Discover the pivotal role of variant histology on survival rates in patients undergoing radical nephroureterectomy for upper tract urothelial carcinoma, and how this knowledge could revolutionize post-surgical outcomes.
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Survival impact of variant histology in patients with upper tract urothelial carcinoma after radical nephroureterectomy.
Ye et al., Urol Oncol 2023
DOI: 10.1016/j.urolonc.2023.12.006
Study Summary:
This retrospective study analyzed the impact of variant histology (VH) on survival outcomes in 635 patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU). Variant histology was present in 19.1% of patients, with squamous cell differentiation (SCD) in 10.7% and adenocarcinoma differentiation (AD) in 4.4%. After propensity score matching, VH was found to be significantly associated with worse overall survival (OS) and cancer-specific survival (CSS) in patients with locally advanced UTUC (pT>2). Specifically, SCD was linked to poorer outcomes compared to pure urothelial carcinoma (pUC), with an OS hazard ratio (HR) of 1.81 and a CSS HR of 1.73. However, AD showed similar survival outcomes to pUC. Additionally, SCD patients with extensive squamous components had a markedly decreased OS (HR 4.17), but those with regional components had survival outcomes comparable to pUC.
Significance:
The study highlights that VH, particularly SCD, is associated with more aggressive disease and poorer survival in locally advanced UTUC after RNU. This information is crucial for risk stratification and could influence post-surgical management strategies. The findings also suggest that the extent of squamous differentiation affects survival outcomes, which is a new insight into the prognostic factors of UTUC.
Contribution to Literature:
This research contributes to the understanding of how VH influences prognosis in UTUC. It provides evidence that the type and extent of VH should be considered when assessing patient prognosis and tailoring treatment plans post-RNU.