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Prognostic factors for upper urinary tract urothelial carcinoma

Nature Reviews Urology volume 8, pages 440–447 (2011)Cite this article

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Abstract

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

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Figure 1: CD24 immunoreactivity in urothelial carcinoma of the upper urinary tract.
Figure 2: EGFR immunoreactivity in urothelial carcinoma of the upper urinary tract

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Acknowledgements

C. P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape, LLC-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. Department of Urology, Medical University Graz, Auenbruggerplatz 7, 8036, Graz, Austria

    Thomas F. Chromecki

  2. Department of Urology, Rennes University Hospital, Rue Henri Le Guillou, 35000, Rennes, France

    Karim Bensalah & Grégory Verhoest

  3. Department of Urology, Landeskrankenhaus Weinviertel-Korneuburg, Wiener Ring 3–5, 2100, Korneuburg, Austria

    Mesut Remzi

  4. Department of Urology, Weill Cornell Medical College, New York–Presbyterian Hospital, 525 East 68th Street, Starr 900, New York, 10065, NY, USA

    Eugene K. Cha, Douglas S. Scherr & Shahrokh F. Shariat

  5. Department of Urology, University of Padua, Monoblocco Ospedaliero–IV Floor, Via Giustiniani 2, 35128, Padua, Italy

    Giacomo Novara

  6. Department of Urology, University of Montreal Health Center, 1058 rue St-Denis, Montreal, H2X 3J4, QC, Canada

    Pierre I. Karakiewicz

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T. F. Chromecki was responsible for researching the data and writing the article. T. F Chromecki, K. Bensalah, M. Remzi, G. Verhoest, E. K. Cha, D. S. Scherr, G. Novara, P. I. Karakiewicz and S. F. Shariat contributed equally to the discussion of content and reviewing the manuscript before submission.

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Chromecki, T., Bensalah, K., Remzi, M. et al. Prognostic factors for upper urinary tract urothelial carcinoma. Nat Rev Urol 8, 440–447 (2011). https://doi.org/10.1038/nrurol.2011.96

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