Preoperative Hydronephrosis, Ureteroscopic Biopsy Grade and Urinary Cytology Can Improve Prediction of Advanced Upper Tract Urothelial Carcinoma

James C. Brien, Shahrokh F. Shariat, Michael P. Herman, Casey K. Ng, Douglas S. Scherr, Benjamin Scoll, Robert G. Uzzo, Mark Wille, Scott E. Eggener, John D. Terrell, Steven M. Lucas, Yair Lotan, Stephen A. Boorjian, Jay Raman

Research output: Contribution to journalArticle

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Abstract

Purpose: We evaluated the value of hydronephrosis, ureteroscopic biopsy grade and urinary cytology to predict advanced upper tract urothelial carcinoma. Materials and Methods: We reviewed the charts of 469 patients with upper tract urothelial carcinoma treated with radical nephroureterectomy or distal ureterectomy. Complete data on hydronephrosis (present vs absent), ureteroscopic grade (high vs low) and urinary cytology (positive vs negative) were available in 172 patients. The outcome was muscle invasive (pT2-pT4) or nonorgan confined (pT3 or greater, or lymph node metastasis) upper tract urothelial carcinoma. Results: Of the patients 92 (54%) had hydronephrosis, 74 (43%) had high grade disease on ureteroscopic biopsy and 137 (80%) had positive cytology. On univariate analysis hydronephrosis (p <0.001), high ureteroscopic grade (p <0.001) and positive cytology (p = 0.03) were associated with muscle invasive and nonorgan confined disease. On multivariate analysis adjusting for tumor site, gender and age hydronephrosis and high ureteroscopic grade were associated with muscle invasive carcinoma (HR 12.0 and 4.5, respectively, each p <0.001) but cytology was not (HR 2.3, p = 0.17). However, all 3 variables were independently associated with nonorgan confined disease (HR 5.1, p <0.001; HR 3.9, p <0.001; and HR 3.1, p = 0.035, respectively). Combining these 3 tests incrementally improved the prediction of upper tract urothelial carcinoma stage. Abnormality of all 3 tests had 89% and 73% positive predictive value for muscle invasive and nonorgan confined upper tract urothelial carcinoma, respectively, but when all tests were normal, the negative predictive value was 100%. Conclusions: Preoperative evaluation for hydronephrosis, ureteroscopic grade and cytology can identify patients at risk for advanced upper tract urothelial carcinoma. Such knowledge may impact surgery choice and extent as well as the need for perioperative chemotherapy regimens.

Original languageEnglish (US)
Pages (from-to)69-73
Number of pages5
JournalJournal of Urology
Volume184
Issue number1
DOIs
StatePublished - Jul 1 2010

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Hydronephrosis
Cell Biology
Carcinoma
Biopsy
Muscles
Multivariate Analysis
Lymph Nodes
Neoplasm Metastasis
Drug Therapy
Neoplasms

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Brien, James C. ; Shariat, Shahrokh F. ; Herman, Michael P. ; Ng, Casey K. ; Scherr, Douglas S. ; Scoll, Benjamin ; Uzzo, Robert G. ; Wille, Mark ; Eggener, Scott E. ; Terrell, John D. ; Lucas, Steven M. ; Lotan, Yair ; Boorjian, Stephen A. ; Raman, Jay. / Preoperative Hydronephrosis, Ureteroscopic Biopsy Grade and Urinary Cytology Can Improve Prediction of Advanced Upper Tract Urothelial Carcinoma. In: Journal of Urology. 2010 ; Vol. 184, No. 1. pp. 69-73.
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title = "Preoperative Hydronephrosis, Ureteroscopic Biopsy Grade and Urinary Cytology Can Improve Prediction of Advanced Upper Tract Urothelial Carcinoma",
abstract = "Purpose: We evaluated the value of hydronephrosis, ureteroscopic biopsy grade and urinary cytology to predict advanced upper tract urothelial carcinoma. Materials and Methods: We reviewed the charts of 469 patients with upper tract urothelial carcinoma treated with radical nephroureterectomy or distal ureterectomy. Complete data on hydronephrosis (present vs absent), ureteroscopic grade (high vs low) and urinary cytology (positive vs negative) were available in 172 patients. The outcome was muscle invasive (pT2-pT4) or nonorgan confined (pT3 or greater, or lymph node metastasis) upper tract urothelial carcinoma. Results: Of the patients 92 (54{\%}) had hydronephrosis, 74 (43{\%}) had high grade disease on ureteroscopic biopsy and 137 (80{\%}) had positive cytology. On univariate analysis hydronephrosis (p <0.001), high ureteroscopic grade (p <0.001) and positive cytology (p = 0.03) were associated with muscle invasive and nonorgan confined disease. On multivariate analysis adjusting for tumor site, gender and age hydronephrosis and high ureteroscopic grade were associated with muscle invasive carcinoma (HR 12.0 and 4.5, respectively, each p <0.001) but cytology was not (HR 2.3, p = 0.17). However, all 3 variables were independently associated with nonorgan confined disease (HR 5.1, p <0.001; HR 3.9, p <0.001; and HR 3.1, p = 0.035, respectively). Combining these 3 tests incrementally improved the prediction of upper tract urothelial carcinoma stage. Abnormality of all 3 tests had 89{\%} and 73{\%} positive predictive value for muscle invasive and nonorgan confined upper tract urothelial carcinoma, respectively, but when all tests were normal, the negative predictive value was 100{\%}. Conclusions: Preoperative evaluation for hydronephrosis, ureteroscopic grade and cytology can identify patients at risk for advanced upper tract urothelial carcinoma. Such knowledge may impact surgery choice and extent as well as the need for perioperative chemotherapy regimens.",
author = "Brien, {James C.} and Shariat, {Shahrokh F.} and Herman, {Michael P.} and Ng, {Casey K.} and Scherr, {Douglas S.} and Benjamin Scoll and Uzzo, {Robert G.} and Mark Wille and Eggener, {Scott E.} and Terrell, {John D.} and Lucas, {Steven M.} and Yair Lotan and Boorjian, {Stephen A.} and Jay Raman",
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Brien, JC, Shariat, SF, Herman, MP, Ng, CK, Scherr, DS, Scoll, B, Uzzo, RG, Wille, M, Eggener, SE, Terrell, JD, Lucas, SM, Lotan, Y, Boorjian, SA & Raman, J 2010, 'Preoperative Hydronephrosis, Ureteroscopic Biopsy Grade and Urinary Cytology Can Improve Prediction of Advanced Upper Tract Urothelial Carcinoma', Journal of Urology, vol. 184, no. 1, pp. 69-73. https://doi.org/10.1016/j.juro.2010.03.030

Preoperative Hydronephrosis, Ureteroscopic Biopsy Grade and Urinary Cytology Can Improve Prediction of Advanced Upper Tract Urothelial Carcinoma. / Brien, James C.; Shariat, Shahrokh F.; Herman, Michael P.; Ng, Casey K.; Scherr, Douglas S.; Scoll, Benjamin; Uzzo, Robert G.; Wille, Mark; Eggener, Scott E.; Terrell, John D.; Lucas, Steven M.; Lotan, Yair; Boorjian, Stephen A.; Raman, Jay.

In: Journal of Urology, Vol. 184, No. 1, 01.07.2010, p. 69-73.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Preoperative Hydronephrosis, Ureteroscopic Biopsy Grade and Urinary Cytology Can Improve Prediction of Advanced Upper Tract Urothelial Carcinoma

AU - Brien, James C.

AU - Shariat, Shahrokh F.

AU - Herman, Michael P.

AU - Ng, Casey K.

AU - Scherr, Douglas S.

AU - Scoll, Benjamin

AU - Uzzo, Robert G.

AU - Wille, Mark

AU - Eggener, Scott E.

AU - Terrell, John D.

AU - Lucas, Steven M.

AU - Lotan, Yair

AU - Boorjian, Stephen A.

AU - Raman, Jay

PY - 2010/7/1

Y1 - 2010/7/1

N2 - Purpose: We evaluated the value of hydronephrosis, ureteroscopic biopsy grade and urinary cytology to predict advanced upper tract urothelial carcinoma. Materials and Methods: We reviewed the charts of 469 patients with upper tract urothelial carcinoma treated with radical nephroureterectomy or distal ureterectomy. Complete data on hydronephrosis (present vs absent), ureteroscopic grade (high vs low) and urinary cytology (positive vs negative) were available in 172 patients. The outcome was muscle invasive (pT2-pT4) or nonorgan confined (pT3 or greater, or lymph node metastasis) upper tract urothelial carcinoma. Results: Of the patients 92 (54%) had hydronephrosis, 74 (43%) had high grade disease on ureteroscopic biopsy and 137 (80%) had positive cytology. On univariate analysis hydronephrosis (p <0.001), high ureteroscopic grade (p <0.001) and positive cytology (p = 0.03) were associated with muscle invasive and nonorgan confined disease. On multivariate analysis adjusting for tumor site, gender and age hydronephrosis and high ureteroscopic grade were associated with muscle invasive carcinoma (HR 12.0 and 4.5, respectively, each p <0.001) but cytology was not (HR 2.3, p = 0.17). However, all 3 variables were independently associated with nonorgan confined disease (HR 5.1, p <0.001; HR 3.9, p <0.001; and HR 3.1, p = 0.035, respectively). Combining these 3 tests incrementally improved the prediction of upper tract urothelial carcinoma stage. Abnormality of all 3 tests had 89% and 73% positive predictive value for muscle invasive and nonorgan confined upper tract urothelial carcinoma, respectively, but when all tests were normal, the negative predictive value was 100%. Conclusions: Preoperative evaluation for hydronephrosis, ureteroscopic grade and cytology can identify patients at risk for advanced upper tract urothelial carcinoma. Such knowledge may impact surgery choice and extent as well as the need for perioperative chemotherapy regimens.

AB - Purpose: We evaluated the value of hydronephrosis, ureteroscopic biopsy grade and urinary cytology to predict advanced upper tract urothelial carcinoma. Materials and Methods: We reviewed the charts of 469 patients with upper tract urothelial carcinoma treated with radical nephroureterectomy or distal ureterectomy. Complete data on hydronephrosis (present vs absent), ureteroscopic grade (high vs low) and urinary cytology (positive vs negative) were available in 172 patients. The outcome was muscle invasive (pT2-pT4) or nonorgan confined (pT3 or greater, or lymph node metastasis) upper tract urothelial carcinoma. Results: Of the patients 92 (54%) had hydronephrosis, 74 (43%) had high grade disease on ureteroscopic biopsy and 137 (80%) had positive cytology. On univariate analysis hydronephrosis (p <0.001), high ureteroscopic grade (p <0.001) and positive cytology (p = 0.03) were associated with muscle invasive and nonorgan confined disease. On multivariate analysis adjusting for tumor site, gender and age hydronephrosis and high ureteroscopic grade were associated with muscle invasive carcinoma (HR 12.0 and 4.5, respectively, each p <0.001) but cytology was not (HR 2.3, p = 0.17). However, all 3 variables were independently associated with nonorgan confined disease (HR 5.1, p <0.001; HR 3.9, p <0.001; and HR 3.1, p = 0.035, respectively). Combining these 3 tests incrementally improved the prediction of upper tract urothelial carcinoma stage. Abnormality of all 3 tests had 89% and 73% positive predictive value for muscle invasive and nonorgan confined upper tract urothelial carcinoma, respectively, but when all tests were normal, the negative predictive value was 100%. Conclusions: Preoperative evaluation for hydronephrosis, ureteroscopic grade and cytology can identify patients at risk for advanced upper tract urothelial carcinoma. Such knowledge may impact surgery choice and extent as well as the need for perioperative chemotherapy regimens.

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