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Introduction: The presence of hydronephrosis (HN) has been implicated as a predictor of poor outcomes for patients diagnosed with bladder cancer. Smaller reports suggest a similar negative relationship exists for upper-tract urothelial carcinoma (UTUC).
Materials & Methods: 469 pts with localized UTUC from 6 tertiary referral centers who underwent a radical nephroureterectomy (91%) or segmental ureterectomy (9%) without neoadjuvant chemotherapy were integrated into a database. Preoperative HN data variables were available in 408 pts.
Results: 192 pts (47%) had > pT2 disease, 145 (36%) had non-organ confined disease and 298 (73%) had high grade disease on final pathology. Forty-six percent of pts had tumors in the renal pelvis, 27% in the ureter, and 27% in both. Preoperatively, 223 pts (55%) had HN (39% low grade and 61% high grade). HN was associated with > pT2 stage (p<0.001) and non-organ confined disease (p<0.001). On preoperative multivariate analysis that adjusted for the effects of gender, age, and tumor location, HN was an independent predictor of muscle invasive disease (HR 7.4, p<0.001), non-organ confined disease (HR 5.5, p<0.001), and high pathologic grade (HR 1.6, p=0.03). Even after controlling for ureteroscopic biopsy grade and urinary cytology (n=172), HN remained an independent predictor of muscle invasive stage (HR 12.0, p<0.001) and non-organ confined disease (HR 5.1, p<0.001).
Conclusions: The presence of preoperative HN is a significant predictor for advanced stage UTUC. This imaging modality may improve preoperative risk stratification to guide use of endoscopic versus extirpative surgery and/or the need for neoadjuvant chemotherapy regimens.