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The Performance of Tumor Size as Risk Stratification Parameter in Upper Tract Urothelial Carcinoma (UTUC)

B. Foerster, M. Abufaraj, A. Mari, T. Seisen, M. Bandini, D. Schweitzer, AK. Czech, M. Moschini, D. D'Andrea, M. Bianchi, K. Hendricksen, M. Rouprêt, A. Briganti, BWG. van Rhijn, P. Chłosta, P. Colin, H. John, SF. Shariat

. 2021 ; 19 (3) : 272.e1-272.e7. [pub] 20200918

Jazyk angličtina Země Spojené státy americké

Typ dokumentu časopisecké články, práce podpořená grantem

Perzistentní odkaz   https://www.medvik.cz/link/bmc21025645

INTRODUCTION: The objective of this study was to evaluate the performance of different tumor diameters for identifying ≥ pT2 upper tract urothelial carcinoma (UTUC) at radical nephroureterectomy. PATIENTS AND METHODS: This was a multi-institutional retrospective study that included 932 patients who underwent radical nephroureterectomy for nonmetastatic UTUC between 2000 and 2016. Tumor sizes were pathologically assessed and categorized into 4 groups: ≤ 1 cm, 1.1 to 2 cm, 2.1 to 3 cm, and > 3 cm. We performed logistic regression and decision-curve analyses. RESULTS: Overall, 45 (4.8%) patients had a tumor size ≤ 1 cm, 141 (15.1%) between 1.1 and 2 cm, 247 (26.5%) between 2.1 and 3 cm, and 499 (53.5%) > 3 cm. In preoperative predictive models that were adjusted for the effects of standard clinicopathologic features, tumor diameters > 2 cm (odds ratio, 2.38; 95% confidence interval, 1.70-3.32; P < .001) and > 3 cm (odds ratio, 1.81; 95% confidence interval, 1.38-2.38; P < .001) were independently associated with ≥ pT2 pathologic staging. The addition of the > 2-cm diameter cutoff improved the area under the curve of the model from 58.8% to 63.0%. Decision-curve analyses demonstrated a clinical net benefit of 0.09 and a net reduction of 8 per 100 patients. CONCLUSION: The 2-cm cutoff appears to be most useful in identifying patients at risk of harboring ≥ pT2 UTUC. This confirms the current European Association of Urology guideline's risk stratification. Tumor size alone is not sufficient for optimal risk stratification, rather a constellation of features is needed to select the best candidate for kidney-sparing surgery.

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$a Foerster, Beat $u Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
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$a The Performance of Tumor Size as Risk Stratification Parameter in Upper Tract Urothelial Carcinoma (UTUC) / $c B. Foerster, M. Abufaraj, A. Mari, T. Seisen, M. Bandini, D. Schweitzer, AK. Czech, M. Moschini, D. D'Andrea, M. Bianchi, K. Hendricksen, M. Rouprêt, A. Briganti, BWG. van Rhijn, P. Chłosta, P. Colin, H. John, SF. Shariat
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$a INTRODUCTION: The objective of this study was to evaluate the performance of different tumor diameters for identifying ≥ pT2 upper tract urothelial carcinoma (UTUC) at radical nephroureterectomy. PATIENTS AND METHODS: This was a multi-institutional retrospective study that included 932 patients who underwent radical nephroureterectomy for nonmetastatic UTUC between 2000 and 2016. Tumor sizes were pathologically assessed and categorized into 4 groups: ≤ 1 cm, 1.1 to 2 cm, 2.1 to 3 cm, and > 3 cm. We performed logistic regression and decision-curve analyses. RESULTS: Overall, 45 (4.8%) patients had a tumor size ≤ 1 cm, 141 (15.1%) between 1.1 and 2 cm, 247 (26.5%) between 2.1 and 3 cm, and 499 (53.5%) > 3 cm. In preoperative predictive models that were adjusted for the effects of standard clinicopathologic features, tumor diameters > 2 cm (odds ratio, 2.38; 95% confidence interval, 1.70-3.32; P < .001) and > 3 cm (odds ratio, 1.81; 95% confidence interval, 1.38-2.38; P < .001) were independently associated with ≥ pT2 pathologic staging. The addition of the > 2-cm diameter cutoff improved the area under the curve of the model from 58.8% to 63.0%. Decision-curve analyses demonstrated a clinical net benefit of 0.09 and a net reduction of 8 per 100 patients. CONCLUSION: The 2-cm cutoff appears to be most useful in identifying patients at risk of harboring ≥ pT2 UTUC. This confirms the current European Association of Urology guideline's risk stratification. Tumor size alone is not sufficient for optimal risk stratification, rather a constellation of features is needed to select the best candidate for kidney-sparing surgery.
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$a Abufaraj, Mohammad $u Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
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$a Mari, Andrea $u Department of Urology, Medical University of Vienna, Vienna, Austria; Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
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$a Seisen, Thomas $u Department of Urology, Sorbonne University, GRC n°5, Predictive Onco-Uro, AP-HP, Urology, Hôpital Pitié-Salpêtrière, Paris, France
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$a Bandini, Marco $u Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
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$a Schweitzer, Donald $u Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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$a Czech, Anna K $u Department of Urology, Jagiellonian University Medical College, Krakow, Poland
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$a Moschini, Marco $u Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy; Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
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$a D'Andrea, David $u Department of Urology, Medical University of Vienna, Vienna, Austria
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$a Bianchi, Marco $u Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
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$a Hendricksen, Kees $u Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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$a Rouprêt, Morgan $u Department of Urology, Sorbonne University, GRC n°5, Predictive Onco-Uro, AP-HP, Urology, Hôpital Pitié-Salpêtrière, Paris, France
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$a Briganti, Alberto $u Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
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$a van Rhijn, Bas W G $u Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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$a Chłosta, Piotr $u Department of Urology, Jagiellonian University Medical College, Krakow, Poland
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$a Colin, Pierre $u Department of Urology, Hôpital Privé de La Louvière, Générale de Santé, Lille, France
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$a John, Hubert $u Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
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$a Shariat, Shahrokh F $u Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. Electronic address: sfshariat@gmail.com
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