Oncologic outcomes in patients with variant histologies of upper tract urothelial cancer: Results from an international multicenter cohort
Recommended Citation
Pallauf M, Fletcher SA, Rezaee M, Roupret M, Boorjian SA, Potretzke AM, Djaladat H, Ghoreifi A, Soria F, Mari A, Campi R, Khene Z, Kikuchi E, Rink M, Fujita K, D’Andrea D, Boormans JL, Ploussard G, Breda A, Abdollah F, Raman JD, Shariat SF, Pradere B, Singla N. Oncologic outcomes in patients with variant histologies of upper tract urothelial cancer: Results from an international multicenter cohort. Eur Urol 2024; 85:S369-S370.
Document Type
Conference Proceeding
Publication Date
3-1-2024
Publication Title
Eur Urol
Abstract
Introduction & Objectives: Histologic variants (VH) of urothelial carcinoma (UC) of the lower urinary tract are associated with worse oncologic outcomes than pure UC. However, outcomes for patients with VH in the upper urinary tract are poorly described, given their rarity. We sought to elucidate the oncologic outcomes for patients with upper tract urothelial carcinoma (UTUC) with VH. Materials & Methods: We queried an international, multicenter cohort of non-metastatic UTUC patients treated with radical nephrouterectomy (RNU). We categorized patients into pure UC (no-VH) and VH. VH was sub-categorized based on the distribution of subtypes into ‘squamous/glandular/trophoblastic’ (VH-S) and ‘other’ (VH-O), comprising all other VH. We compared clinicopathologic characteristics and oncologic outcomes, including recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS), among groups. We performed subanalyses matched by pathologic stage: organ-confined (OC: ≤pT2 and pN0-x) and non-organ-confined (NOC: ≥pT3 or pN1-2). Kaplan Meier methods and multivariable proportional hazards Cox regression with multivariate imputation by chained equations (MICE) for missing predictor covariates were performed to evaluate outcomes. Results: We included 3,435 patients treated from 1985-2022 across 23 centers worldwide and identified 201 (6%) with VH. The median follow-up was 30 months (IQR 12-61). The most common VH subtype was VH-S (133/201, 66%). Neoadjuvant (12% vs. 5%, p<0.001) and adjuvant (27% vs. 13%, p<0.001) systemic therapy were more often administered in VH than in no-VH patients. Lymph node dissection was also more often performed in VH patients (54% vs. 39%, p<0.001). Patients with VH presented with more advanced pT (p<0.001) and pN (p<0.001) stage. In patients with OC disease, VH had worse RFS than no-VH (5-year RFS 58% vs. 80%, p=0.004), though CSS and OS were not significantly different. Stratified by VH subtype, VH-S exhibited similar oncologic outcomes as no-VH, but VH-O demonstrated worse stage-matched RFS (4-year RFS 39% vs. 83%, p<0.001 [OC] and 28% vs. 46%, p=0.01 [NOC]) and OS (5-year OS 45% vs. 75%, p=0.004 [OC]) compared to no-VH. VH-O independently predicted worse survival outcomes on multivariable Cox regression analyses. Conclusions: UTUC patients with VH exhibit more aggressive disease at presentation compared to pure UC. Despite the increased use of systemic therapy, certain VH subtypes demonstrate worse oncologic outcomes compared to pure UC. Further study is warranted to elucidate the biology of different UTUC VH subtypes to optimize treatment approaches.
Volume
85
First Page
S369
Last Page
S370
