The aim of this study was to investigate clinical and ureteroscopic factors considered as important for the prediction of invasive upper tract urothelial carcinoma (UTUC) and establish a model using a new ureteroscopic scoring.
We analyzed tumor depth and grade from ureteroscopic biopsies in 172 patients who underwent imaging studies, urine cytology, and radical nephroureterectomy. Invasive UTUC was defined as muscle-invasive or non-organ confined tumors. Ureteroscopic scoring was defined as sum of the risk factors, lamina propria invasion, or presence of a high-grade tumor.
In the multivariate analysis, lamina propria invasion was a significant factor associated with an increased risk of invasive UTUC. Positive urine cytology, hydronephrosis, and local invasion on imaging were also significant. Presence of a high-grade tumor was not significant due to interaction with lamina propria invasion (P < 0.001). In the ureteroscopic scoring model, the odds ratio of invasive UTUC was significantly related to the ureteroscopic scoring number (30.9% (56/81), 66.7% (14/42), and 83.7% (41/49) according to the sum of risk factors 0 to 2, respectively, (P < 0.001). Positive predictive value (PPV) for invasive UTUC was increased in relation to the number of risk factors including urine cytology, hydronephrosis, local invasion on imaging, and any abnormal ureteroscopic finding (lamina propria invasion or presence of high-grade tumors). The PPV gradually increased as follows: 6.3%, 33.3%, 52.1%, 81.6%, to 92.9% for 0 to 4 positive risk factors, respectively (P < 0.001).
When lamina propria invasion and presence of a high-grade tumor were incorporated, our novel ureteroscopic scoring model was highly predictive of invasive UTUC.
Surgical oncology. 2017 Apr 17 [Epub]
Seong Soo Jeon, Hyun Hwan Sung, Hwang Gyun Jeon, Deok Hyun Han, Byong Chang Jeong, Seong Il Seo, Hyun Moo Lee, Han-Yong Choi
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea., Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: .