Although previous literature shows tumor location as a prognostic factor in upper tract urothelial carcinoma (UTUC), there remains uninvestigated regarding the impact of tumor location on grade concordance and discrepancies between ureteroscopic (URS) biopsy and final radical nephroureterectomy(RNU) pathology.
In this international study, we retrospectively reviewed the records of 1,498 patients with UTUC who underwent diagnostic URS with concomitant biopsy followed by RNU between 2005 and 2020. Tumor location was divided into four sections: the calyceal-pelvic system, proximal ureter, middle ureter, and distal ureter. Patients with multifocal tumors were excluded from the study. We performed multiple comparison tests and logistic regression analyses.
Overall, 1,154 patients were included; 54.4% of those with low-grade URS biopsies were upgraded on RNU. In the multiple comparison tests, middle ureter tumors exhibited the highest probability of upgrading, meanwhile pelvicalyceal tumors exhibited the lowest probability of upgrading (73.7% vs 48.5%, p=0.007). Downgrading was comparable across all tumor locations. On multivariable analyses, middle ureteral location was significantly associated with a low probability of grade concordance (OR 0.59; 95%CI, 0.35-1.00; p =0.049) and an increased risk of upgrading (OR 2.80; 95%CI, 1.20-6.52; p =0.017). The discordance did not vary regardless of caliceal location, including the lower calyx.
Middle ureteral tumors diagnosed to be low-grade had a high probability to be undergraded. Our data can inform providers and their patients regarding the likelihood of undergrading according to tumor location, facilitating patient counselling and shared decision making regarding the choice of kidney sparing vs RNU.
Journal of endourology. 2024 Sep 12 [Epub ahead of print]
Satoshi Katayama, Benjamin Pradere, Nico C Grossmann, Aaron M Potretzke, Stephen J Boorjian, Alireza Ghoreifi, Siamak Daneshmand, Hooman Djaladat, John Sfakianos, Andrea Mari, Zine-Eddine Khene, David D'Andrea, Nozomi Hayakawa, Kazutoshi Fujita, Axel Heidenreich, Jay D Raman, Mathieu Roumiguie, Firas Abdollah, Alberto Breda, Matteo Fontana, Morgan Roupret, Vitaly Margulis, Pierre I Karakiewicz, Motoo Araki, Yasutomo Nasu, Shahrokh F Shariat
Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Urology, Shikata-cho, Okayama, Okayama, Japan, 7008558., CHU Tours, Department of urology, 2 boulevard tonnellé, Tours, France, 37000; ., Medical University of Vienna, Urology, Währinger Gürtel 18-20, Zurich, Austria, 8091., Mayo Clinic, Urology, 200 1st St. SW, Rochester, Minnesota, United States, 55905; ., Mayo Clinic, Urology, Rochester, Minnesota, United States; ., University of Southern California, Urology, 1441Eastlake Ave, Suite 7416, Los Angeles, California, United States, 90089; ., USC, Institute of Urology, 1441 Eastlake Ave, Suite 7416, Los Angeles, California, United States, 90024., University of Southern California, Los Angeles, United States; ., Icahn School of Medicine at Mount Sinai, Urology, 1425 madison ave L6-58, New York, New York, United States, 10029; ., Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Urology, Largo Brambilla 3, Firenze, Italy, 50100., Hospital Pontchaillou, CHU Rennes, Department of Urology, Rennes, France; ., Medical University of Vienna, Wien, Austria; ., St. Marianna University, School of Medicine, Department of Urology, Kawasaki, Japan; ., Kindai University Faculty of Medicine Hospital, Department of Urology, Osakasayama, Osaka, Japan; ., University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Urology, Cologne, Germany, Cologne, Germany; ., University of Texas - Southwestern Medical Center, Urology, 5323 Harry Hines Blvd., J8-106, Dallas, Texas, United States, 75390., CHU Toulouse, Department of urology, Toulouse, France; ., Henry Ford Health System, Vattikuti Urology Institute, Center for Outcomes Research Analytics and Evaluation, 2799 West Grand Boulevard, Detroit, Michigan, United States, 48202; ., Fundacio Puigvert, Urology , Barcelona, Cataluña, Spain; ., IRCCS Fondazione Ca' Granda - Ospedale Maggiore Policlinico, Urology, Via della Commenda 15, Milan, Italy, 20100; ., Pitié-Salpétrière Hospital, Academic Urology, 47-83 Boulevard de l'Hôpital, Paris, France, 75013., UT Southwestern Medical, Urology, 5339 harry hines blvd, Dallas, Texas, United States, 75390; ., University of Montreal Health Center, Cancer Prognostics and Health Outcomes Unit, Montreal, Quebec, Canada., Okayama University, Urology, 2-5-1 Shikata-cho, Okayama, Japan, 700-8558., okayama University, Urology, 2-5-1 Shikata, Okayama, Okayama, Japan, 700-8558; ., Medical University of Vienna, Wien, Wien, Austria; .