The Effect Of Concomitant Varian Histology On The Prognosis Of Patients With Upper Urinary Tract Urothelial Carcinoma After Radical Surgery

Objective: To identify the effect of Concomitant Varian Histology(CVH)on the prognosis of patients with upper urinary tract urothelial carcinoma(UTUC)after radical surgery.Method: This study retrospectively analyzed the clinical and pathological data of 91 patients with UTUC in our hospital from January 2009 to December 2012,and asked the physician to re-examine the pathology of radical nephroureterectomy(RNU).The difference of cancerspecific survival(CSS),recurrence-free survival(DFS)and overall survival(OS)between pure UTUC group and CVH group were compared.The Kaplan-Meier curve and Log-rank test were used to analyze the risk factors.The risk factors were analyzed by multivariable analysis using Cox proportional hazards regression analyses.Results: Of the 91 UTUC patients after RNU,the median follow-up was 46 months.A total of 18 patients(19.78%)were recruited with CVH,7 of whom(38.89%)died and 9(50%)relapsed.Compared with the pure UTUC group,tumors in the high-level group(P =0.025)were more likely to be UTUC associated with CVH.To evaluation of the UTUC with CVH group and the pure UTUC group after RNU 5-years CSS,DFS,OS rates were approximately: 71.53%,60.23%,65.58%(P<0.05);65.61%,52.46%,58.56%(P<0.05);72.94%,59.23% and 67.26%(P<0.05).Univariate analysis showed that CVH was associated with CSS(P=0.005),DFS(P=0.048),OS(P =0.047).Multivariate analysis that CVH was an independent risk factor for CSS(HR=0.233,95% CI: 0.065-0.842,P = 0.026),OS(HR = 0.246,95% CI: 0.076-0.793,P = 0.019),was not an independent risk factor for DFS(HR = 0.412,95% CI: 0.138-1.224,P = 0.110)that affected UTUC.Conclusion: Approximately one fifth of the pathologic diagnoses are CVH with UTUC after RNU.This study found that CVH is associated with UTUC patients after RNU,CSS,OS independent risk factors,the prognosis of these patients was worse than the pure UTUC.Pathologists should seek potential CVH in pathologic specimens of UTUC patients and routinely report to guide clinical development of adjuvant therapy and follow-up programs.