Preoperative predictors of pathological tumour stage and prognosis may be used when selecting candidates for intensified treatment in upper tract urothelial carcinoma

Figures & data

Table 3. Univariate analyses for prediction of non-organ confined disease according to variables at CT scan.

Variable	n (%)^a
Continuous variables		All	NOCD	95% CI^b	OCD	95% CI^c	p Value
Tumour size (cm)	163 (91)	4.2	4.8	4.2–5.3	3.9	3.6–4.3	.006^d
Contrast enhancement (HU)	111(62)	38	36	32–40	39	35–43	.4^a
Categorical variables					OR^e	95% CI^b	p
Fatty tissue oedema (all)	164 (92)				2.55	1.19–5.46	.016^b
Fatty tissue oedema (ureter only)	55 (31)				8.0	2.13–30.1	.002^b
Hydronephrosis	173 (97)				0.62	0.32–1.17	.14^b
Pathological lymph nodes	173 (97)				14.5	3.19–66.4	.001^b
Local invasion	162 (91)				5.31	2.53–11.1	<.001^b

Tumour size, oedema in the fatty tissue surrounding the tumour, the presence of pathological lymph nodes and local invasion into renal, peripelvic or periureteric tissue were shown to be significant predictors of non-organ confined disease at final pathology after nephroureterectomy.

^aRefers to total number and % of total study population with adequate CT scan quality to assess the given variable.

^bLogistic regression.

^cConfidence interval.

^dStudents t-test.

^eOdds ratios.

Table 1. Patient and tumour characteristics.

		Percentage of total
Age years mean (median)	72 (73)
Gender	No.
Male	120	67
Female	59	33
Symptoms
None	47	26
Local	132	74
ECOG^a
0	93	52
1	72	40
2+	14	8
Smoking status
Current smoker	63	35
Previous smoker	48	27
Never smoked	68	38
Previous bladder cancer
Yes	41	23
No	138	77
Previous endoscopic treatment
Yes	20	11
No	159	89
Tumour primary location
Renal pelvis	115	64
Ureter	64	36
Tumour grade^b
Low	48	27
High	129	72
Missing	2	1
Non-organ confined disease^c
Yes	68	38
No	111	62

^aEastern Cooperative oncology group.

^btumour grade according to WHO/ISUP classification 2004.

^cpT3 or more and/or N + disease at final pathology after nephroureterectomy.

Table 2. Univariate odds ratios for non-organ confined disease according to patient risk variable.

Variable	OR^b	95 % CI^a	p Value
Age	0.99	0.96–1.02	.5
Female vs. male	1.07	0.56–2.02	.8
Symptoms
Local vs. none	1.26	0.63–2.53	.5
ECOG^c
1 or more vs. 0	1.03	0.56–1.89	.9
Smoking status
Never smoking vs. history of smoking	1.68	0.90–3.11	.1
Previous bladder cancer	0.93	0.45–1.90	.8
Previous endoscopic treatment	0.51	0.18–1.47	.2
Tumour location
Ureter vs. kidney pelvis	0.71	0.37–1.34	.3

No patient variable was shown to predict non-organ confined disease at final pathology after RNU.

^aConfidence interval.

^bOdds ratios.

^cEastern cooperative oncology group.

Table 4. Results of the analyses made from the ureterenoscopic variables regarding determination of biopsy tumour grade and prediction of non-organ confined disease at final pathology after nephroureterectomy.

Variable	n	%	OR^a	CI^b	p Value
Diagnostic URS performed	95	100
Biopsy method
Forceps only	66	70
Basket only	14	15
Both forceps and basket	13	14
N/A	2	2
Biopsy verified UTUC	66	69
Biopsy WHO grade 2004	57	60
High grade	23		3.59	1.07–12.0	.04
Low grade	34
Low-grade tumours at URS	34
Remain low-grade at final pathology	22	65^c
Upgraded to high-grade at final pathology	12	35^c
Biopsy tumour stage	60	63
Ta/Tx	50
T1 or T2	10		3.55	0.87–14.5	.08
Cytology taken	60	63
Malignant cells	37		1.84	0.55–6.14	.3

^aOdds ratios.

^bConfidence interval.

^cPercentage of low-grade tumours at biopsy either verified as low-grade tumours or upgraded to high-grade tumours at final pathology after radical nephroureterectomy.

Table 5. Multivariate regression analyses for prediction of NOCD at final specimen according to risk variables.

Variable
	OR^a	CI^b	p Value
Tumour size at CT	0.94	0.77–1.16	.6
History of smoking vs. never smokers	1.53	0.72–3.24	.3
Hydronephrosis at CT	0.59	0.28–1.23	.2
Reactive oedema in fatty tissue surrounding tumour at CT	0.62	0.26–1.50	.3
Pathological lymph nodes at CT	6.21	1.21–31.3	.03
Local invasion into renal parenchyma or periureteric tissue	3.36	1.47–7.69	.004

Variables with a p value of <.2 were taken into the analysis. Pathological lymph nodes and local invasion into renal parenchyma, peripelvic or periureteric tissue assessed at CT were significant predictors of non-organ confined disease at final pathology.

^aOdds ratios.

^bConfidence intervals.

Figure 1. Demonstrating a proposed flowchart that can be used in the selection of patients for perioperative chemotherapy and/or extended LND in adjunct to radical nephroureterectomy for upper tract urothelial carcinoma. UTUC: upper tract urothelial carcinoma. RNU: Radical nephroureterectomy. LND: Lymph node dissection; NOCD: non-organ confined disease; OCD: organ-confined disease; MID: muscle-invasive disease; GFR: glomerular filtration rate.