TY  - JOUR
A1  - Koll, Florestan
A1  - Meisenzahl, Eva
A1  - Haller, Bernhard
A1  - Maisch, Philipp
A1  - Kirchhoff, Florian
A1  - Horn, Thomas
A1  - Gschwend, Jürgen E.
A1  - Schmid, Sebastian C.
T1  - Evaluation of pre-operative biopsy, surgical procedures and oncologic outcomes in upper tract urothelial carcinoma (UTUC)
T2  - Frontiers in Surgery
N2  - Purpose: Discordance between pre-operative biopsy and final pathology for Upper Tract Urothelial Carcinoma (UTUC) is high and optimal management remains controversial. The aim of this study is to evaluate the accuracy of pre-operative biopsy, to identify prognostic factors and to evaluate the effect of adjuvant chemotherapy on survival and oncologic outcome in UTUC.
Methods: We analyzed records of patients receiving surgical treatment for UTUC. Pathology of pre-operative biopsy was compared to surgical specimen. We used Kaplan-Meier method to estimate survival probabilities and Cox's proportional hazards models to estimate the association between covariates and event times. Primary endpoint was overall survival (OS). A matched-pair analysis was performed to evaluate the effect of adjuvant chemotherapy.
Results: 151 patients underwent surgical treatment (28% open, 36% laparoscopic, 17% robotic radical nephroureterectomy; 14% segmental ureteral resections and 5% palliative nephrectomy) for UTUC and were included in the analysis. Upstaging from <pT1 in endoscopic biopsy to ≥pT1 in final pathology occurred in 61% of patients and upgrading from low-grade to high-grade occurred in 30% of patients. Five-year OS was 59.5%. In the univariate Cox-regression model pathological stage, grade, lymphovascular invasion and positive surgical margins were associated with OS. Matched pair analysis for stage (<pT3; ≥pT3; pN+) and age revealed a significant survival benefit for adjuvant chemotherapy (HR 0.40, 0.14–0.77, p < 0.018) in this cohort.
Conclusion: UTUC is often underestimated in pre-operative biopsy, and it is associated with significant mortality. Pathological stage and grade, lymphovascular invasion and lymph node metastases are predictors of oncologic outcome and survival.
KW  - adjuvant chemotherapy
KW  - nephroureterectomy
KW  - segmental ureteral resection
KW  - ureteroscopy
KW  - upper tract urothelial carcinoma
KW  - UTUC
Y1  - 2021
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/86400
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-864009
SN  - 2296-875X
VL  - 9
IS  - art. 790738
SP  - 1
EP  - 9
PB  - Frontiers Media
CY  - Lausanne
ER  -