The impact of histological subtypes on stage at presentation and overall survival of patients with upper tract urothelial carcinoma: A nationwide cohort analysis

Document Type

Conference Proceeding

Publication Date


Publication Title

Eur Urol


Introduction & Objectives: The impact of urinary upper tract cancer histology on patient prognosis and outcomes has been poorly elucidated in literature. This might stem from the rarity of certain histological subtypes. To address this void, we set to examine the impact of cancer histology on stage at presentation and overall survival (OS) of patient with urinary upper tract cancer who were treated surgically within a large North American nationwide cohort.

Materials & Methods: Our cohort included 9750 cM0 UTUC patients who underwent a radical nephroureterectomy (RNU), between 2004 and 2015, within the National Cancer Database (NCDB). These patients had either pathologically proven urothelial carcinoma (UC)/papillary urothelial carcinoma, or one of the following variant histology: pure squamous, sarcomatoid/spindle cell carcinoma, or micropapillary urothelial carcinoma (MPUC). Kaplan-Meier curves and log-rank test were used to depict and compare survival curves among the different histological subtypes. Cox regression analysis tested the impact of histological subtypes on OS after accounting for: age, sex, race, year of diagnosis Charlson Comorbidity Index, income, treatment center type, insurance status, pathological tumor stage, nodal stage, and pathological LVI status.

Results: Mean (SD) age was 70.90 10.9 years. The histological subtype was UC, pure squamous, sacromatoid/spindle cell carcinoma, and MPUC in respectively 49.8%, 0.61%, 0.71%, and 48.9% of patients. For these histological subtypes, the rate of pT3/4 disease was respectively 46.5%, 48.6%, 68.2%, and 31.0% (p<0.001), and the rate of pN1 or higher disease was 9.47%, 5.45%, 9.375%, and 3.98% (p<0.001), respectively. The mean (SD) follow-up was 42.9 35.3 months. The 5-year OS rate for these histological subtypes was respectively 42.5%, 28.1%, 26.7%, and 56.8% (p<0.001). On multivariate analysis, patients with pure squamous had a 1.94-fold higher risk of death (95% CI: 1.28-2.82, p<0.001), those with sarcamatoid/spindle cell carcinoma had a 1.89-fold higher risk of death (95% CI: 1.41-2.53, P<0.001), while those with MPUC were 27% less likely to die (HR 0.73; 95% CI: 0.67-079, p<0.001) than their counterparts with UC.

Conclusions: To the best of our knowledge, our report is the first to examine the impact of urinary upper tract cancer histological subtype on cancer control outcomes in a large North American cohort. Our results indicated that the sarcomatoid/spindle cell carcinoma have a higher tumor and nodal stage at presentations in comparison to the other subtype, and that this subtype along with pure squamous have the least favorable survival outcomes. On the other hand, MPUC seem to have most favorable survival outcomes.



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