8-armed octopus: Evaluation of clinicopathologic prognostic factors of urothelial carcinoma of the upper urinary system

Abstract

Background/aim: This study was designed to determine the characteristic features of upper urinary system urothelial carcinomas(UUSUCs) and to evaluate the clinicopathological parameters associated with prognosis.Materials and methods: A total of 74 cases of UUSUC were included, from three different centers. Demographic data andhistopathological features such as tumor localization, concomitant tumor in the urinary system, distant metastasis with overall survivaland disease-free survival obtained from the hospital records were evaluated retrospectively. Histopathologic prognostic features such asgrade, perineural invasion, lymphovascular invasion, tumor necrosis, and surgical margin status were also evaluated.Results: Seventy cases (94.6%) underwent open nephroureterectomy whereas 4 cases (5.4%) had laparoscopic nefroureterectomy.Thirty-eight (51.4%) cases were located in the pelvis, 7 (9.5%) in the ureter, 29 (39.2%) both in the pelvis and ureter. Fifty-six (75.7%)cases were alive; however, 18 (24.3%) patients were found to be dead. pTa, pT1, pT2, pT3, and pT4 tumors were reported in 16 (21.6%),13 (17.6%), 4 (5.4%), 28 (37.8%), and 13 (17.6%) patients, respectively. Histopathologically, 17 cases (23%) were low-grade, 57 cases(77%) were high-grade. Statistically significant correlation was observed between overall survival and lymph node metastasis, distantmetastasis, tumor necrosis, and differentiation by univariate analysis. Only distant metastasis was statistically associated with overallsurvival by multivariate analysis. We found no significant relationship between disease-free survival and all parameters.Conclusions: Differentiation and necrosis of tumor, lymph node involvement, and presence of distant metastasis is associated with theoverall survival of urothelial carcinoma of the upper urinary system.