Grade and Stage Migration for Upper Tract Urothelial Carcinoma
AK Smith, AA Thomas, AJ Stephenson, SC Campbell, JS Jones, DE Hansel. Cleveland Clinic, Cleveland, OH
Background: In the era of the advent of minimally invasive technology to manage urothelial tumors, increasing numbers of patients are managed conservatively with surveillance and serial biopsies, coupled with fulguration or resection of neoplasms. We examined our series of patients with upper urinary tract cancers who underwent endoscopic biopsy and/or radical excision to identify histopathological findings and clinical outcomes associated with these tumors.
Design: The clinicopathological records of patients treated at our institution from 1992 to 2008 for urothelial cancers were reviewed. Forty patients with upper urinary tract urothelial carcinoma identified on 2 or more consecutive biopsies and/or biopsy followed by nephroureterectomy or ureterectomy were included in the study.
Results: The median interval between biopsies was 1.5 months (range 0.5 to 59.5 months). One patient was rendered cancer-free by endoscopic resection of the tumor, as the nephroureterectomy specimen obtained 1.5 months after the initial treatment contained no malignancy. Grade migration was observed in 8 patients (20%), with 2 progressing from dysplasia to high grade papillary carcinoma and 4 patients from low to high grade. One patient had a high grade tumor initially and low grade on subsequent biopsy, and another patient regressed from low grade to atypia. Stage migration was observed in 12 patients (30%), progressing from non-invasive to invasive in 11 and vice versa in 1. The interval during which the stage migration was observed averaged 7.2 months, as compared to a 4.4 month average for the rest of the group.
Conclusions: Grade and stage migration of urothelial carcinoma may occur in patients with upper tract disease managed conservatively. This may represent true morphological change of the tumor as well as a biopsy sampling error. Therefore close surveillance with serial biopsies should be emphasized in the conservative management of the upper tract urothelial neoplasms.
Category: Genitourinary (including renal tumors)
Tuesday, March 10, 2009 1:00 PM
Poster Session IV # 144, Tuesday Afternoon