Preoperative hydronephrosis grade independently predicts worse pathological outcomes in patients undergoing nephroureterectomy for upper tract urothelial carcinoma

Yujiro Ito, Eiji Kikuchi, Nobuyuki Tanaka, Akira Miyajima, Shuji Mikami, Masahiro Jinzaki, Mototsugu Oya

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Abstract

Purpose: We analyzed the prognostic impact of hydronephrosis grade on disease specific survival and evaluated whether hydronephrosis grade could preoperatively predict worse pathological outcomes in cases of upper tract urothelial carcinoma treated surgically. Materials and Methods: We identified and retrospectively reviewed the records of 91 patients who were evaluated by multidetector computerized tomography and/or magnetic resonance imaging preoperatively, and treated with nephroureterectomy at our institution from 2000 to 2009. Ipsilateral hydronephrosis was graded 0 to 4 by 2 urological radiologists blinded to clinical outcomes. We analyzed the associations between hydronephrosis grade, and pathological findings and patient outcomes. Results: Preoperatively 67 patients (73.6%) had ipsilateral hydronephrosis. Grade was 1 to 4 in 3 (3.3%), 17 (18.7%), 23 (25.3%) and 24 cases (26.4%), respectively. Higher hydronephrosis grade was significantly associated with a ureteral tumor (p = 0.0307), higher pT stage (p = 0.0002) and lymphovascular invasion (p = 0.0014). Higher hydronephrosis grade was not associated with disease specific or metastasis-free survival. On preoperative multivariate analysis high hydronephrosis grade predicted pathological T stage (T3 or greater) (HR 4.98, p = 0.0228), positive lymphovascular invasion (HR 6.37, p = 0.0022) and grade 3 (HR 2.98, p = 0.0311). Conclusions: On image analysis preoperative hydronephrosis grade was associated with features of aggressive disease and predicted an advanced pathological outcome in patients with upper tract urothelial carcinoma. This information could prove useful to select candidates for neoadjuvant chemotherapy and make decisions concerning surgical options.

Original languageEnglish
Pages (from-to)1621-1626
Number of pages6
JournalJournal of Urology
Volume185
Issue number5
DOIs
Publication statusPublished - 2011 May

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Hydronephrosis
Carcinoma
Survival
Multivariate Analysis
Tomography
Magnetic Resonance Imaging
Neoplasm Metastasis
Drug Therapy

Keywords

  • carcinoma
  • hydronephrosis
  • kidney
  • ureter
  • urothelium

ASJC Scopus subject areas

  • Urology

Cite this

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title = "Preoperative hydronephrosis grade independently predicts worse pathological outcomes in patients undergoing nephroureterectomy for upper tract urothelial carcinoma",
abstract = "Purpose: We analyzed the prognostic impact of hydronephrosis grade on disease specific survival and evaluated whether hydronephrosis grade could preoperatively predict worse pathological outcomes in cases of upper tract urothelial carcinoma treated surgically. Materials and Methods: We identified and retrospectively reviewed the records of 91 patients who were evaluated by multidetector computerized tomography and/or magnetic resonance imaging preoperatively, and treated with nephroureterectomy at our institution from 2000 to 2009. Ipsilateral hydronephrosis was graded 0 to 4 by 2 urological radiologists blinded to clinical outcomes. We analyzed the associations between hydronephrosis grade, and pathological findings and patient outcomes. Results: Preoperatively 67 patients (73.6{\%}) had ipsilateral hydronephrosis. Grade was 1 to 4 in 3 (3.3{\%}), 17 (18.7{\%}), 23 (25.3{\%}) and 24 cases (26.4{\%}), respectively. Higher hydronephrosis grade was significantly associated with a ureteral tumor (p = 0.0307), higher pT stage (p = 0.0002) and lymphovascular invasion (p = 0.0014). Higher hydronephrosis grade was not associated with disease specific or metastasis-free survival. On preoperative multivariate analysis high hydronephrosis grade predicted pathological T stage (T3 or greater) (HR 4.98, p = 0.0228), positive lymphovascular invasion (HR 6.37, p = 0.0022) and grade 3 (HR 2.98, p = 0.0311). Conclusions: On image analysis preoperative hydronephrosis grade was associated with features of aggressive disease and predicted an advanced pathological outcome in patients with upper tract urothelial carcinoma. This information could prove useful to select candidates for neoadjuvant chemotherapy and make decisions concerning surgical options.",
keywords = "carcinoma, hydronephrosis, kidney, ureter, urothelium",
author = "Yujiro Ito and Eiji Kikuchi and Nobuyuki Tanaka and Akira Miyajima and Shuji Mikami and Masahiro Jinzaki and Mototsugu Oya",
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T1 - Preoperative hydronephrosis grade independently predicts worse pathological outcomes in patients undergoing nephroureterectomy for upper tract urothelial carcinoma

AU - Ito, Yujiro

AU - Kikuchi, Eiji

AU - Tanaka, Nobuyuki

AU - Miyajima, Akira

AU - Mikami, Shuji

AU - Jinzaki, Masahiro

AU - Oya, Mototsugu

PY - 2011/5

Y1 - 2011/5

N2 - Purpose: We analyzed the prognostic impact of hydronephrosis grade on disease specific survival and evaluated whether hydronephrosis grade could preoperatively predict worse pathological outcomes in cases of upper tract urothelial carcinoma treated surgically. Materials and Methods: We identified and retrospectively reviewed the records of 91 patients who were evaluated by multidetector computerized tomography and/or magnetic resonance imaging preoperatively, and treated with nephroureterectomy at our institution from 2000 to 2009. Ipsilateral hydronephrosis was graded 0 to 4 by 2 urological radiologists blinded to clinical outcomes. We analyzed the associations between hydronephrosis grade, and pathological findings and patient outcomes. Results: Preoperatively 67 patients (73.6%) had ipsilateral hydronephrosis. Grade was 1 to 4 in 3 (3.3%), 17 (18.7%), 23 (25.3%) and 24 cases (26.4%), respectively. Higher hydronephrosis grade was significantly associated with a ureteral tumor (p = 0.0307), higher pT stage (p = 0.0002) and lymphovascular invasion (p = 0.0014). Higher hydronephrosis grade was not associated with disease specific or metastasis-free survival. On preoperative multivariate analysis high hydronephrosis grade predicted pathological T stage (T3 or greater) (HR 4.98, p = 0.0228), positive lymphovascular invasion (HR 6.37, p = 0.0022) and grade 3 (HR 2.98, p = 0.0311). Conclusions: On image analysis preoperative hydronephrosis grade was associated with features of aggressive disease and predicted an advanced pathological outcome in patients with upper tract urothelial carcinoma. This information could prove useful to select candidates for neoadjuvant chemotherapy and make decisions concerning surgical options.

AB - Purpose: We analyzed the prognostic impact of hydronephrosis grade on disease specific survival and evaluated whether hydronephrosis grade could preoperatively predict worse pathological outcomes in cases of upper tract urothelial carcinoma treated surgically. Materials and Methods: We identified and retrospectively reviewed the records of 91 patients who were evaluated by multidetector computerized tomography and/or magnetic resonance imaging preoperatively, and treated with nephroureterectomy at our institution from 2000 to 2009. Ipsilateral hydronephrosis was graded 0 to 4 by 2 urological radiologists blinded to clinical outcomes. We analyzed the associations between hydronephrosis grade, and pathological findings and patient outcomes. Results: Preoperatively 67 patients (73.6%) had ipsilateral hydronephrosis. Grade was 1 to 4 in 3 (3.3%), 17 (18.7%), 23 (25.3%) and 24 cases (26.4%), respectively. Higher hydronephrosis grade was significantly associated with a ureteral tumor (p = 0.0307), higher pT stage (p = 0.0002) and lymphovascular invasion (p = 0.0014). Higher hydronephrosis grade was not associated with disease specific or metastasis-free survival. On preoperative multivariate analysis high hydronephrosis grade predicted pathological T stage (T3 or greater) (HR 4.98, p = 0.0228), positive lymphovascular invasion (HR 6.37, p = 0.0022) and grade 3 (HR 2.98, p = 0.0311). Conclusions: On image analysis preoperative hydronephrosis grade was associated with features of aggressive disease and predicted an advanced pathological outcome in patients with upper tract urothelial carcinoma. This information could prove useful to select candidates for neoadjuvant chemotherapy and make decisions concerning surgical options.

KW - carcinoma

KW - hydronephrosis

KW - kidney

KW - ureter

KW - urothelium

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