Abstract：
BACKGROUND: Similar to bladder cancer, about one third of upper tract urothelial carcinoma (UTUC) present variant histology (VH). We aim to evaluate the incidence, clinical characteristics and the impact on outcomes of VH in UTUC.
METHODS: We consecutively enrolled 77 patients treated between 2009 and 2022 by radical surgery for UTUC from a secondary and a tertiary referral center. A pathology review of all specimens was performed by 1 independent uropathologist for each center. We compared pure UTUC and UTUC with VH and the accuracy of endoscopic biopsy. Descriptive and comparative analysis was performed to assess the association with clinical characteristics and the Kaplan-Meier estimator to compare outcomes.
RESULTS: Median follow-up after surgery was 51 months. VH was present in 21/77 (28%) patients and 4/21 (19%) patients had multiple variants. The most frequent VH was squamous 12/21 (57%), followed by glandular 7/21 (33%) and micropapillary 3/21 variants (14%). Neuroendocrine carcinoma was present in 2 patients. Nested variant was found in 1 patient. Muscle invasive tumor (≥pT2) was present in 30/56 (54%) patients with pure UTUC and in 18/21 (86%) patients with VH (P < 0.05). Presence of carcinoma in situ was seen in 24/56 (43%) patients with pure UTUC and in 16/21 (76%) with VH (P < 0.05). Cumulative 8/56 (14%) with pure UTUC had a nonintravesical recurrence (6 patients with local and 2 distant recurrence) compared to 8/21 (38%) (3 local, 3 nodal, 2 distant) in the subgroup with VH (P < 0.05). Opposite effect was noted for bladder recurrence: 60% for pure UTUC vs. 29% for tumors with VH (P < 0.05). Review of preoperative endoscopic biopsy did not show the presence of VH in any patients. Differences in outcomes did not reach significance: 3yr-OS 63% vs. 42% (P 0.28) and 3yr-CSS 77% vs. 50% (P 0.7).
CONCLUSIONS: Almost a third of UTUC present VH. Presence of VH is related to more aggressive tumor characteristics and associated with unfavorable outcomes. Due to a higher rate of extravesical recurrences in UTUC with VH, Follow-up controls should include cross sectional imaging and cystoscopy.
METHODS: We consecutively enrolled 77 patients treated between 2009 and 2022 by radical surgery for UTUC from a secondary and a tertiary referral center. A pathology review of all specimens was performed by 1 independent uropathologist for each center. We compared pure UTUC and UTUC with VH and the accuracy of endoscopic biopsy. Descriptive and comparative analysis was performed to assess the association with clinical characteristics and the Kaplan-Meier estimator to compare outcomes.
RESULTS: Median follow-up after surgery was 51 months. VH was present in 21/77 (28%) patients and 4/21 (19%) patients had multiple variants. The most frequent VH was squamous 12/21 (57%), followed by glandular 7/21 (33%) and micropapillary 3/21 variants (14%). Neuroendocrine carcinoma was present in 2 patients. Nested variant was found in 1 patient. Muscle invasive tumor (≥pT2) was present in 30/56 (54%) patients with pure UTUC and in 18/21 (86%) patients with VH (P < 0.05). Presence of carcinoma in situ was seen in 24/56 (43%) patients with pure UTUC and in 16/21 (76%) with VH (P < 0.05). Cumulative 8/56 (14%) with pure UTUC had a nonintravesical recurrence (6 patients with local and 2 distant recurrence) compared to 8/21 (38%) (3 local, 3 nodal, 2 distant) in the subgroup with VH (P < 0.05). Opposite effect was noted for bladder recurrence: 60% for pure UTUC vs. 29% for tumors with VH (P < 0.05). Review of preoperative endoscopic biopsy did not show the presence of VH in any patients. Differences in outcomes did not reach significance: 3yr-OS 63% vs. 42% (P 0.28) and 3yr-CSS 77% vs. 50% (P 0.7).
CONCLUSIONS: Almost a third of UTUC present VH. Presence of VH is related to more aggressive tumor characteristics and associated with unfavorable outcomes. Due to a higher rate of extravesical recurrences in UTUC with VH, Follow-up controls should include cross sectional imaging and cystoscopy.
摘要：
背景：与膀胱癌相似，约三分之一的上尿路尿路上皮癌（UTUC）呈现变异组织学（VH）。我们的目标是评估发病率，UTUC患者的临床特征及VH对结局的影响。
方法：我们从二级和三级转诊中心连续纳入了2009年至2022年间接受UTUC根治性手术治疗的77例患者。每个中心由1名独立的泌尿系病理学家对所有标本进行病理学检查。我们比较了纯UTUC和UTUC与VH和内窥镜活检的准确性。进行描述性和比较分析以评估与临床特征的关联，并进行Kaplan-Meier估计以比较结果。
结果：手术后的中位随访时间为51个月。VH存在于21/77(28%)患者中,并且4/21(19%)患者具有多个变体。最常见的VH是鳞状12/21（57％），其次是腺体7/21（33％）和微乳头状3/21变体（14％）。神经内分泌癌2例。在1例患者中发现嵌套变体。30/56（54％）的单纯UTUC患者和18/21（86％）的VH患者存在肌肉浸润性肿瘤（≥pT2）（P<0.05）。在24/56（43％）的纯UTUC患者和16/21（76％）的VH患者中存在原位癌（P<0.05）。纯UTUC的累积8/56（14％）具有非膀胱内复发（6例局部复发和2例远处复发），而8/21（38％）（3局部，3个节点，2远缘)在VH亚组中(P<0.05)。膀胱复发有相反的效果：纯UTUC与60％29%为肿瘤伴VH(P<0.05)。术前内镜活检检查未显示任何患者存在VH。结果差异未达到显着：3yr-OS63％与42%(P0.28)和3yr-CSS77%与50%(P<0.7)。
结论：近三分之一的UTUC呈现VH。VH的存在与更具侵袭性的肿瘤特征相关,并且与不利的结果相关。由于具有VH的UTUC的外复发率较高，后续控制应包括横断面成像和膀胱镜检查。
方法：我们从二级和三级转诊中心连续纳入了2009年至2022年间接受UTUC根治性手术治疗的77例患者。每个中心由1名独立的泌尿系病理学家对所有标本进行病理学检查。我们比较了纯UTUC和UTUC与VH和内窥镜活检的准确性。进行描述性和比较分析以评估与临床特征的关联，并进行Kaplan-Meier估计以比较结果。
结果：手术后的中位随访时间为51个月。VH存在于21/77(28%)患者中,并且4/21(19%)患者具有多个变体。最常见的VH是鳞状12/21（57％），其次是腺体7/21（33％）和微乳头状3/21变体（14％）。神经内分泌癌2例。在1例患者中发现嵌套变体。30/56（54％）的单纯UTUC患者和18/21（86％）的VH患者存在肌肉浸润性肿瘤（≥pT2）（P<0.05）。在24/56（43％）的纯UTUC患者和16/21（76％）的VH患者中存在原位癌（P<0.05）。纯UTUC的累积8/56（14％）具有非膀胱内复发（6例局部复发和2例远处复发），而8/21（38％）（3局部，3个节点，2远缘)在VH亚组中(P<0.05)。膀胱复发有相反的效果：纯UTUC与60％29%为肿瘤伴VH(P<0.05)。术前内镜活检检查未显示任何患者存在VH。结果差异未达到显着：3yr-OS63％与42%(P0.28)和3yr-CSS77%与50%(P<0.7)。
结论：近三分之一的UTUC呈现VH。VH的存在与更具侵袭性的肿瘤特征相关,并且与不利的结果相关。由于具有VH的UTUC的外复发率较高，后续控制应包括横断面成像和膀胱镜检查。
