Discordance Between Clinical and Pathological Staging and Grading in Upper Tract Urothelial Carcinoma
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Discordance Between Clinical and Pathological Staging and Grading in Upper Tract Urothelial Carcinoma. / Mori, Keiichiro; Katayama, Satoshi; Laukhtina, Ekaterina; Schuettfort, Victor M; Pradere, Benjamin; Quhal, Fahad; Sari Motlagh, Reza; Mostafaei, Hadi; Grossmann, Nico C; Rajwa, Pawel; Zimmermann, Kristin; Karakiewicz, Pierre I; Abufaraj, Mohammad; Fajkovic, Harun; Rouprêt, Morgan; Margulis, Vitaly; Enikeev, Dmitry V; Egawa, Shin; Shariat, Shahrokh F.
In: CLIN GENITOURIN CANC, Vol. 20, No. 1, 02.2022, p. 95.e1-95.e6.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Discordance Between Clinical and Pathological Staging and Grading in Upper Tract Urothelial Carcinoma
AU - Mori, Keiichiro
AU - Katayama, Satoshi
AU - Laukhtina, Ekaterina
AU - Schuettfort, Victor M
AU - Pradere, Benjamin
AU - Quhal, Fahad
AU - Sari Motlagh, Reza
AU - Mostafaei, Hadi
AU - Grossmann, Nico C
AU - Rajwa, Pawel
AU - Zimmermann, Kristin
AU - Karakiewicz, Pierre I
AU - Abufaraj, Mohammad
AU - Fajkovic, Harun
AU - Rouprêt, Morgan
AU - Margulis, Vitaly
AU - Enikeev, Dmitry V
AU - Egawa, Shin
AU - Shariat, Shahrokh F
N1 - Copyright © 2021. Published by Elsevier Inc.
PY - 2022/2
Y1 - 2022/2
N2 - INTRODUCTION: This study aimed to evaluate the concordance in tumor stage and grade between ureteroscopic (URS) biopsy and radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC).PATIENTS AND METHODS: Records of 1,214 UTUC patients who had undergone URS biopsy followed by RNU were included. Univariable and multivariable logistic regression analyses were performed to identify factors contributing to the pathological upstaging.RESULTS: The concordance between URS biopsy-based clinical and RNU pathological staging was 34.5%. Clinical understaging occurred in 59.5% patients. Upstaging to muscle-invasive disease occurred in 240 (41.7%) of 575 patients diagnosed with ≤cT1 disease. Of those diagnosed with muscle-invasive disease on final pathology, 89.6% had been clinically diagnosed with ≤cT1 disease. In the univariable analyses, computed tomography urography (CTU)-based invasion, ureter location, hydronephrosis, high-grade cytology, high-grade biopsy, sessile architecture, age, and women sex were significantly associated with pathological upstaging (P < .05). In the multivariable analyses, CTU-based invasion and hydronephrosis remained associated with pathological upstaging (P < .05). URS biopsy-based clinical and pathological gradings were concordant in 634 (54.2%) patients. Clinical undergrading occurred in 496 (42.4%) patients.CONCLUSIONS: Clinical understaging/undergrading and upstaging to muscle-invasive disease occurred in a high proportion of UTUC patients undergoing RNU. Despite the inherent selection bias, these data underline the challenges of accurate UTUC staging and grading. In daily clinical practice, URS biopsy and CTU offer the most accurate preoperative information albeit with limited predictive value when used alone. These findings should be considered when utilizing preoperative, risk-adapted strategies.
AB - INTRODUCTION: This study aimed to evaluate the concordance in tumor stage and grade between ureteroscopic (URS) biopsy and radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC).PATIENTS AND METHODS: Records of 1,214 UTUC patients who had undergone URS biopsy followed by RNU were included. Univariable and multivariable logistic regression analyses were performed to identify factors contributing to the pathological upstaging.RESULTS: The concordance between URS biopsy-based clinical and RNU pathological staging was 34.5%. Clinical understaging occurred in 59.5% patients. Upstaging to muscle-invasive disease occurred in 240 (41.7%) of 575 patients diagnosed with ≤cT1 disease. Of those diagnosed with muscle-invasive disease on final pathology, 89.6% had been clinically diagnosed with ≤cT1 disease. In the univariable analyses, computed tomography urography (CTU)-based invasion, ureter location, hydronephrosis, high-grade cytology, high-grade biopsy, sessile architecture, age, and women sex were significantly associated with pathological upstaging (P < .05). In the multivariable analyses, CTU-based invasion and hydronephrosis remained associated with pathological upstaging (P < .05). URS biopsy-based clinical and pathological gradings were concordant in 634 (54.2%) patients. Clinical undergrading occurred in 496 (42.4%) patients.CONCLUSIONS: Clinical understaging/undergrading and upstaging to muscle-invasive disease occurred in a high proportion of UTUC patients undergoing RNU. Despite the inherent selection bias, these data underline the challenges of accurate UTUC staging and grading. In daily clinical practice, URS biopsy and CTU offer the most accurate preoperative information albeit with limited predictive value when used alone. These findings should be considered when utilizing preoperative, risk-adapted strategies.
U2 - 10.1016/j.clgc.2021.10.002
DO - 10.1016/j.clgc.2021.10.002
M3 - SCORING: Journal article
C2 - 34764007
VL - 20
SP - 95.e1-95.e6
JO - CLIN GENITOURIN CANC
JF - CLIN GENITOURIN CANC
SN - 1558-7673
IS - 1
ER -
