%0 Journal Article
%T Novel Classification for Upper Tract Urothelial Carcinoma to Better Risk-stratify Patients Eligible for Kidney-sparing Strategies: An International Collaborative Study.
%A Marcq G
%A Foerster B
%A Abufaraj M
%A Matin SF
%A Azizi M
%A Gupta M
%A Li WM
%A Seisen T
%A Clinton T
%A Xylinas E
%A Mir MC
%A Schweitzer D
%A Mari A
%A Kimura S
%A Bandini M
%A Mathieu R
%A Ku JH
%A Guruli G
%A Grabbert M
%A Czech AK
%A Muilwijk T
%A Pycha A
%A D'Andrea D
%A Petros FG
%A Spiess PE
%A Bivalacqua T
%A Wu WJ
%A Rouprêt M
%A Krabbe LM
%A Hendricksen K
%A Egawa S
%A Briganti A
%A Moschini M
%A Graffeille V
%A Autorino R
%A John P
%A Heidenreich A
%A Chlosta P
%A Joniau S
%A Soria F
%A Pierorazio PM
%A Shariat SF
%A Kassouf W
%J Eur Urol Focus
%V 0
%N 0
%D Mar 2021 24
%M 33773965
%F 5.952
%R 10.1016/j.euf.2021.03.018
%X <B>BACKGROUND: </B>The European Association of Urology risk stratification dichotomizes patients with upper tract urothelial carcinoma (UTUC) into two risk categories.<BR><B>OBJECTIVE: </B>To evaluate the predictive value of a new classification to better risk stratify patients eligible for kidney-sparing surgery (KSS).<BR><B>METHODS: </B>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.<BR><B>UNASSIGNED: </B>A multivariate logistic regression analysis identified predictors of muscle invasion (≥pT2) at RNU. The Youden index was used to identify cutoff points.<BR><B>CONCLUSIONS: </B>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).<BR><B>CONCLUSIONS: </B>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.<BR><B>UNASSIGNED: </B>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.