Combining imaging and ureteroscopy variables in a preoperative multivariable model for prediction of muscle‐invasive and non‐organ confined disease in patients with upper tract urothelial carcinoma

• Published in: BJU international Vol. 109; no. 1; pp. 77 - 82
• Main Authors: Favaretto, Ricardo L., Shariat, Shahrokh F., Savage, Caroline, Godoy, Guilherme, Chade, Daher C., Kaag, Matthew, Bochner, Bernard H., Coleman, Jonathan, Dalbagni, Guido
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.2012; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Biological and medical sciences; Carcinoma, Transitional Cell - diagnosis; Carcinoma, Transitional Cell - surgery; Chemotherapy; Cystectomy; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging - methods; Male; Medical research; Medical sciences; Middle Aged; Muscle Neoplasms - diagnosis; Neoplasm Invasiveness - diagnosis; Neoplasm Staging; Nephrology. Urinary tract diseases; nephroureterectomy; Patients; Predictive Value of Tests; Preoperative Period; Prognosis; renal pelvis; Retrospective Studies; Studies; Tomography, X-Ray Computed - methods; transitional cell carcinoma; Tumors of the urinary system; Ureteroscopy - methods; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urologic Neoplasms - diagnosis; Urologic Neoplasms - surgery; urothelial carcinoma; Young Adult; Nephrology; Prognosis; Variable; Disease; Early stage; Transitional cell carcinoma; Urology; Muscle; Endoscopy; Human; Urinary system disease; Renal pelvis; Prediction; Nephroureterectomy; Urinary tract disease; Malignant tumor; Ureteroscopy; Upper urinary tract transitional cell carcinoma; urothelial carcinoma; Non invasive method; Medical imagery; Models; Preoperative; Predictive factor; Cancer
• ISSN: 1464-4096; 1464-410X; 1464-410X
• DOI: 10.1111/j.1464-410X.2011.10288.x

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Improved patient selection for conservative management, neoadjuvant chemotherapy, and/or extended lymphadenectomy is urgently needed. We developed a highly accurate preoperative model to predict muscle‐invasive and non‐organ‐confined upper tract urothelial carcinoma based on standard imaging and ureteroscopy features. OBJECTIVE • To create a preoperative multivariable model to identify patients at risk of muscle‐invasive (pT2+) upper tract urothelial carcinoma (UTUC) and/or non‐organ confined (pT3+ or N+) UTUC (NOC‐UTUC) who potentially could benefit from radical nephroureterectomy (RNU), neoadjuvant chemotherapy and/or an extended lymph node dissection. PATIENTS AND METHODS • We retrospectively analysed data from 324 consecutive patients treated with RNU between 1995 and 2008 at a tertiary cancer centre. • Patients with muscle‐invasive bladder cancer were excluded, resulting in 274 patients for analysis. • Logistic regression models were used to predict pT2+ and NOC‐UTUC. Pre‐specified predictors included local invasion (i.e. parenchymal, renal sinus fat, or periureteric) on imaging, hydronephrosis on imaging, high‐grade tumours on ureteroscopy, and tumour location on ureteroscopy. • Predictive accuracy was measured by the area under the curve (AUC). RESULTS • The median follow‐up for patients without disease recurrence or death was 4.2 years. • Overall, 49% of the patients had pT2+, and 30% had NOC‐UTUC at the time of RNU. • In the multivariable analysis, only local invasion on imaging and ureteroscopy high grade were significantly associated with pathological stage. • AUC to predict pT2+ and NOC‐UTUC were 0.71 and 0.70, respectively. CONCLUSIONS • We designed a preoperative prediction model for pT2+ and NOC‐UTUC, based on readily available imaging and ureteroscopic grade. • Further research is needed to determine whether use of this prediction model to select patients for conservative management vs RNU, neoadjuvant chemotherapy, and/or extended lymphadenectomy will improve patient outcomes.