Department of Urology, Klinikum der Universität München, Munich, Germany,
Department of Urology, Klinikum der Universität München, Munich, Germany.
Urol Int. 2021;105(7-8):631-636. doi: 10.1159/000513459. Epub 2021 Feb 12.
The aim of the study was to evaluate the impact of fluorescence in situ hybridization (FISH) diagnostics on the T stage in final histology specimen of patients undergoing radical nephroureterectomy (RNU) due to upper tract urothelial carcinoma (UTUC) at a large tertiary care center.
We retrospectively analyzed patients who underwent RNU at our center between 2008 and 2020. Inclusion criteria were RNU due to UTUC. Urine cytologies were used for FISH analysis to detect chromosomal abnormalities. Pre-FISH group was defined as patients without access to routine preoperative urinary FISH testing (2008-2014), and FISH group was defined as patients with access to routine FISH testing. Primary outcome was T stage in final histology. Statistical analysis was performed by χ2 test and Mann-Whitney U test.
Out of 212 patients who underwent RNU at our center between 2008 and 2020, 155 patients were included into the final analysis. The median age was 71 (range 33-90) years, and 108 (69.7%) patients were male and 47 (30.3%) female. Age and gender were not differently distributed in both groups (age: p = 0.925; gender: p = 0.682). Organ-confined disease was found in 37/72 patients in the pre-FISH cohort and in 48/83 patients in the FISH cohort (p = 0.422). Within organ-confined disease, 18/37 patients revealed a T stage smaller than T1 in the pre-FISH cohort and 35/48 patients in the FISH cohort (p = 0.022).
Preoperative FISH diagnostics add important information to preoperative diagnostic workup of patients with UTUC. Within organ-confined disease, a significant shift toward T stages lower than T1 is observed. Further research is required to determine the impact of this shift on survival in UTUC.
本研究旨在评估荧光原位杂交（FISH）诊断对上尿路尿路上皮癌（UTUC）患者根治性肾输尿管切除术（RNU）后最终组织学标本 T 分期的影响，该研究在一家大型三级保健中心进行。
我们回顾性分析了 2008 年至 2020 年期间在我院接受 RNU 的患者。纳入标准为因 UTUC 而行 RNU。尿细胞学用于 FISH 分析以检测染色体异常。预 FISH 组定义为未接受常规术前尿 FISH 检测的患者（2008-2014 年），FISH 组定义为接受常规 FISH 检测的患者。主要结局为最终组织学的 T 分期。采用 χ2 检验和 Mann-Whitney U 检验进行统计学分析。
在 2008 年至 2020 年期间在我院接受 RNU 的 212 例患者中，有 155 例患者纳入最终分析。中位年龄为 71 岁（范围 33-90 岁），108 例（69.7%）为男性，47 例（30.3%）为女性。两组患者的年龄和性别分布无差异（年龄：p=0.925；性别：p=0.682）。在预 FISH 组中，72 例患者中有 37 例为器官局限性疾病，而在 FISH 组中，83 例患者中有 48 例为器官局限性疾病（p=0.422）。在器官局限性疾病中，预 FISH 组中有 18 例患者的 T 分期小于 T1，而 FISH 组中有 35 例患者的 T 分期小于 T1（p=0.022）。
术前 FISH 诊断为 UTUC 患者的术前诊断提供了重要信息。在器官局限性疾病中，观察到 T 分期明显向 T1 以下转移。需要进一步研究以确定这种转移对 UTUC 患者生存的影响。
