Prognostic significance of subclassifying pathological T3 upper tract urothelial carcinoma: Results from a multicenter cohort study

Objective The population with pathological T3 (pT3) upper tract urothelial carcinoma (UTUC) is heterogeneous, thereby making prognostication challenging. We assessed the clinical ramifications of subclassifying pT3 UTUC after nephroureterectomy. Methods We conducted a retrospective analysis includin...

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Published in:International journal of urology 2024-02, Vol.31 (2), p.125-132
Main Authors: Suhara, Yushi, Urabe, Fumihiko, Yoshihara, Kentaro, Kurawaki, Shiro, Fukuokaya, Wataru, Iwatani, Kosuke, Imai, Yu, Sakanaka, Keigo, Hisakane, Akira, Kurauchi, Takashi, Kayano, Sotaro, Onuma, Hajime, Mori, Keiichiro, Kimura, Shoji, Tashiro, Kojiro, Tsuzuki, Shunsuke, Miki, Jun, Sato, Shun, Takahashi, Hiroyuki, Kimura, Takahiro
Format: Article
Language:English
Subjects:
Metastases
Multivariate analysis
pathological T3
Population studies
Risk factors
subclassification of pT3
Survival
upper tract urothelial carcinoma
Urothelial carcinoma
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Summary:Objective The population with pathological T3 (pT3) upper tract urothelial carcinoma (UTUC) is heterogeneous, thereby making prognostication challenging. We assessed the clinical ramifications of subclassifying pT3 UTUC after nephroureterectomy. Methods We conducted a retrospective analysis including 308 patients who underwent nephroureterectomy for pT3N0–1M0 UTUC. pT3 was subclassified into pT3a and pT3b based on invasion of the peripelvic and/or periureteral fat. Cox's proportional hazard models were utilized to determine the significant prognosticators of oncological outcomes, encompassing intravesical recurrence‐free survival, recurrence‐free survival (RFS), cancer‐specific survival (CSS), and overall survival. Results Multivariate analysis elucidated that pT3b status, pathological N1 status, and lymphovascular invasion status were independent risk factors for an unfavorable RFS and CSS. Although the RFS and CSS of patients with pT3b UTUC were superior to those in patients with pT4 UTUC, no significant disparities were detected between patients with pT3a and pT2. Conclusion Our findings demonstrate that pT3 UTUC with peripelvic/periureteral fat invasion is independently associated with metastasis and cancer‐specific death after nephroureterectomy. These findings provide patients and physicians with invaluable insight into the risk for disease progression in pT3 UTUC patients.
ISSN:0919-8172
1442-2042
DOI:10.1111/iju.15321