Impact of histological variants on clinical outcomes of patients with upper urinary tract urothelial carcinoma

Michael Rink, Brian D. Robinson, David A. Green, Eugene K. Cha, Jens Hansen, Evi Comploj, Vitaly Margulis, Jay Raman, Casey K. Ng, Mesut Remzi, Karim Bensalah, Wareef Kabbani, Andrea Haitel, Nathalie Rioux-Leclercq, Charles C. Guo, Felix K. Chun, Eiji Kikuchi, Wassim Kassouf, Kanishka Sircar, Maxine Sun & 6 others Guru Sonpavde, Yair Lotan, Armin Pycha, Pierre I. Karakiewicz, Douglas S. Scherr, Shahrokh F. Shariat

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Abstract

Purpose: We investigated the clinical and prognostic impact of variant histologies on upper tract urothelial carcinoma outcomes after radical nephroureterectomy. Materials and Methods: Data on 1,648 patients with upper tract urothelial carcinoma treated with radical nephroureterectomy without preoperative chemotherapy or radiotherapy were reviewed for histological differentiation and variants. We analyzed differences between pure upper tract urothelial carcinoma and upper tract urothelial carcinoma with variant histology, and differences in the histological variants using different stratifications. Results: A total of 398 patients (24.2%) had histological upper tract urothelial carcinoma variants. The most common variants were squamous cell and glandular differentiation in 9.9% and 4.4% of cases, respectively. Histological variants were associated with advanced tumor stage, tumor multifocality, sessile tumor architecture, tumor necrosis, lymphovascular invasion and lymph node metastasis compared to pure upper tract urothelial carcinoma (p ≤0.031). On univariable analysis variant histology was associated with disease recurrence (p = 0.002) and cancer specific mortality (p = 0.003). In 174 patients treated with adjuvant chemotherapy there was no difference in disease recurrence or survival between variant histology and pure upper tract urothelial carcinoma (p = 0.42 and 0.59, respectively). On multivariable analysis adjusted for the effects of standard clinicopathological characteristics variant histology was not associated with either end point. Conclusions: Almost 25% of patients with upper tract urothelial carcinoma treated with radical nephroureterectomy harbored histological variants. Variant histology was associated with features of biologically aggressive upper tract urothelial carcinoma. While variant histology is associated with worse outcomes on univariable analysis but this effect did not remain significant on multivariable analysis.

Original languageEnglish (US)
Pages (from-to)398-404
Number of pages7
JournalJournal of Urology
Volume188
Issue number2
DOIs
StatePublished - Aug 1 2012

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Urinary Tract
Carcinoma
Histology
Neoplasms
Recurrence
Adjuvant Chemotherapy
Cell Differentiation
Necrosis
Radiotherapy
Lymph Nodes
Epithelial Cells
Neoplasm Metastasis
Drug Therapy
Survival
Mortality

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Rink, M., Robinson, B. D., Green, D. A., Cha, E. K., Hansen, J., Comploj, E., ... Shariat, S. F. (2012). Impact of histological variants on clinical outcomes of patients with upper urinary tract urothelial carcinoma. Journal of Urology, 188(2), 398-404. https://doi.org/10.1016/j.juro.2012.04.009
Rink, Michael ; Robinson, Brian D. ; Green, David A. ; Cha, Eugene K. ; Hansen, Jens ; Comploj, Evi ; Margulis, Vitaly ; Raman, Jay ; Ng, Casey K. ; Remzi, Mesut ; Bensalah, Karim ; Kabbani, Wareef ; Haitel, Andrea ; Rioux-Leclercq, Nathalie ; Guo, Charles C. ; Chun, Felix K. ; Kikuchi, Eiji ; Kassouf, Wassim ; Sircar, Kanishka ; Sun, Maxine ; Sonpavde, Guru ; Lotan, Yair ; Pycha, Armin ; Karakiewicz, Pierre I. ; Scherr, Douglas S. ; Shariat, Shahrokh F. / Impact of histological variants on clinical outcomes of patients with upper urinary tract urothelial carcinoma. In: Journal of Urology. 2012 ; Vol. 188, No. 2. pp. 398-404.
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abstract = "Purpose: We investigated the clinical and prognostic impact of variant histologies on upper tract urothelial carcinoma outcomes after radical nephroureterectomy. Materials and Methods: Data on 1,648 patients with upper tract urothelial carcinoma treated with radical nephroureterectomy without preoperative chemotherapy or radiotherapy were reviewed for histological differentiation and variants. We analyzed differences between pure upper tract urothelial carcinoma and upper tract urothelial carcinoma with variant histology, and differences in the histological variants using different stratifications. Results: A total of 398 patients (24.2{\%}) had histological upper tract urothelial carcinoma variants. The most common variants were squamous cell and glandular differentiation in 9.9{\%} and 4.4{\%} of cases, respectively. Histological variants were associated with advanced tumor stage, tumor multifocality, sessile tumor architecture, tumor necrosis, lymphovascular invasion and lymph node metastasis compared to pure upper tract urothelial carcinoma (p ≤0.031). On univariable analysis variant histology was associated with disease recurrence (p = 0.002) and cancer specific mortality (p = 0.003). In 174 patients treated with adjuvant chemotherapy there was no difference in disease recurrence or survival between variant histology and pure upper tract urothelial carcinoma (p = 0.42 and 0.59, respectively). On multivariable analysis adjusted for the effects of standard clinicopathological characteristics variant histology was not associated with either end point. Conclusions: Almost 25{\%} of patients with upper tract urothelial carcinoma treated with radical nephroureterectomy harbored histological variants. Variant histology was associated with features of biologically aggressive upper tract urothelial carcinoma. While variant histology is associated with worse outcomes on univariable analysis but this effect did not remain significant on multivariable analysis.",
author = "Michael Rink and Robinson, {Brian D.} and Green, {David A.} and Cha, {Eugene K.} and Jens Hansen and Evi Comploj and Vitaly Margulis and Jay Raman and Ng, {Casey K.} and Mesut Remzi and Karim Bensalah and Wareef Kabbani and Andrea Haitel and Nathalie Rioux-Leclercq and Guo, {Charles C.} and Chun, {Felix K.} and Eiji Kikuchi and Wassim Kassouf and Kanishka Sircar and Maxine Sun and Guru Sonpavde and Yair Lotan and Armin Pycha and Karakiewicz, {Pierre I.} and Scherr, {Douglas S.} and Shariat, {Shahrokh F.}",
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Rink, M, Robinson, BD, Green, DA, Cha, EK, Hansen, J, Comploj, E, Margulis, V, Raman, J, Ng, CK, Remzi, M, Bensalah, K, Kabbani, W, Haitel, A, Rioux-Leclercq, N, Guo, CC, Chun, FK, Kikuchi, E, Kassouf, W, Sircar, K, Sun, M, Sonpavde, G, Lotan, Y, Pycha, A, Karakiewicz, PI, Scherr, DS & Shariat, SF 2012, 'Impact of histological variants on clinical outcomes of patients with upper urinary tract urothelial carcinoma', Journal of Urology, vol. 188, no. 2, pp. 398-404. https://doi.org/10.1016/j.juro.2012.04.009

Impact of histological variants on clinical outcomes of patients with upper urinary tract urothelial carcinoma. / Rink, Michael; Robinson, Brian D.; Green, David A.; Cha, Eugene K.; Hansen, Jens; Comploj, Evi; Margulis, Vitaly; Raman, Jay; Ng, Casey K.; Remzi, Mesut; Bensalah, Karim; Kabbani, Wareef; Haitel, Andrea; Rioux-Leclercq, Nathalie; Guo, Charles C.; Chun, Felix K.; Kikuchi, Eiji; Kassouf, Wassim; Sircar, Kanishka; Sun, Maxine; Sonpavde, Guru; Lotan, Yair; Pycha, Armin; Karakiewicz, Pierre I.; Scherr, Douglas S.; Shariat, Shahrokh F.

In: Journal of Urology, Vol. 188, No. 2, 01.08.2012, p. 398-404.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of histological variants on clinical outcomes of patients with upper urinary tract urothelial carcinoma

AU - Rink, Michael

AU - Robinson, Brian D.

AU - Green, David A.

AU - Cha, Eugene K.

AU - Hansen, Jens

AU - Comploj, Evi

AU - Margulis, Vitaly

AU - Raman, Jay

AU - Ng, Casey K.

AU - Remzi, Mesut

AU - Bensalah, Karim

AU - Kabbani, Wareef

AU - Haitel, Andrea

AU - Rioux-Leclercq, Nathalie

AU - Guo, Charles C.

AU - Chun, Felix K.

AU - Kikuchi, Eiji

AU - Kassouf, Wassim

AU - Sircar, Kanishka

AU - Sun, Maxine

AU - Sonpavde, Guru

AU - Lotan, Yair

AU - Pycha, Armin

AU - Karakiewicz, Pierre I.

AU - Scherr, Douglas S.

AU - Shariat, Shahrokh F.

PY - 2012/8/1

Y1 - 2012/8/1

N2 - Purpose: We investigated the clinical and prognostic impact of variant histologies on upper tract urothelial carcinoma outcomes after radical nephroureterectomy. Materials and Methods: Data on 1,648 patients with upper tract urothelial carcinoma treated with radical nephroureterectomy without preoperative chemotherapy or radiotherapy were reviewed for histological differentiation and variants. We analyzed differences between pure upper tract urothelial carcinoma and upper tract urothelial carcinoma with variant histology, and differences in the histological variants using different stratifications. Results: A total of 398 patients (24.2%) had histological upper tract urothelial carcinoma variants. The most common variants were squamous cell and glandular differentiation in 9.9% and 4.4% of cases, respectively. Histological variants were associated with advanced tumor stage, tumor multifocality, sessile tumor architecture, tumor necrosis, lymphovascular invasion and lymph node metastasis compared to pure upper tract urothelial carcinoma (p ≤0.031). On univariable analysis variant histology was associated with disease recurrence (p = 0.002) and cancer specific mortality (p = 0.003). In 174 patients treated with adjuvant chemotherapy there was no difference in disease recurrence or survival between variant histology and pure upper tract urothelial carcinoma (p = 0.42 and 0.59, respectively). On multivariable analysis adjusted for the effects of standard clinicopathological characteristics variant histology was not associated with either end point. Conclusions: Almost 25% of patients with upper tract urothelial carcinoma treated with radical nephroureterectomy harbored histological variants. Variant histology was associated with features of biologically aggressive upper tract urothelial carcinoma. While variant histology is associated with worse outcomes on univariable analysis but this effect did not remain significant on multivariable analysis.

AB - Purpose: We investigated the clinical and prognostic impact of variant histologies on upper tract urothelial carcinoma outcomes after radical nephroureterectomy. Materials and Methods: Data on 1,648 patients with upper tract urothelial carcinoma treated with radical nephroureterectomy without preoperative chemotherapy or radiotherapy were reviewed for histological differentiation and variants. We analyzed differences between pure upper tract urothelial carcinoma and upper tract urothelial carcinoma with variant histology, and differences in the histological variants using different stratifications. Results: A total of 398 patients (24.2%) had histological upper tract urothelial carcinoma variants. The most common variants were squamous cell and glandular differentiation in 9.9% and 4.4% of cases, respectively. Histological variants were associated with advanced tumor stage, tumor multifocality, sessile tumor architecture, tumor necrosis, lymphovascular invasion and lymph node metastasis compared to pure upper tract urothelial carcinoma (p ≤0.031). On univariable analysis variant histology was associated with disease recurrence (p = 0.002) and cancer specific mortality (p = 0.003). In 174 patients treated with adjuvant chemotherapy there was no difference in disease recurrence or survival between variant histology and pure upper tract urothelial carcinoma (p = 0.42 and 0.59, respectively). On multivariable analysis adjusted for the effects of standard clinicopathological characteristics variant histology was not associated with either end point. Conclusions: Almost 25% of patients with upper tract urothelial carcinoma treated with radical nephroureterectomy harbored histological variants. Variant histology was associated with features of biologically aggressive upper tract urothelial carcinoma. While variant histology is associated with worse outcomes on univariable analysis but this effect did not remain significant on multivariable analysis.

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