組織變異型上泌尿道尿路上皮癌之存活分析以及臨床特徵

吳英龍¹、黃逸修^1,2、林登龍^1,2、張延驊^1,2、鍾孝仁^1,2、林子平^1,2、林志杰^1,2、

黃奕燊^1,2、魏子鈞¹、黃子豪¹、顧明軒¹、黃志賢^1,2 

臺北榮民總醫院 泌尿部¹  

國立陽明交通大學醫學院泌尿學科及書田泌尿科學研究中心² 

Survival Outcomes and Clinical Characteristics of Variant Histology in Upper Tract Urothelial Carcinoma

Ying-Long Wu¹, Eric Yi-Hsiu Huang^1,2, Alex T.L. Lin^1,2, Yen-Hwa Chang^1,2, Hsiao-Jen Chung^1,2,

Tzu-Ping Lin^1,2, Chih-Chieh Lin^1,2, I-Shen Huang^1,2, Tzu-Chun Wei^1,2,

Tzu-Hao Huang^1,2, Ming-Hsuan Ku^1,2, William J.S. Huang^1,2

¹Department of Urology, Taipei Veterans General Hospital

²Department of Urology, College of Medicine and Shu-Tien Urological Science Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

Purpose:

Upper tract urothelial carcinoma (UTUC) has an incidence range of 1.2–4.7 cases per 100,000 person-years globally, with variant histology (VH) accounting for about 7% of all UTUC. Little is known about VH of UTUC due to its rarity. We aim to identify the clinical characteristics of these variant subtypes and their survival outcomes.

Materials and Methods:

A retrospective review was conducted on UTUC patients with VH who underwent nephroureterectomy (NU) at our hospital from 1999 to 2021. The follow-up endpoint was until the end of the year 2023. The clinical characteristics, including patient demographics, peri-operative variables, and tumor factors were analyzed using the Chi-square or Student's t-test. The impact of VH on overall survival (OS) and cancer-specific survival (CSS) was estimated using the Kaplan-Meier method and log-rank test.

Results:

In total, 66 patients with VH were identified with a median follow-up period of 25 months (IQR 11-52.8 months). Squamous cell carcinoma (SCC) accounted for 42.4% of VH (n=28) followed by sarcomatoid (n=12, 18.2%) and micropapillary (n=10, 15.2%). The median age at surgery was 74 years (IQR 66-79). Very high proportion of patients with advanced stage were noticed with 52 patients of pathological stage higher than T3 (78.8%). Meanwhile, we noticed that VH had large tumor size with 66.7% of the patient with tumor size ≥3cm and all are pathological high grade. Adjuvant therapies include Cisplatin-based chemotherapy and immunotherapy (PD-1 inhibitors). The 2-year overall survival rate of VH was about 48.5% and cancer-specific survival rate was about 54%.

Conclusion:

Our experience revealed that variant histology (VH) UTUC predominantly consists of squamous cell carcinoma (SCC), sarcomatoid, and micropapillary subtypes. Additionally, VH typically presents with advanced pathological stages and larger tumor sizes, frequently exhibiting high grade characteristics. Moving forward, we plan to conduct further investigations to compare VH UTUC with conventional UTUC, aiming to deepen our understanding of this rare but clinically significant subset.