title: Multi-institutional validation of the ability of preoperative hydronephrosis to predict advanced pathologic tumor stage in upper-tract urothelial carcinoma.
abstract: OBJECTIVE
  The presence of hydronephrosis (HN) has been implicated as a predictor of poor outcomes for patients diagnosed with bladder cancer. Small, single institution preliminary reports suggest a similar negative relationship may exist for upper-tract urothelial carcinoma (UTUC). Herein, we attempt to validate the prognostic value of preoperative HN in a large, multi-institutional cohort of UTUC patients.
  
  
  METHODS
  Data on 469 patients with localized UTUC from 5 tertiary referral centers who underwent a radical nephroureterectomy (91%) or distal ureterectomy (9%) without neoadjuvant chemotherapy were integrated into a relational database. Preoperative HN data, including presence vs. absence and high vs. low grade, were available in 408 patients. The association of HN with pathologic features was evaluated.
  
  
  RESULTS
  A total of 254 men and 154 women with a median age of 69 years (IQR 15) were analyzed. Overall, 192 patients (47%) had ≥pT2 disease, 145 (36%) had non-organ-confined (NOC) cancers (≥pT3 and/or positive lymph nodes), and 298 (73%) had high grade UTUC on final pathology. Forty-six percent of patients had tumors in the renal pelvis, 27% in the ureter, and 27% in both locations. Preoperatively, 223 patients (55%) were noted to have ipsilateral HN (39% low grade and 61% high grade). Hydronephrosis was associated with ≥pT2 stage (P < 0.001), NOC disease (P < 0.001), and high grade cancers (P = 0.04). On multivariate analysis adjusting for gender, age, and tumor location, HN was an independent predictor of muscle invasive (HR 7.4, P < 0.001), NOC (HR 5.5, P < 0.001), and high pathologic grade (HR 1.6, P = 0.03) UTUC disease.
  
  
  CONCLUSIONS
  The presence of preoperative HN was associated with advanced stage UTUC. This readily available imaging modality may improve preoperative risk stratification for UTUC patients thereby guiding use of endoscopic versus extirpative surgery as well as the need for neoadjuvant chemotherapy regimens.
authors: Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA.
authors: Jamie C
authors: JC
authors: Messer
authors: John D
authors: JD
authors: Terrell
authors: Michael P
authors: MP
authors: Herman
authors: Casey K
authors: CK
authors: Ng
authors: Douglas S
authors: DS
authors: Scherr
authors: Benjamin
authors: B
authors: Scoll
authors: Stephen A
authors: SA
authors: Boorjian
authors: Robert G
authors: RG
authors: Uzzo
authors: Mark
authors: M
authors: Wille
authors: Scott E
authors: SE
authors: Eggener
authors: Steven M
authors: SM
authors: Lucas
authors: Yair
authors: Y
authors: Lotan
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Jay D
authors: JD
authors: Raman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000175:diagnosis*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009392:Nephrectomy / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014516:Ureteral Neoplasms / Q000150:complications / Q000175:diagnosis*; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000175:diagnosis*