430 MULTI-INSTITUTIONAL VALIDATION OF THE PREDICTIVE VALUE OF PREOPERATIVE HYDRONEPHROSIS FOR ADVANCED STAGE UPPER-TRACT UROTHELIAL CARCINOMA (2010)

You have accessJournal of UrologyUrothelial Cancer: Upper Tract Tumors1 Apr 2010430 MULTI-INSTITUTIONAL VALIDATION OF THE PREDICTIVE VALUE OF PREOPERATIVE HYDRONEPHROSIS FOR ADVANCED STAGE UPPER-TRACT UROTHELIAL CARCINOMA John Terrell, James Brien, Michael Herman, Casey Ng, Douglas Scherr, Benjamin Scoll, Stephen Boorjian, Robert Uzzo, Mark Wille, Scott Eggener, Steven Lucas, Yair Lotan, Shahrokh Shariat, and Jay Raman John TerrellJohn Terrell Dallas, TX More articles by this author , James BrienJames Brien Hershey, PA More articles by this author , Michael HermanMichael Herman New York, NY More articles by this author , Casey NgCasey Ng New York, NY More articles by this author , Douglas ScherrDouglas Scherr New York, NY More articles by this author , Benjamin ScollBenjamin Scoll Phildelphia, PA More articles by this author , Stephen BoorjianStephen Boorjian Phildelphia, PA More articles by this author , Robert UzzoRobert Uzzo Phildelphia, PA More articles by this author , Mark WilleMark Wille Chicago, IL More articles by this author , Scott EggenerScott Eggener Chicago, IL More articles by this author , Steven LucasSteven Lucas Dallas, TX More articles by this author , Yair LotanYair Lotan Dallas, TX More articles by this author , Shahrokh ShariatShahrokh Shariat New York, NY More articles by this author , and Jay RamanJay Raman Hershey, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.500AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The presence of hydronephrosis (HN) has been implicated as a predictor of poor outcomes for patients diagnosed with bladder cancer. Small, single institution preliminary reports suggest a similar negative relationship may exist for upper-tract urothelial carcinoma (UTUC). Herein, we attempt to validate the prognostic value of preoperative HN in a large, multi-institutional cohort of UTUC patients (pts). METHODS Data on 469 pts with localized UTUC from 6 tertiary referral centers who underwent a radical nephroureterectomy (91%) or segmental ureterectomy (9%) without neoadjuvant chemotherapy were integrated into a relational database. Preoperative HN data, including presence vs. absence and high vs. low grade, were available in 408 pts. The association of HN with pathologic features was evaluated. RESULTS 254 men and 154 women with a median age of 69 years (IQR 15) were analyzed. Overall, 192 pts (47%) had > pT2 disease, 145 (36%) had non-organ confined disease (> pT3 and/or positive lymph nodes), and 298 (73%) had high grade disease on final pathology. Forty-six percent of pts had tumors in the renal pelvis, 27% in the ureter, and 27% in both. Preoperatively, 223 pts (55%) had HN (39% low grade and 61% high grade). HN was associated with > pT2 stage (p<0.001) and non-organ confined disease (p<0.001). On preoperative multivariate analysis that adjusted for the effects of gender, age, and tumor location, HN was an independent predictor of muscle invasive disease (HR 7.4, p<0.001), non-organ confined disease (HR 5.5, p<0.001), and high pathologic grade (HR 1.6, p=0.03). Even after controlling for ureteroscopic biopsy grade and urinary cytology data (n=172), HN remained an independent predictor of muscle invasive stage (HR 12.0, p<0.001) and non-organ confined disease (HR 5.1, p<0.001). The grade of HN further stratified pts into distinctly different risk-groups. CONCLUSIONS The presence of preoperative HN is a significant predictor for advanced stage UTUC. This readily available imaging modality may improve preoperative risk stratification to guide use of endoscopic versus extirpative surgery as well as the need for neoadjuvant chemotherapy regimens. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e170 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Terrell Dallas, TX More articles by this author James Brien Hershey, PA More articles by this author Michael Herman New York, NY More articles by this author Casey Ng New York, NY More articles by this author Douglas Scherr New York, NY More articles by this author Benjamin Scoll Phildelphia, PA More articles by this author Stephen Boorjian Phildelphia, PA More articles by this author Robert Uzzo Phildelphia, PA More articles by this author Mark Wille Chicago, IL More articles by this author Scott Eggener Chicago, IL More articles by this author Steven Lucas Dallas, TX More articles by this author Yair Lotan Dallas, TX More articles by this author Shahrokh Shariat New York, NY More articles by this author Jay Raman Hershey, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...