Prognostic factors for upper urinary tract urothelial carcinoma

• Published in: Nature reviews. Urology Vol. 8; no. 8; pp. 440 - 447
• Main Authors: Shariat, Shahrokh F, Chromecki, Thomas F, Bensalah, Karim, Remzi, Mesut, Verhoest, Grégory, Cha, Eugene K, Scherr, Douglas S, Novara, Giacomo, Karakiewicz, Pierre I
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-08-2011; Nature Publishing Group
• Subjects: 692/53/2422; 692/699/67/589; 692/700/139/1677; Animals; Bioengineering; Biomarkers, Tumor - chemistry; Biomarkers, Tumor - metabolism; Cancer; Care and treatment; Clinical outcomes; Decision making; Diagnosis; Disease; Disease Models, Animal; Evidence-based medicine; Health aspects; Human health and pathology; Humans; Hydronephrosis; Kidney Neoplasms; Kidney Neoplasms - chemistry; Kidney Neoplasms - diagnosis; Kidney Neoplasms - pathology; Life Sciences; Lymphatic system; Medical education; Medical prognosis; Medicine; Medicine & Public Health; Mortality; Nephrectomy; Patients; Prognosis; review-article; Risk factors; Tumor Markers, Biological; Tumors; Urinary Bladder Neoplasms; Urinary Bladder Neoplasms - chemistry; Urinary Bladder Neoplasms - diagnosis; Urinary Bladder Neoplasms - pathology; Urinary tract cancer; Urogenital system; Urology; Urology and Nephrology; Urothelium; Urothelium - chemistry; Urothelium - metabolism; Urothelium - pathology; Italy; Austria
• ISSN: 1759-4812; 1759-4820
• DOI: 10.1038/nrurol.2011.96

Both the cure rate and morbidity of upper urinary tract urothelial carcinoma are sensitive to nuances of treatment so appropriate management is crucial. Here, Chromecki
et al
. discuss a number of potential prognostic factors—encompassing clinical characteristics, pathological factors and molecular markers—that might be utilized clinically to identify patients in need of more-aggressive therapy.
Upper urinary tract urothelial carcinoma (UTUC) is a rare disease, which means there are little evidence-based data available to guide clinical decision-making. Although diagnosis and treatment of UTUC have improved significantly over the last 5 years, accurate risk stratification remains a challenge owing to the difficulty of clinical staging. A number of potential prognostic factors have been identified, encompassing clinical characteristics, pathological factors and molecular markers. Tumor stage and lymph node status are the most important predictors of survival in patients with UTUC. Preoperative evaluation for hydronephrosis can identify patients at risk of non-organ-confined disease. In the subgroup of patients with stage ≥pT2 disease, a longer interval between diagnosis and radical nephroureterectomy is associated with a higher risk of disease recurrence and cancer-specific mortality. Extensive tumor necrosis, sessile tumor architecture and lymphovascular invasion are independent predictors of clinical outcomes for patients with UTUC treated with radical nephroureterectomy. The incorporation of such prognosticators into clinical prediction models might help to guide decision-making with regard to timing of surveillance, type of treatment, performance of lymphadenectomy, and consideration of neoadjuvant or adjuvant systemic therapies.
Key Points
Tumor stage and lymph node status are the most important predictors of survival in patients with upper urinary tract urothelial carcinoma (UTUC)
Preoperative evaluation for hydronephrosis can identify patients at risk of non-organ-confined UTUC
In the subgroup of patients with stage ≥pT2 disease, a longer interval from diagnosis to radical nephroureterectomy (more than 3 months) is associated with higher risk of disease recurrence and cancer-specific mortality
Tumor location (renal pelvis versus ureter) has no prognostic impact when adjusted for the effects of established features of disease severity
Extensive tumor necrosis (defined as >10% of the tumor area) and sessile tumor architecture are independent predictors of clinical outcomes for patients with UTUC treated with radical nephroureterectomy
Lymphovascular invasion is associated with established features of biologically aggressive UTUC and is a strong predictor of disease recurrence and cancer-specific mortality