Moderate or severe hydronephrosis predicts worse oncologic outcomes in patients with high-grade (HG) upper tract urothelial carcinoma (UTUC), according to a new study.

In these patients, moderate or severe hydronephrosis (HN) is associated with a significant 5.5 times greater likelihood of local or systemic cancer recurrence and 5.2 times greater likelihood of cancer-related death compared with no or mild HN, researchers led by Vitaly Margulis, MD, of the University of Texas Southwestern Medical Center in Dallas, reported online ahead of print in Urologic Oncology. Moderate or severe HN also is associated with a significant 9.3 times increased risk of muscle-invasive cancer and 4.5 times increased risk of non-organ-confined cancer.

The researchers found no association between degree of HN and oncologic outcomes among patients with low-grade disease.

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The study, which was retrospective, included 141 patients who underwent extirpative surgery for localized upper tract urothelial carcinomas. Of these, 113 had HG disease (80%), 49 (35%) had muscle-invasive disease and 41 (29%) had non-organ-confined disease. At a median follow-up of 34 months, 49 patients (35%) had intravesical recurrence, 28 (20%) experienced local or systemic recurrence, and 24 (17%) died from their cancer.

“Because preoperative imaging is a routinely available diagnostic tool, HN may serve as a surrogate parameter for advanced disease and may be used to help counsel patients with HG tumors toward neoadjuvant chemotherapy and radical surgical treatment,” the investigators concluded.