Abstract

Introduction & Objectives While the use of adjuvant chemotherapy for the improvement of long term oncological outcomes in those with locally advanced Upper tract TCC (UTTCC) appears to be gaining traction, the role of neoadjuvant treatment for tumour down-staging prior to surgery remains more contentious. Despite this, the potential benefits are evident; providing chemotherapy prior to surgically induced renal impairment and reduced patient performance status. To this end, a number of RCTs are ongoing to test its application. A key component of this approach however requires the accurate identification of those with high risk UTTCC. We aimed to test the reliability of staging CT to identify those with locally advanced T2-4 UTTCC by comparison to end histological data. Materials & Methods We performed a retrospective review of 130 consecutive patients having undergone nephro-ureterectomy at a tertiary UK Urology centre between June 2013 and June 2018. All baseline staging CT reports were assessed for the documentation of TNM staging as well as the presence and severity of hydronephrosis, and compared to the final histology reports. Results In all, 94 patients were included in the review, with 36 excluded due to a non-commitment to TNM classification by the radiologist or benign pathology indication for the procedure. Of those remaining, 43 (46%) were identified to have pathologically pT2+ disease. Radiological staging of T2 disease correlated to only 12% pT2 disease, with 58% of patients inappropriately overstaged. Where T3 disease was identified on CT, 77% were found to have pT2+ disease (p<0.005). Only a single case of radiologically T4 disease underwent nephroureterectomy which had been appropriately staged. Further hallmarks of pT2+ disease included radiologically N1-2 staging (p<0.03). There was no correlation to severe hydronephrosis (p=0.18) or tumour size (p=0.23). Conclusions While the radiological diagnosis of T3/T4 disease matched pathological staging with relative reliability, T2 staging is a poor predictor of end pathology, and our series would suggest to be an inappropriate tool for adjusting pre-operative management decisions.

Conference Title

European urology conference

Conference Country

Palestine

Conference Date

July 17, 2020 - July 20, 2020

Conference Sponsor

European association of Urological surgeons

Additional Info

Conference Website