Evaluation of Pre-operative Biopsy, Surgical Procedures and Oncologic Outcomes in Upper Tract Urothelial Carcinoma (UTUC)

Purpose: Discordance between pre-operative biopsy and final pathology for Upper Tract Urothelial Carcinoma (UTUC) is high and optimal management remains controversial. The aim of this study is to evaluate the accuracy of pre-operative biopsy, to identify prognostic factors and to evaluate the effect...

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Autores principales:	Florestan J. Koll, Eva Meisenzahl, Bernhard Haller, Philipp Maisch, Florian Kirchhoff, Thomas Horn, Jürgen E. Gschwend, Sebastian C. Schmid
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	adjuvant chemotherapy nephroureterectomy segmental ureteral resection ureteroscopy upper tract urothelial carcinoma UTUC Surgery RD1-811
Acceso en línea:	https://doaj.org/article/b826d23d0bf04cf0810904123afdf502
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spelling	oai:doaj.org-article:b826d23d0bf04cf0810904123afdf5022021-11-30T22:43:50ZEvaluation of Pre-operative Biopsy, Surgical Procedures and Oncologic Outcomes in Upper Tract Urothelial Carcinoma (UTUC)2296-875X10.3389/fsurg.2021.790738https://doaj.org/article/b826d23d0bf04cf0810904123afdf5022021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fsurg.2021.790738/fullhttps://doaj.org/toc/2296-875XPurpose: Discordance between pre-operative biopsy and final pathology for Upper Tract Urothelial Carcinoma (UTUC) is high and optimal management remains controversial. The aim of this study is to evaluate the accuracy of pre-operative biopsy, to identify prognostic factors and to evaluate the effect of adjuvant chemotherapy on survival and oncologic outcome in UTUC.Methods: We analyzed records of patients receiving surgical treatment for UTUC. Pathology of pre-operative biopsy was compared to surgical specimen. We used Kaplan-Meier method to estimate survival probabilities and Cox's proportional hazards models to estimate the association between covariates and event times. Primary endpoint was overall survival (OS). A matched-pair analysis was performed to evaluate the effect of adjuvant chemotherapy.Results: 151 patients underwent surgical treatment (28% open, 36% laparoscopic, 17% robotic radical nephroureterectomy; 14% segmental ureteral resections and 5% palliative nephrectomy) for UTUC and were included in the analysis. Upstaging from <pT1 in endoscopic biopsy to ≥pT1 in final pathology occurred in 61% of patients and upgrading from low-grade to high-grade occurred in 30% of patients. Five-year OS was 59.5%. In the univariate Cox-regression model pathological stage, grade, lymphovascular invasion and positive surgical margins were associated with OS. Matched pair analysis for stage (<pT3; ≥pT3; pN+) and age revealed a significant survival benefit for adjuvant chemotherapy (HR 0.40, 0.14–0.77, p < 0.018) in this cohort.Conclusion: UTUC is often underestimated in pre-operative biopsy, and it is associated with significant mortality. Pathological stage and grade, lymphovascular invasion and lymph node metastases are predictors of oncologic outcome and survival.Florestan J. KollFlorestan J. KollEva MeisenzahlBernhard HallerPhilipp MaischPhilipp MaischFlorian KirchhoffThomas HornJürgen E. GschwendSebastian C. SchmidFrontiers Media S.A.articleadjuvant chemotherapynephroureterectomysegmental ureteral resectionureteroscopyupper tract urothelial carcinomaUTUCSurgeryRD1-811ENFrontiers in Surgery, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	adjuvant chemotherapy nephroureterectomy segmental ureteral resection ureteroscopy upper tract urothelial carcinoma UTUC Surgery RD1-811
spellingShingle	adjuvant chemotherapy nephroureterectomy segmental ureteral resection ureteroscopy upper tract urothelial carcinoma UTUC Surgery RD1-811 Florestan J. Koll Florestan J. Koll Eva Meisenzahl Bernhard Haller Philipp Maisch Philipp Maisch Florian Kirchhoff Thomas Horn Jürgen E. Gschwend Sebastian C. Schmid Evaluation of Pre-operative Biopsy, Surgical Procedures and Oncologic Outcomes in Upper Tract Urothelial Carcinoma (UTUC)
description	Purpose: Discordance between pre-operative biopsy and final pathology for Upper Tract Urothelial Carcinoma (UTUC) is high and optimal management remains controversial. The aim of this study is to evaluate the accuracy of pre-operative biopsy, to identify prognostic factors and to evaluate the effect of adjuvant chemotherapy on survival and oncologic outcome in UTUC.Methods: We analyzed records of patients receiving surgical treatment for UTUC. Pathology of pre-operative biopsy was compared to surgical specimen. We used Kaplan-Meier method to estimate survival probabilities and Cox's proportional hazards models to estimate the association between covariates and event times. Primary endpoint was overall survival (OS). A matched-pair analysis was performed to evaluate the effect of adjuvant chemotherapy.Results: 151 patients underwent surgical treatment (28% open, 36% laparoscopic, 17% robotic radical nephroureterectomy; 14% segmental ureteral resections and 5% palliative nephrectomy) for UTUC and were included in the analysis. Upstaging from <pT1 in endoscopic biopsy to ≥pT1 in final pathology occurred in 61% of patients and upgrading from low-grade to high-grade occurred in 30% of patients. Five-year OS was 59.5%. In the univariate Cox-regression model pathological stage, grade, lymphovascular invasion and positive surgical margins were associated with OS. Matched pair analysis for stage (<pT3; ≥pT3; pN+) and age revealed a significant survival benefit for adjuvant chemotherapy (HR 0.40, 0.14–0.77, p < 0.018) in this cohort.Conclusion: UTUC is often underestimated in pre-operative biopsy, and it is associated with significant mortality. Pathological stage and grade, lymphovascular invasion and lymph node metastases are predictors of oncologic outcome and survival.
format	article
author	Florestan J. Koll Florestan J. Koll Eva Meisenzahl Bernhard Haller Philipp Maisch Philipp Maisch Florian Kirchhoff Thomas Horn Jürgen E. Gschwend Sebastian C. Schmid
author_facet	Florestan J. Koll Florestan J. Koll Eva Meisenzahl Bernhard Haller Philipp Maisch Philipp Maisch Florian Kirchhoff Thomas Horn Jürgen E. Gschwend Sebastian C. Schmid
author_sort	Florestan J. Koll
title	Evaluation of Pre-operative Biopsy, Surgical Procedures and Oncologic Outcomes in Upper Tract Urothelial Carcinoma (UTUC)
title_short	Evaluation of Pre-operative Biopsy, Surgical Procedures and Oncologic Outcomes in Upper Tract Urothelial Carcinoma (UTUC)
title_full	Evaluation of Pre-operative Biopsy, Surgical Procedures and Oncologic Outcomes in Upper Tract Urothelial Carcinoma (UTUC)
title_fullStr	Evaluation of Pre-operative Biopsy, Surgical Procedures and Oncologic Outcomes in Upper Tract Urothelial Carcinoma (UTUC)
title_full_unstemmed	Evaluation of Pre-operative Biopsy, Surgical Procedures and Oncologic Outcomes in Upper Tract Urothelial Carcinoma (UTUC)
title_sort	evaluation of pre-operative biopsy, surgical procedures and oncologic outcomes in upper tract urothelial carcinoma (utuc)
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/b826d23d0bf04cf0810904123afdf502
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Evaluation of Pre-operative Biopsy, Surgical Procedures and Oncologic Outcomes in Upper Tract Urothelial Carcinoma (UTUC)

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