Impact of variant histology on disease aggressiveness and outcome after nephroureterectomy in Japanese patients with upper tract urothelial carcinoma

• Published in: International journal of clinical oncology Vol. 20; no. 2; pp. 362 - 368
• Main Authors: Sakano, Shigeru, Matsuyama, Hideyasu, Kamiryo, Yoriaki, Hayashida, Shigeaki, Yamamoto, Norio, Kaneda, Yoshitaka, Nasu, Takahito, Baba, Yoshikazu, Shimabukuro, Tomoyuki, Suga, Akinobu, Yamamoto, Mitsutaka, Aoki, Akihiko, Takai, Kimio, Yoshihiro, Satoru, Oba, Kazuo
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.04.2015; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Bladder cancer; Blood Vessels - pathology; Cancer Research; Cancer surgery; Carcinoma - pathology; Carcinoma - surgery; Female; Histology; Humans; Japan; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Lymphatic Vessels - pathology; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Grading; Neoplasm Invasiveness; Neoplasm Staging; Nephrectomy; Oncology; Original Article; Retrospective Studies; Surgical Oncology; Survival Rate; Treatment Outcome; Ureter - surgery; Ureteral Neoplasms - pathology; Ureteral Neoplasms - surgery; Urothelium; Japan; Ureteral neoplasms; Histology; Transitional cell carcinoma; Survival; Kidney pelvis
• ISSN: 1341-9625; 1437-7772
• DOI: 10.1007/s10147-014-0721-3

Background Patients with urinary bladder urothelial carcinoma (UC) with variant histology have features of more advanced disease and a likelihood of poorer survival than those with pure UC. We investigated the impact of variant histology on disease aggressiveness and clinical outcome after radical nephroureterectomy (RNU) in Japanese patients with upper tract UC (UTUC). Information on variant histology might guide appropriate patient selection for adjuvant therapy after RNU. Methods We enrolled 502 UTUC patients treated with RNU in this retrospective cohort study, and analyzed associations of variant histology with clinicopathological variables and disease-specific survival. Results The median follow-up was 41.4 months. A total of 60 (12.0 %) UTUC patients had variant histology. UTUC with variant histology was significantly associated with advanced pathological T stage (pT ≥ 3), higher tumor grade (G3), and more lymphovascular invasion ( P  < 0.0001). Variant histology in all patients was significantly associated with worse disease-specific survival after RNU on univariate analysis ( P  = 0.0004), but this effect did not remain significant on multivariate analysis. However, variant histology was a significantly independent predictor for disease-specific survival in patients with pT ≥ 3 tumors ( P  = 0.0095). Conclusions UTUC with variant histology might be a phenotype of high-grade, locally aggressive advanced tumors rather than of systemic disease. Variant histology may be useful for selection of patients with pT ≥ 3 UTUC for adjuvant therapy. Prospective studies in a larger number of patients with a centralized pathological review are needed to confirm our results.