Impact of Variant Histology on Oncological Outcomes in Upper Tract Urothelial Carcinoma: Results From the ROBUUST Collaborative Group

Antoin Douglawi; Alireza Ghoreifi; Umberto Carbonara; Wesley Yip; Robert G Uzzo; Vitaly Margulis; Matteo Ferro; Ottavio De Cobelli; Zhenjie Wu; Giuseppe Simone; Riccardo Mastroianni; Koon H Rha; Daniel D Eun; Adam C Reese; James R Porter; Ithaar Derweesh; Reza Mehrazin; Giuseppe Rosiello; Riccardo Tellini; Marcus Jamil; Alexander Kenigsberg; Jason M Farrow; William P Schrock; Giovanni Cacciamani; Abhishek Srivastava; Amit S Bhattu; Alexandre Mottrie; Mark L Gonzalgo; Chandru P Sundaram; Firas Abdollah; Andrea Minervini; Riccardo Autorino; Hooman Djaladat

doi:10.1016/j.clgc.2023.05.011

Impact of Variant Histology on Oncological Outcomes in Upper Tract Urothelial Carcinoma: Results From the ROBUUST Collaborative Group

Clin Genitourin Cancer. 2023 Oct;21(5):563-568. doi: 10.1016/j.clgc.2023.05.011. Epub 2023 May 24.

Authors

Antoin Douglawi¹, Alireza Ghoreifi¹, Umberto Carbonara², Wesley Yip¹, Robert G Uzzo³, Vitaly Margulis⁴, Matteo Ferro⁵, Ottavio De Cobelli⁵, Zhenjie Wu⁶, Giuseppe Simone⁷, Riccardo Mastroianni⁷, Koon H Rha⁸, Daniel D Eun⁹, Adam C Reese⁹, James R Porter¹⁰, Ithaar Derweesh¹¹, Reza Mehrazin¹², Giuseppe Rosiello¹³, Riccardo Tellini¹⁴, Marcus Jamil¹⁵, Alexander Kenigsberg⁴, Jason M Farrow¹⁶, William P Schrock¹⁶, Giovanni Cacciamani¹, Abhishek Srivastava³, Amit S Bhattu¹⁷, Alexandre Mottrie¹³, Mark L Gonzalgo¹⁷, Chandru P Sundaram¹⁶, Firas Abdollah¹⁵, Andrea Minervini¹⁴, Riccardo Autorino¹⁸, Hooman Djaladat¹⁹

Affiliations

¹ Institute of Urology, University of Southern California, Los Angeles, CA.
² Division of Urology, Virginia Commonwealth University, Richmond, Virginia.
³ Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA.
⁴ Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
⁵ Department of Urology, Istituto Europeo di Oncologia (IEO), Milan, Italy.
⁶ Department of Urology, Shanghai Hospital, Naval Medical University Shanghai, China.
⁷ Istituto Regina Elena (IRE), Department of Urology, Rome, Italy.
⁸ Department of Urology, Yonsei University, Seoul, Republic of Korea.
⁹ Department of Urology, Temple University, Philadelphia, PA.
¹⁰ Swedish Medical Center, Seattle, WA.
¹¹ Department of Urology, University of California San Diego, San Diego, CA.
¹² Icahn School of Medicine at Mount Sinai, Department of Urology, New York, NY.
¹³ Onze Lieve Vrouwziekenhuis (OLV), Aalst, Belgium; ORSI Academy, Melle, Belgium.
¹⁴ Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, Florence, Italy.
¹⁵ Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI.
¹⁶ Department of Urology, Indiana University, Indianapolis, IN.
¹⁷ Department of Urology, University of Miami, Miami, FL.
¹⁸ Department of Urology, Rush University, Chicago, IL.
¹⁹ Institute of Urology, University of Southern California, Los Angeles, CA. Electronic address: [email protected].

PMID: 37301663
DOI: 10.1016/j.clgc.2023.05.011

Abstract

Introduction: Oncologic implications of variant histology (VH) have been extensively studied in bladder cancer; however, further investigation is needed in upper tract urothelial carcinoma (UTUC). Our study aims to evaluate the impact of VH on oncological outcomes in UTUC patients treated with radical nephroureterectomy (RNU).

Methods: A retrospective analysis was performed on patients who underwent a robotic or laparoscopic RNU for UTUC using the ROBUUST database, a multi-institutional collaborative including 17 centers worldwide. Logistic regression was used to assess the effect of VH on urothelial recurrence (bladder, contralateral upper tract), metastasis, and survival following RNU.

Results: A total of 687 patients were included in this study. Median (IQR) age was 71 (64-78) years and 470 (68%) had organ confined disease. VH was present in 70 (10.2%) patients. In a median follow-up of 16 months, the incidence of urothelial recurrence, metastasis, and mortality was 26.8%, 15.3%, and 11.8%, respectively. VH was associated with increased risk of metastasis (HR 4.3, P <.0001) and death (HR 2.0, P =.046). In multivariable analysis, VH was noted to be an independent risk factor for metastasis (HR 1.8, P =.03) but not for urothelial recurrence (HR 0.99, P =.97) or death (HR 1.4, P =.2).

Conclusion: Variant histology can be found in 10% of patients with UTUC and is an independent risk factor for metastasis following RNU. Overall survival rates and the risk of urothelial recurrence in the bladder or contralateral kidney are not affected by the presence of VH.

Keywords: Laparoscopy; Minimally invasive; Nephroureterectomy; Upper tract; Urothelial carcinoma.

Publication types

Multicenter Study

MeSH terms

Aged
Carcinoma, Transitional Cell* / pathology
Carcinoma, Transitional Cell* / surgery
Humans
Kidney / pathology
Neoplasm Recurrence, Local / pathology
Nephroureterectomy / methods
Retrospective Studies
Ureteral Neoplasms* / pathology
Urinary Bladder Neoplasms* / surgery