Pd20-07 Oncologic Outcomes in Patients With Variant Histologies of Upper Tract Urothelial Cancer: Results From an International Multicenter Cohort

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma I (PD20)1 May 2024PD20-07 ONCOLOGIC OUTCOMES IN PATIENTS WITH VARIANT HISTOLOGIES OF UPPER TRACT UROTHELIAL CANCER: RESULTS FROM AN INTERNATIONAL MULTICENTER COHORT Maximilian Pallauf, Sean A. Fletcher, Michael Rezaee, Morgan Rouprêt, Stephen A. Boorjian, Aaron M. Potretzke, Hooman Djaladat, Alireza Ghoreifi, Francesco Soria, Andrea Mari, Riccardo Campi, Zine-Eddine Khene, Eiji Kikuchi, Michael Rink, Kazutoshi Fujita, David D'Andrea, Joost L. Boormans, Guillaume Ploussard, Alberto Breda, Firas Abdollah, Jay D. Raman, Shahrokh F. Shariat, Benjamin Pradere, and Nirmish Singla Maximilian PallaufMaximilian Pallauf , Sean A. FletcherSean A. Fletcher , Michael RezaeeMichael Rezaee , Morgan RouprêtMorgan Rouprêt , Stephen A. BoorjianStephen A. Boorjian , Aaron M. PotretzkeAaron M. Potretzke , Hooman DjaladatHooman Djaladat , Alireza GhoreifiAlireza Ghoreifi , Francesco SoriaFrancesco Soria , Andrea MariAndrea Mari , Riccardo CampiRiccardo Campi , Zine-Eddine KheneZine-Eddine Khene , Eiji KikuchiEiji Kikuchi , Michael RinkMichael Rink , Kazutoshi FujitaKazutoshi Fujita , David D'AndreaDavid D'Andrea , Joost L. BoormansJoost L. Boormans , Guillaume PloussardGuillaume Ploussard , Alberto BredaAlberto Breda , Firas AbdollahFiras Abdollah , Jay D. RamanJay D. Raman , Shahrokh F. ShariatShahrokh F. Shariat , Benjamin PradereBenjamin Pradere , and Nirmish SinglaNirmish Singla View All Author Informationhttps://doi.org/10.1097/01.JU.0001009556.54476.eb.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Histologic variants (VH) of urothelial carcinoma (UC) of the lower urinary tract are associated with worse oncologic outcomes than pure UC. However, outcomes for patients with VH in the upper urinary tract are poorly described, given their rarity. We sought to elucidate the oncologic outcomes for patients with upper tract urothelial carcinoma (UTUC) with VH. METHODS: We queried an international, multicenter cohort of non-metastatic UTUC patients treated with radical nephrouterectomy (RNU). We categorized patients into pure UC (no-VH) and VH. VH was sub-categorized based on the distribution of subtypes into 'squamous/glandular/trophoblastic' (VH-S) and 'other' (VH-O), comprising all other VH. We compared clinicopathologic characteristics and oncologic outcomes, including recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS), among groups. We performed subanalyses matched by pathologic stage: organ-confined (OC: ≤pT2 and pN0-x) and non-organ-confined (NOC: ≥pT3 or pN1-2). Kaplan Meier methods and multivariable proportional hazards Cox regression with multivariate imputation by chained equations (MICE) for missing predictor covariates were performed to evaluate outcomes. RESULTS: We included 3,435 patients treated from 1985-2022 across 23 centers worldwide and identified 201 (6%) with VH. The median follow-up was 30 months (IQR 12-61). The most common VH subtype was VH-S (133/201, 66%). Neoadjuvant (12% vs. 5%, p<0.001) and adjuvant (27% vs. 13%, p<0.001) systemic therapy were more often administered in VH than in no-VH patients. Lymph node dissection was also more often performed in VH patients (54% vs. 39%, p<0.001). Patients with VH presented with more advanced pT (p<0.001) and pN (p<0.001) stage. In patients with OC disease, VH had worse RFS than no-VH (5-year RFS 58% vs. 80%, p=0.004), though CSS and OS were not significantly different. Stratified by VH subtype, VH-S exhibited similar oncologic outcomes as no-VH, but VH-O demonstrated worse stage-matched RFS (4-year RFS 39% vs. 83%, p<0.001 OC and 28% vs. 46%, p=0.01 NOC) and OS (5-year OS 45% vs. 75%, p=0.004 OC) compared to no-VH. VH-O independently predicted worse survival outcomes on multivariable Cox regression analyses. CONCLUSIONS: UTUC patients with VH exhibit more aggressive disease at presentation compared to pure UC. Despite the increased use of systemic therapy, certain VH subtypes demonstrate worse oncologic outcomes compared to pure UC. Further study is warranted to elucidate the biology of different UTUC VH subtypes to optimize treatment approaches. Source of Funding: This publication was made possible by the Johns Hopkins Institute for Clinical and Translational Research (ICTR) which is funded in part by Grant Number UL1 TR003098 from the National Center for Advancing Translational Sciences (NCATS) a component of the National Institute of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTR, NCATS or NIH.Maximilian Pallauf gratefully acknowledges the support of the Paracelsus Medical University Research and Innovation Fund (2022-FIRE-004-Pallauf) © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e449 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Maximilian Pallauf More articles by this author Sean A. Fletcher More articles by this author Michael Rezaee More articles by this author Morgan Rouprêt More articles by this author Stephen A. Boorjian More articles by this author Aaron M. Potretzke More articles by this author Hooman Djaladat More articles by this author Alireza Ghoreifi More articles by this author Francesco Soria More articles by this author Andrea Mari More articles by this author Riccardo Campi More articles by this author Zine-Eddine Khene More articles by this author Eiji Kikuchi More articles by this author Michael Rink More articles by this author Kazutoshi Fujita More articles by this author David D'Andrea More articles by this author Joost L. Boormans More articles by this author Guillaume Ploussard More articles by this author Alberto Breda More articles by this author Firas Abdollah More articles by this author Jay D. Raman More articles by this author Shahrokh F. Shariat More articles by this author Benjamin Pradere More articles by this author Nirmish Singla More articles by this author Expand All Advertisement PDF downloadLoading ...