Effects of Variant Histology on the Oncologic Outcomes of Patients With Upper Urinary Tract Carcinoma After Radical Nephroureterectomy: A Propensity Score–Matched Analysis

Ho Seok Chung, Eu Chang Hwang, Myung Soo Kim, Seong Hyeon Yu, Seung Il Jung, Taek Won Kang, Chan Choi, Seock Hwan Choi, Tae Gyun Kwon, Joon Hwa Noh, Myung Ki Kim, Won Jin Cho, Sung Gu Kang, Seok Ho Kang, Jun Cheon, Ill Young Seo, Hong Chung, Hong Sup Kim, Chan Ho Lee, Ja Yoon KuHong Koo Ha, Byung Hoon Kim, Chang Wook Jeong, Ja Hyeon Ku, Cheol Kwak, Dongdeuk Kwon

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2 Citations (Scopus)

Abstract

Purpose: To determine the prognostic effect of upper tract urothelial carcinoma (UTUC) with variant histology (VH) after radical nephroureterectomy (RNU). Patients and Methods: The data of 1173 patients who received RNU for UTUC without neoadjuvant chemotherapy in 11 institutions between 2002 and 2016 were retrospectively reviewed. A matched propensity score analysis was performed. Clinicopathologic variables, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were compared between patients with pure UTUC and patients with UTUC and VH. Univariate and multivariate Cox proportional regression models were used to determine the independent variables associated with oncologic outcomes. Results: UTUC with VH was observed in 93 patients (7.9%). After propensity score matching, UTUC with VH showed no difference in clinicopathologic features compared to pure UTUC; however, it was associated with shorter RFS, CSS, and OS (log rank, P =.011, P =.002, P =.006, respectively). Additionally, the multivariate analysis revealed that VH was independently associated with a poor RFS [hazard ratio (HR) = 1.92; 95% confidence interval (CI), 1.27-2.89; P =.002], CSS (HR = 4.47; 95% CI, 1.99-10.1; P =.001), and OS (HR = 3.00; 95% CI, 1.55-5.78; P =.001). However, the Kaplan-Meier method revealed that differences in RFS, CSS, and OS were not significant in patients who received adjuvant chemotherapy (log rank, P =.562, P =.060, P =.153, respectively). Conclusion: UTUC with VH was independently associated with poor oncologic outcomes in patients with UTUC after RNU. Although patients with UTUC and VH had a poor prognosis compared to patients with pure UTUC, adjuvant chemotherapy would be helpful in improving the survival rates of these patients.

Original languageEnglish
Pages (from-to)e394-e407
JournalClinical Genitourinary Cancer
Volume17
Issue number3
DOIs
Publication statusPublished - 2019 Jun

Keywords

  • Histology
  • Nephroureterectomy
  • Prognosis
  • Survival
  • Urothelium

ASJC Scopus subject areas

  • Oncology
  • Urology

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