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Effects of Variant Histology on the Oncologic Outcomes of Patients With Upper Urinary Tract Carcinoma After Radical Nephroureterectomy: A Propensity Score-Matched Analysis
- Source :
- Clinical genitourinary cancer. 17(3)
- Publication Year :
- 2018
-
Abstract
- Purpose To determine the prognostic effect of upper tract urothelial carcinoma (UTUC) with variant histology (VH) after radical nephroureterectomy (RNU). Patients and Methods The data of 1173 patients who received RNU for UTUC without neoadjuvant chemotherapy in 11 institutions between 2002 and 2016 were retrospectively reviewed. A matched propensity score analysis was performed. Clinicopathologic variables, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were compared between patients with pure UTUC and patients with UTUC and VH. Univariate and multivariate Cox proportional regression models were used to determine the independent variables associated with oncologic outcomes. Results UTUC with VH was observed in 93 patients (7.9%). After propensity score matching, UTUC with VH showed no difference in clinicopathologic features compared to pure UTUC; however, it was associated with shorter RFS, CSS, and OS (log rank, P = .011, P = .002, P = .006, respectively). Additionally, the multivariate analysis revealed that VH was independently associated with a poor RFS [hazard ratio (HR) = 1.92; 95% confidence interval (CI), 1.27-2.89; P = .002], CSS (HR = 4.47; 95% CI, 1.99-10.1; P = .001), and OS (HR = 3.00; 95% CI, 1.55-5.78; P = .001). However, the Kaplan-Meier method revealed that differences in RFS, CSS, and OS were not significant in patients who received adjuvant chemotherapy (log rank, P = .562, P = .060, P = .153, respectively). Conclusion UTUC with VH was independently associated with poor oncologic outcomes in patients with UTUC after RNU. Although patients with UTUC and VH had a poor prognosis compared to patients with pure UTUC, adjuvant chemotherapy would be helpful in improving the survival rates of these patients.
- Subjects :
- Male
medicine.medical_specialty
Urologic Neoplasms
Multivariate analysis
Urology
medicine.medical_treatment
030232 urology & nephrology
Nephroureterectomy
03 medical and health sciences
0302 clinical medicine
Carcinoma
medicine
Humans
Neoplasm Invasiveness
Neoplasm Metastasis
Propensity Score
Upper urinary tract
Aged
Neoplasm Staging
Retrospective Studies
Chemotherapy
business.industry
Hazard ratio
Middle Aged
medicine.disease
Confidence interval
Carcinoma, Papillary
Log-rank test
Survival Rate
Oncology
030220 oncology & carcinogenesis
Propensity score matching
Carcinoma, Squamous Cell
Female
Neoplasm Recurrence, Local
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 19380682
- Volume :
- 17
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Clinical genitourinary cancer
- Accession number :
- edsair.doi.dedup.....c10781654417188804cd89b1bdd63b38