title: Positive voided urine cytology predicts worse pathological findings of nephroureterectomy specimens in patients with upper tract urothelial carcinoma: does selective ureteral cytology have an additional efficacy?
abstract: OBJECTIVE
  After radical nephroureterectomy, substantial numbers of patients with upper tract urothelial carcinoma are ineligible for adjuvant chemotherapy owing to diminished renal function. Accurate pre-operative prediction of worse pathological findings in radical nephroureterectomy specimens can guide appropriate patient selection for neoadjuvant chemotherapy. Herein, we evaluated pre-operative voided urine cytology and the additional efficacy of selective ureteral cytology for predicting pathological features in upper tract urothelial carcinoma patients.
  
  
  METHODS
  This retrospective cohort study comprised 722 patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy. Patients with concomitant bladder cancer and those who received neoadjuvant therapy were excluded. Finally, 437 patients with urinary cytology data were enrolled in the study. We assessed the positive voided urine and selective ureteral cytology for predicting higher pathological T stage (≥ pT3), higher tumor grade (3) and positive lymphovascular invasion.
  
  
  RESULTS
  Previous bladder cancer, tumor location, clinical T stage and voided urine cytology (P = 0.029) were independently associated with ≥ pT3, whereas selective ureteral cytology was not. Gender, clinical N category and voided urine cytology (P = 0.017) were independently associated with tumor Grade 3, whereas selective ureteral cytology was not. Hydronephrosis, clinical T stage, clinical N category and voided urine cytology (P = 0.0021) were independently associated with lymphovascular invasion, whereas selective ureteral cytology was not.
  
  
  CONCLUSIONS
  Pre-operative positive voided urine cytology was an independent predictor for worse pathological findings in radical nephroureterectomy specimens, while selective ureteral cytology had no additional efficacy. However, further studies with larger numbers of patients and complete data sets are needed to select patients for more aggressive treatments including neoadjuvant chemotherapy.
authors.affiliation: Department of Urology, Kokura Memorial Hospital, Kokurakita, Kitakyushu, Fukuoka Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi shigerus@yamaguchi-u.ac.jp.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Sakano
authors.affiliation: Department of Urology, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: Teruo
authors.initials: T
authors.lastname: Inamoto
authors.affiliation: Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi.
authors.forename: Ryo
authors.initials: R
authors.lastname: Inoue
authors.affiliation: Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Matsumoto
authors.affiliation: Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nagao
authors.affiliation: Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Urology, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: Haruhito
authors.initials: H
authors.lastname: Azuma
authors.affiliation: Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi.
authors.forename: Hideyasu
authors.initials: H
authors.lastname: Matsuyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003581:Cytodiagnosis / Q000379:methods*; D005260:Female; D006801:Humans; D006869:Hydronephrosis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D014556:Urine / Q000166:cytology*
keywords: cytology; pathology; upper urinary tract; urothelial carcinoma