[Clinicopathologic characteristics and prognosis of upper tract urothelial carcinoma: an analysis of 368 radical nephroureterectomy specimens].

Objective

To evaluate the epidemiology, clinicopathological features and prognosis in upper tract urothelial carcinoma (UTUC) patients.

Methods

All archival 368 UTUC cases that underwent radical nephroureterectomy between September 1999 and October 2014 were reviewed, and their clinicopathological features were analyzed. Follow-up time was 1-216 months, with a mean follow-up of 41 month.

Results

One hundred and twenty-eight male and 240 female patients were included, with a mean age of 68 years ranging from 31 to 88 years. Tumor locations were classified in detail as follows: 148 renal pelvic tumors, 155 ureteral tumors, 58 renal pelvic and ureteral tumors, and 7 transitional tumors. Patients with history of renal transplantation (14.7%, 54/368) were more likely to develop UTUC before the age of 65 (P<0.01), with bilateral tract involved (P<0.01) and multifocal distributed (P=0.004). Histological grade was significantly associated with T stage (P<0.01), lympho-vascular involvement (P=0.001), neural invasion (P=0.005), carcinoma in situ (P=0.001) and extensive necrosis (P=0.020), while high-grade UTUC predominantly occurred in female patients (P=0.010) and histological variants (P<0.01). T stage was positively correlated with tumor size (P<0.01), lympho-vascular involvement (P<0.01), neural invasion (P<0.01) and lymph node metastasis (P=0.001). Furthermore, among the 214 followed-up cases, 76 died of the disease. Histological grade (P=0.002, P=0.005), T stage (P<0.01, P<0.01), lympho-vascular involvement (P=0.001, P=0.008), neural invasion (P<0.01, P=0.001) and extensive necrosis (P=0.017, P=0.023) were significantly associated with shorter overall survival and cancer specific survival of UTUC patients, respectively. In multivariable analyses, T stage (P<0.01, P<0.01) and extensive necrosis (P=0.004, P=0.014) were independent predictive factors of both overall survival and cancer specific survival, while neural invasion (P=0.007) and lymph node metastasis (P=0.007) were independent predictors of the overall survival.

Conclusions

Chinese UTUC reveals its unique epidemiology. UTUC more commonly occurs in women and has a similar incidence between the renal pelvic and ureteral carcinoma. Patients with history of renal transplantation are prone to detect UTUC through physical examination rather than hematuria. Histological grade, T stage, lympho-vascular involvement, neural invasion and extensive necrosis are predictors of survival in UTUC patients, while advanced-stage and extensive necrosis are independent predictors of poor outcome.