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Prognostic significance of urothelial carcinoma with divergent differentiation in upper urinary tract after radical nephroureterectomy without metastatic diseases: A retrospective cohort study.

Abstract To evaluate the impact of urothelial carcinoma with divergent differentiation (UCDD) on the prognosis of patients for primary upper urinary tract urothelial carcinoma (UTUC) with pN0/x status treated with radical nephroureterectomy (RNU) and to evaluate the prognostic value of UCDD in different tumor locations (renal pelvis and ureter).Data from a total of 346 patients with UTUC who received RNU between January 2012 and March 2016 in the institution were retrospectively analyzed. Clinicopathological features and prognostic factors age, sex, complaint, height, weight, blood pressure, tumor grade, stage, smoking status, history of adjuvant chemotherapy, tumor location, history of bladder cancer, tumor necrosis, degree of hydronephrosis, tumor size, tumor focality, and preoperative anemia were compared between patients with pure UTUC and patients with UCDD. The endpoints were cancer-specific survival (CSS), overall survival (OS), and intraluminal recurrence-free survival (IRFS).Overall, divergent differentiation was present in 50 patients (14.5%). UCDD was related to different tumor location (P = .01), smoking (P = .04), higher body mass index (P = .02), and advanced tumor grade (P = .01). By Kaplan-Meier analysis, UCDD was found to be significantly correlated with worse IRFS, CSS, and OS (all P < .01). Multivariate analysis demonstrated that UCDD was an independent predictor of IRFS (P < .01), CSS (P = .01), and OS (P = .01). However, 40 patients died for various reasons and the 5-year OS rates were 91.9% in UCDD- group and 68.0% in UCDD+ group, respectively. In patients with ureteral tumors, UCDD was the significant predictor for IRFS, CSS, and OS. However, the prognostic value of UCDD was not observed in pyelocaliceal tumors.The presence of divergent differentiation is associated with inferior survival. UCDD may identify patients at high risks for poor prognosis especially in patients with ureteral tumors. As a result, more attention and follow-up should be given to patients with ureteric urothelial carcinoma.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28538387
OWN - NLM
STAT- MEDLINE
DA  - 20170524
DCOM- 20170612
LR  - 20170612
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 21
DP  - 2017 May
TI  - Prognostic significance of urothelial carcinoma with divergent differentiation in
      upper urinary tract after radical nephroureterectomy without metastatic diseases:
      A retrospective cohort study.
PG  - e6945
LID - 10.1097/MD.0000000000006945 [doi]
AB  - To evaluate the impact of urothelial carcinoma with divergent differentiation
      (UCDD) on the prognosis of patients for primary upper urinary tract urothelial
      carcinoma (UTUC) with pN0/x status treated with radical nephroureterectomy (RNU) 
      and to evaluate the prognostic value of UCDD in different tumor locations (renal 
      pelvis and ureter).Data from a total of 346 patients with UTUC who received RNU
      between January 2012 and March 2016 in the institution were retrospectively
      analyzed. Clinicopathological features and prognostic factors age, sex,
      complaint, height, weight, blood pressure, tumor grade, stage, smoking status,
      history of adjuvant chemotherapy, tumor location, history of bladder cancer,
      tumor necrosis, degree of hydronephrosis, tumor size, tumor focality, and
      preoperative anemia were compared between patients with pure UTUC and patients
      with UCDD. The endpoints were cancer-specific survival (CSS), overall survival
      (OS), and intraluminal recurrence-free survival (IRFS).Overall, divergent
      differentiation was present in 50 patients (14.5%). UCDD was related to different
      tumor location (P = .01), smoking (P = .04), higher body mass index (P = .02),
      and advanced tumor grade (P = .01). By Kaplan-Meier analysis, UCDD was found to
      be significantly correlated with worse IRFS, CSS, and OS (all P &lt; .01).
      Multivariate analysis demonstrated that UCDD was an independent predictor of IRFS
      (P &lt; .01), CSS (P = .01), and OS (P = .01). However, 40 patients died for various
      reasons and the 5-year OS rates were 91.9% in UCDD- group and 68.0% in UCDD+
      group, respectively. In patients with ureteral tumors, UCDD was the significant
      predictor for IRFS, CSS, and OS. However, the prognostic value of UCDD was not
      observed in pyelocaliceal tumors.The presence of divergent differentiation is
      associated with inferior survival. UCDD may identify patients at high risks for
      poor prognosis especially in patients with ureteral tumors. As a result, more
      attention and follow-up should be given to patients with ureteric urothelial
      carcinoma.
FAU - Qin, Chuan
AU  - Qin C
AD  - aDepartment of Urology bTianjin Key Laboratory of Urology, Tianjin Institute of
      Urology, the Second Hospital of Tianjin Medical University cCollege of Management
      and Economics, Tianjin University, Tianjin, China.
FAU - Liang, En-Li
AU  - Liang EL
FAU - Du, Zhi-Yong
AU  - Du ZY
FAU - Qiu, Xiao-Yu
AU  - Qiu XY
FAU - Tang, Gang
AU  - Tang G
FAU - Chen, Fei-Ran
AU  - Chen FR
FAU - Zhang, Bo
AU  - Zhang B
FAU - Tian, Da-Wei
AU  - Tian DW
FAU - Hu, Hai-Long
AU  - Hu HL
FAU - Wu, Chang-Li
AU  - Wu CL
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Aged
MH  - Carcinoma, Transitional Cell/*diagnosis/mortality/*pathology/physiopathology
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Immunohistochemistry
MH  - Male
MH  - Neoplasm Recurrence, Local/diagnosis/mortality/pathology/physiopathology
MH  - Nephrectomy/*adverse effects
MH  - Prognosis
MH  - Retrospective Studies
MH  - Survival Analysis
MH  - Urologic Neoplasms/*diagnosis/mortality/*pathology/physiopathology
PMC - PMC5457867
EDAT- 2017/05/26 06:00
MHDA- 2017/06/13 06:00
CRDT- 2017/05/25 06:00
AID - 10.1097/MD.0000000000006945 [doi]
AID - 00005792-201705260-00028 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 May;96(21):e6945. doi: 10.1097/MD.0000000000006945.

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