Biological and prognostic implications of biopsy upgrading for high-grade upper tract urothelial carcinoma at nephroureterectomy

Objectives Technical limitations of ureteroscopic (URS) biopsy has been considered responsible for substantial upgrading rate in upper tract urothelial carcinoma (UTUC). However, the impact of tumor specific factors for upgrading remain uninvestigated. Methods Patients who underwent URS biopsy were...

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Autores: Katayama S., Pradere B., Grossman N.C., Potretzke A.M., Boorjian S.A., Ghoreifi A., Daneshmand S., Djaladat H., Sfakianos J.P., Mari A., Khene, ZE, D'Andrea D., Hayakawa N., Breda A., Fontana M., Fujita K., Antonelli A., van Doeveren T., Steinbach C., Mori K., Laukhtina E., Roupret, M, Margulis V., Karakiewicz P.I., Araki M., Compérat E., Nasu Y., Shariat S.F.
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p14872
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=14872
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85146950583&doi=10.1111%2fiju.15061&partnerID=40&md5=2827ff0f4614068a058261e318fcc1c6
Access Level:acceso abierto
Palabra clave:biopsy grade
intratumor heterogeneity
survival
upgrading
upper tract urothelial carcinoma
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spelling Biological and prognostic implications of biopsy upgrading for high-grade upper tract urothelial carcinoma at nephroureterectomyKatayama S.Pradere B.Grossman N.C.Potretzke A.M.Boorjian S.A.Ghoreifi A.Daneshmand S.Djaladat H.Sfakianos J.P.Mari A.Khene, ZED'Andrea D.Hayakawa N.Breda A.Fontana M.Fujita K.Antonelli A.van Doeveren T.Steinbach C.Mori K.Laukhtina E.Roupret, MMargulis V.Karakiewicz P.I.Araki M.Compérat E.Nasu Y.Shariat S.F.biopsy gradeintratumor heterogeneitysurvivalupgradingupper tract urothelial carcinomaObjectives Technical limitations of ureteroscopic (URS) biopsy has been considered responsible for substantial upgrading rate in upper tract urothelial carcinoma (UTUC). However, the impact of tumor specific factors for upgrading remain uninvestigated. Methods Patients who underwent URS biopsy were included between 2005 and 2020 at 13 institutions. We assessed the prognostic impact of upgrading (low-grade on URS biopsy) versus same grade (high-grade on URS biopsy) for high-grade UTUC tumors on radical nephroureterectomy (RNU) specimens. Results This study included 371 patients, of whom 112 (30%) and 259 (70%) were biopsy-based low- and high-grade tumors, respectively. Median follow-up was 27.3 months. Patients with high-grade biopsy were more likely to harbor unfavorable pathologic features, such as lymphovascular invasion (p < 0.001) and positive lymph nodes (LNs; p < 0.001). On multivariable analyses adjusting for the established risk factors, high-grade biopsy was significantly associated with worse overall (hazard ratio [HR] 1.74; 95% confidence interval [CI], 1.10-2.75; p = 0.018), cancer-specific (HR 1.94; 95% CI, 1.07-3.52; p = 0.03), and recurrence-free survival (HR 1.80; 95% CI, 1.13-2.87; p = 0.013). In subgroup analyses of patients with pT2-T4 and/or positive LN, its significant association retained. Furthermore, high-grade biopsy in clinically non-muscle invasive disease significantly predicted upstaging to final pathologically advanced disease (>= pT2) compared to low-grade biopsy. Conclusions High tumor grade on URS biopsy is associated with features of biologically and clinically aggressive UTUC tumors. URS low-grade UTUC that becomes upgraded to high-grade might carry a better prognosis than high-grade UTUC on URS. Tumor specific factors are likely to be responsible for upgrading to high-grade on RNU.WILEY2023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=14872https://www.scopus.com/inward/record.uri?eid=2-s2.0-85146950583&doi=10.1111%2fiju.15061&partnerID=40&md5=2827ff0f4614068a058261e318fcc1c6INTERNATIONAL JOURNAL OF UROLOGYISSN: 09198172ISSNe: 14422042reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p148722026-06-14T12:41:47Z
dc.title.none.fl_str_mv Biological and prognostic implications of biopsy upgrading for high-grade upper tract urothelial carcinoma at nephroureterectomy
title Biological and prognostic implications of biopsy upgrading for high-grade upper tract urothelial carcinoma at nephroureterectomy
spellingShingle Biological and prognostic implications of biopsy upgrading for high-grade upper tract urothelial carcinoma at nephroureterectomy
Katayama S.
biopsy grade
intratumor heterogeneity
survival
upgrading
upper tract urothelial carcinoma
title_short Biological and prognostic implications of biopsy upgrading for high-grade upper tract urothelial carcinoma at nephroureterectomy
title_full Biological and prognostic implications of biopsy upgrading for high-grade upper tract urothelial carcinoma at nephroureterectomy
title_fullStr Biological and prognostic implications of biopsy upgrading for high-grade upper tract urothelial carcinoma at nephroureterectomy
title_full_unstemmed Biological and prognostic implications of biopsy upgrading for high-grade upper tract urothelial carcinoma at nephroureterectomy
title_sort Biological and prognostic implications of biopsy upgrading for high-grade upper tract urothelial carcinoma at nephroureterectomy
dc.creator.none.fl_str_mv Katayama S.
Pradere B.
Grossman N.C.
Potretzke A.M.
Boorjian S.A.
Ghoreifi A.
Daneshmand S.
Djaladat H.
Sfakianos J.P.
Mari A.
Khene, ZE
D'Andrea D.
Hayakawa N.
Breda A.
Fontana M.
Fujita K.
Antonelli A.
van Doeveren T.
Steinbach C.
Mori K.
Laukhtina E.
Roupret, M
Margulis V.
Karakiewicz P.I.
Araki M.
Compérat E.
Nasu Y.
Shariat S.F.
author Katayama S.
author_facet Katayama S.
Pradere B.
Grossman N.C.
Potretzke A.M.
Boorjian S.A.
Ghoreifi A.
Daneshmand S.
Djaladat H.
Sfakianos J.P.
Mari A.
Khene, ZE
D'Andrea D.
Hayakawa N.
Breda A.
Fontana M.
Fujita K.
Antonelli A.
van Doeveren T.
Steinbach C.
Mori K.
Laukhtina E.
Roupret, M
Margulis V.
Karakiewicz P.I.
Araki M.
Compérat E.
Nasu Y.
Shariat S.F.
author_role author
author2 Pradere B.
Grossman N.C.
Potretzke A.M.
Boorjian S.A.
Ghoreifi A.
Daneshmand S.
Djaladat H.
Sfakianos J.P.
Mari A.
Khene, ZE
D'Andrea D.
Hayakawa N.
Breda A.
Fontana M.
Fujita K.
Antonelli A.
van Doeveren T.
Steinbach C.
Mori K.
Laukhtina E.
Roupret, M
Margulis V.
Karakiewicz P.I.
Araki M.
Compérat E.
Nasu Y.
Shariat S.F.
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv biopsy grade
intratumor heterogeneity
survival
upgrading
upper tract urothelial carcinoma
topic biopsy grade
intratumor heterogeneity
survival
upgrading
upper tract urothelial carcinoma
description Objectives Technical limitations of ureteroscopic (URS) biopsy has been considered responsible for substantial upgrading rate in upper tract urothelial carcinoma (UTUC). However, the impact of tumor specific factors for upgrading remain uninvestigated. Methods Patients who underwent URS biopsy were included between 2005 and 2020 at 13 institutions. We assessed the prognostic impact of upgrading (low-grade on URS biopsy) versus same grade (high-grade on URS biopsy) for high-grade UTUC tumors on radical nephroureterectomy (RNU) specimens. Results This study included 371 patients, of whom 112 (30%) and 259 (70%) were biopsy-based low- and high-grade tumors, respectively. Median follow-up was 27.3 months. Patients with high-grade biopsy were more likely to harbor unfavorable pathologic features, such as lymphovascular invasion (p < 0.001) and positive lymph nodes (LNs; p < 0.001). On multivariable analyses adjusting for the established risk factors, high-grade biopsy was significantly associated with worse overall (hazard ratio [HR] 1.74; 95% confidence interval [CI], 1.10-2.75; p = 0.018), cancer-specific (HR 1.94; 95% CI, 1.07-3.52; p = 0.03), and recurrence-free survival (HR 1.80; 95% CI, 1.13-2.87; p = 0.013). In subgroup analyses of patients with pT2-T4 and/or positive LN, its significant association retained. Furthermore, high-grade biopsy in clinically non-muscle invasive disease significantly predicted upstaging to final pathologically advanced disease (>= pT2) compared to low-grade biopsy. Conclusions High tumor grade on URS biopsy is associated with features of biologically and clinically aggressive UTUC tumors. URS low-grade UTUC that becomes upgraded to high-grade might carry a better prognosis than high-grade UTUC on URS. Tumor specific factors are likely to be responsible for upgrading to high-grade on RNU.
publishDate 2023
dc.date.none.fl_str_mv 2023
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=14872
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85146950583&doi=10.1111%2fiju.15061&partnerID=40&md5=2827ff0f4614068a058261e318fcc1c6
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=14872
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85146950583&doi=10.1111%2fiju.15061&partnerID=40&md5=2827ff0f4614068a058261e318fcc1c6
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv WILEY
publisher.none.fl_str_mv WILEY
dc.source.none.fl_str_mv INTERNATIONAL JOURNAL OF UROLOGY
ISSN: 09198172
ISSNe: 14422042
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
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