title: Impact of variant histology on disease aggressiveness and outcome after nephroureterectomy in Japanese patients with upper tract urothelial carcinoma.
abstract: BACKGROUND
  Patients with urinary bladder urothelial carcinoma (UC) with variant histology have features of more advanced disease and a likelihood of poorer survival than those with pure UC. We investigated the impact of variant histology on disease aggressiveness and clinical outcome after radical nephroureterectomy (RNU) in Japanese patients with upper tract UC (UTUC). Information on variant histology might guide appropriate patient selection for adjuvant therapy after RNU.
  
  
  METHODS
  We enrolled 502 UTUC patients treated with RNU in this retrospective cohort study, and analyzed associations of variant histology with clinicopathological variables and disease-specific survival.
  
  
  RESULTS
  The median follow-up was 41.4 months. A total of 60 (12.0 %) UTUC patients had variant histology. UTUC with variant histology was significantly associated with advanced pathological T stage (pT ≥ 3), higher tumor grade (G3), and more lymphovascular invasion (P < 0.0001). Variant histology in all patients was significantly associated with worse disease-specific survival after RNU on univariate analysis (P = 0.0004), but this effect did not remain significant on multivariate analysis. However, variant histology was a significantly independent predictor for disease-specific survival in patients with pT ≥ 3 tumors (P = 0.0095).
  
  
  CONCLUSIONS
  UTUC with variant histology might be a phenotype of high-grade, locally aggressive advanced tumors rather than of systemic disease. Variant histology may be useful for selection of patients with pT ≥ 3 UTUC for adjuvant therapy. Prospective studies in a larger number of patients with a centralized pathological review are needed to confirm our results.
authors: Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan, shigerus@yamaguchi-u.ac.jp.
authors: Shigeru
authors: S
authors: Sakano
authors: Hideyasu
authors: H
authors: Matsuyama
authors: Yoriaki
authors: Y
authors: Kamiryo
authors: Shigeaki
authors: S
authors: Hayashida
authors: Norio
authors: N
authors: Yamamoto
authors: Yoshitaka
authors: Y
authors: Kaneda
authors: Takahito
authors: T
authors: Nasu
authors: Yoshikazu
authors: Y
authors: Baba
authors: Tomoyuki
authors: T
authors: Shimabukuro
authors: Akinobu
authors: A
authors: Suga
authors: Mitsutaka
authors: M
authors: Yamamoto
authors: Akihiko
authors: A
authors: Aoki
authors: Kimio
authors: K
authors: Takai
authors: Satoru
authors: S
authors: Yoshihiro
authors: Kazuo
authors: K
authors: Oba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001808:Blood Vessels / Q000473:pathology; D002277:Carcinoma / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007564:Japan; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D042601:Lymphatic Vessels / Q000473:pathology; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009392:Nephrectomy; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014516:Ureteral Neoplasms / Q000473:pathology* / Q000601:surgery*; D019459:Urothelium