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67th Annual Meeting Abstracts
Preoperative Prediction Of Invasive Upper-Tract Urothelial Carcinoma Stage Using Hydronephrosis, Ureteroscopic Biopsy Grade, And Urinary Cytology
James C Brien1, *Shahrokh F Shariat2, *Michael P Herman3, *Casey K Ng3, Benjamin Scoll4, Stephen A Boorjian4, Robert G Uzzo4, *Scott E Eggener5, *John D Terrell6, Jay D Raman1
1Penn State Hershey Med Center, Hershey, PA;2Memorial Sloan-Kettering Cancer Center, New York, NY;3New York-Presbyterian Hospital / Weill Cornell Medical Center, New York, NY;4Fox Chase Cancer Center, Philadelphia, PA;5University of Chicago Medical Center, chicago, IL;6University of Texas Southwestern Medical Center, Dallas, TX
Introduction:
Hydronephrosis, ureteroscopic (URS) biopsy grade, and urinary cytology are suggested to correlate with advanced pathologic stage for upper-tract urothelial carcinoma (UTUC). In isolation, however, their accuracy remains suboptimal. We hypothesized that combining these variables would allow more accurate preoperative prediction of UTUC stage.
Methods:
Data on hydronephrosis (present vs. absent), urinary cytology (positive or atypical vs. negative), and URS grade (high vs. low) was available in 172 patients who underwent radical nephroureterectomy or segmental ureterectomy for clinically localized UTUC.
Results:
110 men and 62 women were evaluated. Preoperatively, 54% had hydronephrosis, 43% had high grade disease on URS biopsy, and 80% had positive urine cytology. Overall, 45% had > pT2 disease, and 34% had non-organ confined disease (> pT3 or N+). On multivariate analyses, the presence of hydronephrosis (p<0.001) and high URS grade (p<0.001) were associated with muscle-invasive disease and non-organ confined disease, while positive cytology was only associated with the latter (p=0.025). Combining all three variables allowed stratification of patients into risk groups for predicting UTUC stage. Specifically, abnormality of all three features had a positive predictive value of 89% for muscle-invasive and 73% for non-organ confined UTUC. Conversely, normality of all three variables had a negative predictive value of 100% for > pT2 and non-organ confined disease.
Conclusion:
Preoperative hydronephrosis, URS grade, and cytology can be used in conjunction to create a “triple screen” model with high accuracy for prediction of advanced UTUC, which may facilitate improved preoperative stratification to guide clinical decision making regarding treatment options.
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