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3.4.1.1.3. Tobacco consumption. Being a smoker at diagnosis
increases the risk for disease recurrence and mortality
after RNU and recurrence within the bladder
(LE: 3). There is a close relationship between tobacco
consumption and prognosis; smoking cessation improves
cancer control.
3.4.1.1.4. Tumour location. Initial location of the UTUC is a
prognostic factor in some studies (LE: 3). After
adjustment for the effect of tumour stage, patients with
ureteral and/or multifocal tumours seem to have a worse
prognosis than renal pelvic tumours
3.4.1.1.5. Surgical delay. A delay between diagnosis of an
invasive tumour and its removal may increase the risk of
disease progression. Once a decision regarding RNU has
been made, the procedure should be carried out within
12 wk when possible (LE: 3).
3.4.1.1.6. Other. The American Society of Anesthesiologists
score also significantly correlates with cancer-specific survival
after RNU (LE: 3), but the Eastern Cooperative Oncology
Group performance status correlates only with overall
survival (OS) . Obesity and higher body mass index
adversely affect cancer-specific outcomes in UTUCs (LE:
3). The pretreatment–derived neutrophil–lymphocyte ratio
also correlates with higher cancer-specific mortality .
3.4.1.2. Postoperative factors
3.4.1.2.1. Tumour stage and grade. The primary recognised
prognostic factors are tumour stage and grade
3.4.1.2.2. Lymph node involvement. Lymph node metastases and
extranodal extension are powerful predictors of survival
outcomes in UTUC . Lymph node dissection (LND)
performed at the time of RNU allows for optimal tumour
staging (LE: 3). Its curative role remains debated.
3.4.1.2.3. Lymphovascular invasion. Lymphovascular invasion is
present in approximately 20% of UTUCs and is an indepen-
dent predictor of survival . Lymphovascular invasion
status should be specifically reported in the pathological
reports of all UTUC specimens (LE: 3).
3.4.1.2.4. Surgical margins. Positive soft tissue surgical margin
after RNU is a significant factor for developing disease
recurrence. Pathologists should look for and report positive
margins at the level of ureteral transection, bladder cuff, and
around the tumour if T > 2 (LE: 3).
3.4.1.2.5. Pathological factors. Extensive tumour necrosis ( >10%
of the tumour area) is an independent prognostic predictor
in patients who undergo RNU (LE: 3). The architecture of
UTUC is also a strong prognosticator with sessile growth
pattern being associated with worse outcome (LE: 3).
Concomitant CIS in organ-confined UTUC and a history of
bladder CIS are associated with a higher risk of recurrence
and cancer-specific mortality (LE: 3).
3.4.2. Molecular markers
Several studies have investigated the prognostic impact of
markers related to cell adhesion (E-cadherin and CD24), cell
differentiation (Snail and epidermal growth factor receptor),
[(Fig._2)TD$FIG]
Fig. 2 – Upper urinary tract urothelial carcinoma: prognostic factors. ASA = American Society of Anesthesiologists; BMI = body mass index; ECOG
PS = Eastern Cooperative Oncology Group performance status; UTUC = upper urinary tract urothelial carcinoma.
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