Marcq, Gautier ORCID: 0000-0002-1806-1448, Foerster, Beat, Abufaraj, Mohammad, Matin, Surena F., Azizi, Mounsif, Gupta, Mohit, Li, Wei-Ming, Seisen, Thomas, Clinton, Timothy, Xylinas, Evanguelos, Mir, M. Carmen, Schweitzer, Donald ORCID: 0000-0003-4038-0952, Mari, Andrea ORCID: 0000-0001-9070-5706, Kimura, Shoji, Bandini, Marco, Mathieu, Romain, Ku, Ja H., Guruli, Georgi, Grabbert, Markus, Czech, Anna K., Muilwijk, Tim, Pycha, Armin, D'Andrea, David ORCID: 0000-0003-1625-1077, Petros, Firas G., Spiess, Philippe E., Bivalacqua, Trinity, Wu, Wen-Jeng, Roupret, Morgan, Krabbe, Laura-Maria, Hendricksen, Kees, Egawa, Shin, Briganti, Alberto, Moschini, Marco, Graffeille, Vivien, Autorino, Riccardo, John, Patricia, Heidenreich, Axel, Chlosta, Piotr, Joniau, Steven, Soria, Francesco, Pierorazio, Phillip M., Shariat, Shahrokh F. and Kassouf, Wassim (2022). Novel Classification for Upper Tract Urothelial Carcinoma to Better Risk-stratify Patients Eligible for Kidney-sparing Strategies: An International Collaborative Study. Eur. Urol. Focus, 8 (2). S. 491 - 498. AMSTERDAM: ELSEVIER. ISSN 2405-4569

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Abstract

Background: The European Association of Urology risk stratification dichotomizes patients with upper tract urothelial carcinoma (UTUC) into two risk categories. Objective: To evaluate the predictive value of a new classification to better risk stratify patients eligible for kidney-sparing surgery (KSS). Design, setting, and participants: This was a retrospective study including 1214 patients from 21 centers who underwent ureterorenoscopy (URS) with biopsy followed by radical nephroureterectomy (RNU) for nonmetastatic UTUC between 2000 and 2017. Outcome measurements and statistical analysis: A multivariate logistic regression analysis identified predictors of muscle invasion (>= pT2) at RNU. The Youden index was used to identify cutoff points. Results and limitations: A total of 811 patients (67%) were male and the median age was 71 yr (interquartile range 63-77). The presence of non-organ-confined disease on preoperative imaging (p < 0.0001), sessile tumor (p < 0.0001), hydronephrosis (p 0.0003), high-grade cytology (p - 0.0043), or biopsy (p - 0.0174) and higher age at diagnosis (p = 0.029) were independently associated with >= pT2 at RNU. Tumor size was significantly associated with >= pT2 disease only in univariate analysis with a cutoff of 2 cm. Tumor size and all significant categorical variables defined the high-risk category. Tumor multifocality and a history of radical cystectomy help to dichotomize between low-risk and intermediate-risk categories. The odds ratio for muscle invasion were 5.5 (95% confidence interval [CI) 1.3-24.0; p = 0.023) for intermediate risk versus low risk, and 12.7 (95% CI 3.0-54.5; p = 0.0006) for high risk versus low risk. Limitations include the retrospective design and selection bias (all patients underwent RNU). Conclusions: Patients with low-risk UTUC represent ideal candidates for KSS, while some patients with intermediate-risk UTUC may also be considered. This classification needs further prospective validation and may help stratification in clinical trial design. Patient summary: We investigated factors predicting stage 2 or greater cancer of the upper urinary tract at the time of surgery for ureter and kidney removal and designed a new risk stratification. Patients with low or intermediate risk may be eligible for kidney-sparing surgery with close follow-up. Our classification scheme needs further validation based on cancer outcomes. (C) 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Marcq, GautierUNSPECIFIEDorcid.org/0000-0002-1806-1448UNSPECIFIED
Foerster, BeatUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Abufaraj, MohammadUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Matin, Surena F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Azizi, MounsifUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gupta, MohitUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Li, Wei-MingUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Seisen, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Clinton, TimothyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Xylinas, EvanguelosUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mir, M. CarmenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schweitzer, DonaldUNSPECIFIEDorcid.org/0000-0003-4038-0952UNSPECIFIED
Mari, AndreaUNSPECIFIEDorcid.org/0000-0001-9070-5706UNSPECIFIED
Kimura, ShojiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bandini, MarcoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mathieu, RomainUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ku, Ja H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Guruli, GeorgiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Grabbert, MarkusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Czech, Anna K.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Muilwijk, TimUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pycha, ArminUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
D'Andrea, DavidUNSPECIFIEDorcid.org/0000-0003-1625-1077UNSPECIFIED
Petros, Firas G.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Spiess, Philippe E.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bivalacqua, TrinityUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wu, Wen-JengUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Roupret, MorganUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Krabbe, Laura-MariaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hendricksen, KeesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Egawa, ShinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Briganti, AlbertoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Moschini, MarcoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Graffeille, VivienUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Autorino, RiccardoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
John, PatriciaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heidenreich, AxelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chlosta, PiotrUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Joniau, StevenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Soria, FrancescoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pierorazio, Phillip M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Shariat, Shahrokh F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kassouf, WassimUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-699014
DOI: 10.1016/j.euf.2021.03.018
Journal or Publication Title: Eur. Urol. Focus
Volume: 8
Number: 2
Page Range: S. 491 - 498
Date: 2022
Publisher: ELSEVIER
Place of Publication: AMSTERDAM
ISSN: 2405-4569
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
UPPER URINARY-TRACT; BACILLUS-CALMETTE-GUERIN; ENDOSCOPIC MANAGEMENT; BLADDER-CANCER; CELL-CARCINOMA; PREDICTION; GUIDELINES; URETEROSCOPY; EXPERIENCE; OUTCOMESMultiple languages
Urology & NephrologyMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/69901

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