title: Effect of concomitant variant histology on the prognosis of patients with upper urinary tract urothelial carcinoma after radical nephroureterectomy.
abstract: OBJECTIVE
  To evaluate the prognostic effect of concomitant variant histology (CVH) on survival outcomes in patients with upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy.
  
  
  METHODS
  Data on 417 patients with UTUC treated with radical nephroureterectomy without preoperative adjuvant therapy were retrospectively reviewed with a focus on CVH. Clinicopathological features and prognostic factors were compared between patients with pure UTUC and patients with UTUC with CVH. The primary end points were cancer-specific survival (CSS), disease recurrence-free survival (DFS), and overall survival (OS).
  
  
  RESULTS
  UTUC with CVH was present in 90 (21.6%) of 417 patients. At a median follow-up of 26 months, 153 (36.7%) had died of UTUC, 161 (38.6%) had experienced a relapse, and 176 (42.2%) had died of other causes. UTUC with CVH was significantly associated with advanced tumor stage, high tumor grade, tumor diameter, lymphovascular invasion, lymph node metastasis, positive surgical margins, and tumor architecture compared with pure UTUC (all P<0.01). The estimated 5-year CSS, DFS, and OS rates were 64.9%, 61.1%, and 62.1%, respectively, in the pure UTUC group, compared with 36.3%, 34.3%, and 26.5%, respectively, in the UTUC with CVH group (P<0.001). Multivariate analysis demonstrated that CVH was an independent predictor of CSS (hazard ratio [HR] = 1.594; 95% CI: 1.125-2.259; P = 0.009), DFS (HR = 1.549; 95% CI: 1.077-2.152; P = 0.017), and OS (HR = 1.685; 95% CI: 1.212-2.343; P = 0.002).
  
  
  CONCLUSIONS
  Approximately one-fifth of the specimens of patients with UTUC were observed to exhibit CVH. CVH was an independent prognostic factor for CSS, DFS, and OS in patients with UTUC on both univariate and multivariate analyses. Genitourinary pathologists should look for potential CVH components in UTUC specimens and report this in routine pathological practice. The presence of CVH should identify patients as candidates for consultation regarding early adjuvant therapy and intensive surveillance protocols.
authors: Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China; Department of Urology, Dujiangyan Medical Center/The Affiliated Hospital of Chengdu University, Dujiangyan City, Sichuan Province, P.R. China.
authors: Yan
authors: Y
authors: Shibing
authors: Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China.
authors: Song
authors: S
authors: Turun
authors: Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China. Electronic address: weiqiangscu2013@126.com.
authors: Wei
authors: W
authors: Qiang
authors: Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China.
authors: Lei
authors: L
authors: Junhao
authors: Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China.
authors: Yuan
authors: Y
authors: Haichao
authors: Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China.
authors: Qian
authors: Q
authors: Shengqiang
authors: Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China.
authors: Han
authors: H
authors: Ping
authors: Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China.
authors: Cao
authors: C
authors: Dehong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014513:Ureter / Q000601:surgery*; D014571:Urologic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*
keywords: Concomitant variant histology; Prognosis; Radical nephroureterectomy; Survival; Upper urinary tract urothelial carcinoma