ABSTRACT
Objective To investigate the clinical characteristics and prognosis in upper urinary tract urothelial carcinoma concomitant with squamous or glandular differentiation.Methods The medical records of 176 patients treated with radical nephroureterectomy from January 2001 to December 2014 were retrospectively reviewed.This total cohort included 118 men and 58 women.The median age was 70 years (range 37 to 92).Ninety-eight cases had tumors in the left side and the remaining 78 cases in the right side.All eligible patients were divided into two groups according to the presence of squamous or glandular differentiation.One hundred and fifty-nine cases were in group A,including 107 men and 52 women.The median age of this group was 70 years (range 37 to 92).Ninety-one cases had tumors in left side and the remaining 68 cases in right side.Seventeen cases were in group B,including 11 men and 6 women.The median age of this group was 69 years (range 44 to 90).Seven cases had tumors in left side and the remaining 10 cases in right side.There was no significant difference in two groups about sex,age,tumor location,tumor side and existence of hydronephrosis (all P ＞ 0.05).Thirty-two cases(20.1％)and 7 cases (41.2％) in group A and B had previous or synchronous non-muscle-invasive bladder cancer (P =0.047).Kaplan-Meier and Cox proportional hazard regression analysis were used to evaluate predictors of oncologic outcomes.Results Of the 176 patients,10 (5.7％) had squamous differentiation and 7 (4.0％) had glandular differentiation.Comparing with pure urothelial carcinoma,concomitant squamous or glandular differentiation were more likely to have advanced tumor stage [≥ pT2 in group B vs.group A:17 cases (100.0％) vs.114 cases (71.7％)] and high grade [12 cases (70.6％) vs.57 cases(35.8％)] (all P ＜0.05).Overall survival (OS) rates at 3 years and 5 years in group B were significantly lower than those in group A (57.8％ vs.78.9％ and 30.8％ vs.62.8％,respectively;P =0.005).Likewise,cancerspecific survival (CSS) rates at 3 year and 5 years in group B were significantly lower than those in group A (63.5％ vs.80.4％ and 33.9％ vs.66.5％,respectively;P =0.02).Multivariable analysis revealed that squamous or glandular differentiation was a significant risk factor for OS and CSS (P =0.003,P =0.021).However,it was not significantly associated with bladder-recurrence-free survival(P =0.097).Conclusions Comparing with pure upper urinary tract urothelial carcinoma,concomitant squamous or glandular differentiation could increase the risk of advanced tumor stage,high grade and previous or synchronous nonmuscle-invasive bladder cancer.It was also a significant risk factor for postoperative survival and could be valuable for guiding risk stratification after surgery.