Biological and prognostic implications of biopsy upgrading for high-grade upper tract urothelial carcinoma at nephroureterectomy
Katayama, Satoshi (Okayama University Graduate School of Medicine)
Pradere, Benjamin (Medical University of Vienna)
Grossman, Nico C. (University Hospital Zurich (Suïssa))
Potretzke, Aaron M. (Mayo Clinic (Rochester, Estats Units d'Amèrica))
Boorjian, Stephen A. (Mayo Clinic (Rochester, Estats Units d'Amèrica))
Ghoreifi, Alireza (University of Southern California)
Daneshmand, Sia (University of Southern California)
Djaladat, Hooman (University of Southern California)
Sfakianos, John P. (Icahn School of Medicine at Mount Sinai Hospital)
Mari, Andrea (Università degli Studi di Firenze)
Khene, Zine-Eddine (Hospital Pontchaillou)
D'Andrea, David (Medical University of Vienna)
Hayakawa, Nozomi (St. Marianna University School of Medicine)
Breda, Alberto (Institut d'Investigació Biomèdica Sant Pau)
Fontana, Matteo (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Fujita, Kazutoshi (Osaka University Graduate School of Medicine)
Antonelli, Alessandro (University of Verona)
van Doeveren, Thomas (University Medical Centre Rotterdam)
Steinbach, Christina (Medical University of Vienna)
Mori, Keiichiro (The Jikei University School of Medicine)
Laukhtina, Ekaterina (Sechenov University)
Rouprêt, Morgan (Sorbonne University)
Margulis, Vitaly (University of Texas Southwestern Medical Center)
Karakiewicz, Pierre I. (University of Montreal Health Centre)
Araki, Motoo (Okayama University Graduate School of Medicine)
Compérat, Eva (Medical University of Vienna)
Nasu, Yasutomo (Okayama University Graduate School of Medicine)
Shariat, Shahrokh (Karl Landsteiner Institute of Urology and Andrology)
Universitat Autònoma de Barcelona

Fecha:	2023
Resumen:	Technical limitations of ureteroscopic (URS) biopsy has been considered responsible for substantial upgrading rate in upper tract urothelial carcinoma (UTUC). However, the impact of tumor specific factors for upgrading remain uninvestigated. Patients who underwent URS biopsy were included between 2005 and 2020 at 13 institutions. We assessed the prognostic impact of upgrading (low-grade on URS biopsy) versus same grade (high-grade on URS biopsy) for high-grade UTUC tumors on radical nephroureterectomy (RNU) specimens. This study included 371 patients, of whom 112 (30%) and 259 (70%) were biopsy-based low- and high-grade tumors, respectively. Median follow-up was 27. 3 months. Patients with high-grade biopsy were more likely to harbor unfavorable pathologic features, such as lymphovascular invasion (p < 0. 001) and positive lymph nodes (LNs; p < 0. 001). On multivariable analyses adjusting for the established risk factors, high-grade biopsy was significantly associated with worse overall (hazard ratio [HR] 1. 74; 95% confidence interval [CI], 1. 10-2. 75; p = 0. 018), cancer-specific (HR 1. 94; 95% CI, 1. 07-3. 52; p = 0. 03), and recurrence-free survival (HR 1. 80; 95% CI, 1. 13-2. 87; p = 0. 013). In subgroup analyses of patients with pT2-T4 and/or positive LN, its significant association retained. Furthermore, high-grade biopsy in clinically non-muscle invasive disease significantly predicted upstaging to final pathologically advanced disease (≥pT2) compared to low-grade biopsy. High tumor grade on URS biopsy is associated with features of biologically and clinically aggressive UTUC tumors. URS low-grade UTUC that becomes upgraded to high-grade might carry a better prognosis than high-grade UTUC on URS. Tumor specific factors are likely to be responsible for upgrading to high-grade on RNU.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Biopsy grade ; Intratumor heterogeneity ; Survival ; Upgrading ; Upper tract urothelial carcinoma
Publicado en:	International Journal of Urology, Vol. 30 Núm. 1 (january 2023) , p. 63-69, ISSN 1442-2042

DOI: 10.1111/iju.15061
PMID: 36349904

7 p, 363.3 KB

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