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Impact of histologic variants on the oncological outcomes of patients with upper urinary tract cancers treated with radical surgery: a multi-institutional retrospective study

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Abstract

Background

No definitive evidence exists regarding the clinical significance of histologic variants (HV) in upper urinary tract cancer. We investigated the impact of HV on prognosis in patients with upper urinary tract cancer following radical surgery.

Patients and methods

We retrospectively analyzed 451 patients with upper urinary tract cancer who underwent radical nephroureterectomy at six affiliated hospitals from 1990 to 2015. Patients with distant metastatic disease prior to surgery and those who received neoadjuvant chemotherapy were excluded, leaving 441 eligible patients. Patients were classified into two groups: pure urothelial carcinoma (UC) and HV. The clinicopathological variables of each group were examined using Kaplan–Meier plots and proportional Cox hazard ratios (HR) to compare the oncological outcomes between the two groups.

Results

HV included 37 patients (8%). Compared with the pure UC patients, HV patients had significantly worse recurrence-free survival (RFS) and cancer-specific survival (CSS; RFS p = 0.0002, CSS p = 0.0001). Multivariate analysis for RFS revealed HV were independent predictors (HR 1.92; p = 0.026), but the association did not remain significant for CSS. There was no significant difference in CSS between the adjuvant chemotherapy (AC) group and the non-AC group for all HV patients, except in patients with ≥ pT3 tumor or positive lymph node status where the AC group had significantly favorable CSS.

Conclusions

HV in upper urinary tract cancer are independent predictors for RFS, but not for CSS. AC improved CSS for HV patients with ≥ pT3 tumor or positive lymph node status.

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Acknowledgements

This work was supported in part by a Parent’s Association (Keyaki Kai) Grant of Kitasato University School of Medicine. No additional external funding received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan

    Yasukiyo Murakami, Kazumasa Matsumoto, Takahiro Hirayama & Masatsugu Iwamura

  2. Department of Urology, Kanagawa Prefectural Federation of Agricultural Cooperatives for Health and Welfare Sagamihara Kyodo Hospital, 2-8-18 Hashimoto, Midori-ku, Sagamihara, Kanagawa, 252-5188, Japan

    Takuji Utsunomiya

  3. Department of Urology, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8642, Japan

    Masaomi Ikeda & Akira Irie

  4. Department of Urology, Kitasato University Medical Center, 6-100 Arai, Kitamoto, Saitama, 364-8501, Japan

    Dai Koguchi & Yoshinori Taoka

  5. Department of Urology, Higashiyamato Hospital, 1-13-12, Minami-machi, Higashiyamato, Tokyo, 207-0014, Japan

    Daisuke Matsuda

  6. Department of Urology, National Hospital Organization Sagamihara Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara, Kanagawa, 252-0314, Japan

    Norihiko Okuno

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  1. Yasukiyo Murakami
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  2. Kazumasa Matsumoto
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  3. Masaomi Ikeda
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  4. Takahiro Hirayama
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  5. Takuji Utsunomiya
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  6. Dai Koguchi
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  7. Daisuke Matsuda
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  9. Yoshinori Taoka
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  10. Akira Irie
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  11. Masatsugu Iwamura
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Correspondence to Kazumasa Matsumoto.

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Murakami, Y., Matsumoto, K., Ikeda, M. et al. Impact of histologic variants on the oncological outcomes of patients with upper urinary tract cancers treated with radical surgery: a multi-institutional retrospective study. Int J Clin Oncol 24, 1412–1418 (2019). https://doi.org/10.1007/s10147-019-01486-y

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  • DOI: https://doi.org/10.1007/s10147-019-01486-y

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