prognostic implications of biopsy upgrading for high‐grade upper tract urothelial carcinoma at nephroureterectomy |
title_short | Biological and prognostic implications of biopsy upgrading for high‐grade upper tract urothelial carcinoma at nephroureterectomy |
title_sort | biological and prognostic implications of biopsy upgrading for high‐grade upper tract urothelial carcinoma at nephroureterectomy |
topic | Original Articles: Clinical Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10098861/ https://www.ncbi.nlm.nih.gov/pubmed/36349904 http://dx.doi.org/10.1111/iju.15061 |
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