[801] Urothelial Carcinoma Involving Both Upper and Lower Urinary Tracts: Predictors of High Grade Tumor in Upper Urinary Tract

AM Leathersich, D Cao. Washington University, St. Louis, MO

Background: Urothelial carcinoma (UC) involving both upper and lower urinary tracts (UUT, LUT), either synchronous or metachronous, is relatively uncommon. Grade and stage of LUT UCs have been cited as significant prognostic indicators. However, little data is available regarding the predictive factors for high grade (HG) UUT tumors.
Design: The departmental surgical pathology files were searched from 1989-2007 for patients with UUT UC treated with nephrectomy and with prior or subsequent LUT UC, sampled either by biopsy or resection. UUT UC were evaluated for: age, tumor location, grade, stage, lymph node status, diagnosis interval between UUT and LUT UCs (synchronous within 2 months of each other, diagnosis 2-12 months apart, diagnosis >12 months apart) and grade of corresponding LUT UC.
Results: A total of 246 consecutive patients with UUT UC were identified. Among them 86 (35%) patients (mean age 78) had UCs also involving LUT: 23 cases with a synchronous diagnosis; 41 cases with UUT UC first, 22 cases with LUT UC first. 34 (40%) of cases had low grade (LG) UC in both sites, and 33 (38%) had HG UC in both sites. When the LUT UC was HG, it was more likely that the UUT UC was also HG (33/35 vs. 17/50, p = 0.0001).

UC Grade: UUT versus LUT

	Upper Tract LG (n)	Upper Tract HG (n)
Lower Tract LG (n)	34	17
Lower Tract HG (n)	2	33

p<0.0001

When both UUT UC and LUT UC presented synchronously or when they presented more than one year apart, the UUT UC was more likely to be HG (41/56 vs. 10/30, p < 0.05). Involvement of ureter with (32) or without (3) pelvis was associated with increased HG disease in comparison with UUT confined to pelvis (26/36 vs. 18/50, p<0.05). Similarly, involvement of the ureter (35) was associated with higher stage (III or IV) at presentation (54% vs. 27%), but this prediction was not statistically significant.

UUT UC Site and Grade

	Low Grade	95% CI	High Grade	95% CI
Ureter +/- Pelvis	10/36	15.9,44.0	26/36	56.1,84.2
Pelvis Only	32/50	50.1,75.9	18/50	24.1,49.9

p<0.05

HG UUT UC was more often seen in high stage disease (p < 0.05). Other parameters, such as patient age or which carcinoma was diagnosed first, did not predict HG disease in the UUT.
Conclusions: There is a strong correlation with tumor grade between UUT UCs and LUT UCs. HG LUT UC was predictive of HG UC in the UUT. Additionally, UUT UC and LUT UC with a synchronous diagnosis or a diagnosis interval of greater than one year were strong predictive factors for HG UUT UCs. Ureter involvement was also correlated with HG UUT UC.
Category: Genitourinary (including renal tumors)

Tuesday, March 10, 2009 9:30 AM

Poster Session III # 99, Tuesday Morning