Background:
\nThere is considerable discrepancy among international guidelines regarding risk stratification of low-grade (LG) upper tract urothelial carcinoma (UTUC). The EAU classifies tumors as high-risk based on factors such as size and multifocality, while the AUA considers multifocality as unfavorable low-risk, excludes size, and incorporates history of bladder cancer. Risk classification directly affects treatment decisions. We aimed to evaluate the impact of these classification differences on oncological outcomes.
\nMethods:
\nWe conducted a retrospective multicenter study of LG UTUC patients managed endoscopically between 2004 and 2023. Demographic, clinical, pathological, and oncological data were collected. Each patient was classified according to both EAU and AUA guidelines. Concordant groups (agreed-low, agreed-high) were compared with patients for whom classification was discordant (not-agreed).
\nResults:
\nA total of 127 patients were included. Median follow-up time was 49.2 months (IQR 26-73). According to EAU criteria, 44 (34.6%) were low-risk and 83 (65.4%) high-risk. By AUA criteria, 25 (19.7%) were favorable low-risk and 102 (80.3%) unfavorable low-risk. Agreement between the two systems was only fair (Cohen\u2019s kappa 0.284, p=0.001).
\nAmong EAU low-risk patients, 28 (63.6%) were categorized as unfavorable by AUA. Among AUA favorable patients, 9 (36%) were categorized as high-risk by EAU.
\nOncological outcomes of the discordant group (n=37) more closely resembled the agreed-low group (n=16) than the agreed-high group (n=74). Recurrence rates were 68.8% in agreed-low, 83.8% in agreed-high, and 65% in not-agreed group (p=0.06). Histological progression occurred in 7.1%, 14.1%, and 2.8%, respectively (p=0.16). Metastatic disease developed in 6.3%, 14.9%, and 2.7%, respectively (p=0.08). Rates of nephroureterectomy were 12.5%, 24.3%, and 19% (p=0.59). Kaplan\u2013Meier analysis demonstrated no survival difference between groups (log-rank p=0.29).
\nConclusion:
\nAgreement between EAU and AUA risk classification systems for LG UTUC is only moderate. Patients with discordant classification demonstrated oncological outcomes more comparable to low-risk groups, suggesting that current guideline discrepancies may overestimate risk in this subgroup.<\/p>","protected":false},"excerpt":{"rendered":"
Background: There is considerable discrepancy among international guidelines regarding risk stratification of low-grade (LG) upper tract urothelial carcinoma (UTUC). The EAU classifies tumors as high-risk based on factors such as size and multifocality, while the AUA considers multifocality as unfavorable … read more<\/a><\/p>","protected":false},"author":3,"featured_media":233,"menu_order":0,"template":"","meta":{"_acf_changed":false},"portfolio-type":[19],"portfolio-tag":[],"class_list":["post-232","portfolio","type-portfolio","status-publish","has-post-thumbnail","hentry","portfolio-type-unmoderated-posters"],"acf":[],"_links":{"self":[{"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/portfolio\/232","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/portfolio"}],"about":[{"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/types\/portfolio"}],"author":[{"embeddable":true,"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/users\/3"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/media\/233"}],"wp:attachment":[{"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/media?parent=232"}],"wp:term":[{"taxonomy":"portfolio-type","embeddable":true,"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/portfolio-type?post=232"},{"taxonomy":"portfolio-tag","embeddable":true,"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/portfolio-tag?post=232"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}