Microscopic hematuria predicts lower stage in patients with upper tract urothelial carcinoma
Authors Qi N, Zhang J, Chen Y, Wen R, Li H
Received 18 July 2018
Accepted for publication 24 September 2018
Published 24 October 2018 Volume 2018:10 Pages 4929—4933
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Harikrishna Nakshatri
Nienie Qi,1,* Jiufeng Zhang,2,* Yue Chen,1 Rumin Wen,1 Hailong Li1
1Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China; 2Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
*These authors contributed equally to this work
Background: The aim of this study was to assess the association between the severity of hematuria (microscopic or gross) and the tumor stage and grade in a population of histopathologically confirmed upper tract urothelial carcinoma (UTUC) patients.
Patients and methods: We conducted a multicenter, observational study of patients who were newly diagnosed with UTUC between January 2011 and December 2016. Demographic information, pathology, and the status of hematuria were retrospectively reviewed. The association between the severity of hematuria and the tumor stage and grade was evaluated using logistic regression.
Results: The UTUC patients presented with gross hematuria (GH, 76.7%), microscopic hematuria (MH, 11.1%), and no hematuria (12.2%) at the time of diagnosis. The pathological stages at diagnosis for those with MH were Ta in 5.1%, T1 in 47.5%, and ≥T2 in 47.5%. The stages at diagnosis for those with GH were Ta in 1.7%, T1 in 35.5%, and ≥T2 in 62.7%. On univariate and multivariate logistic regression analyses, after adjusting for clinical factors such as age, gender, and smoking history, GH was an independent risk factor for muscle-invasive UTUC (≥T2 disease) at diagnosis (OR 1.89, 95% CI 1.073–3.329; P=0.027). High-grade tumor was found in 47.8% of patients with GH and 39.0% of those with MH. The severity of hematuria was not associated with tumor grade.
Conclusion: We are the first to report evidence that microscopic hematuria at presentation accurately predicts lower pathological stage in patients with newly diagnosed UTUC. Earlier detection of disease, before the development of GH, may influence the treatment decision and survival. The type of hematuria at the time of diagnosis does not impact the tumor grade.
Keywords: upper tract urothelial carcinoma, gross hematuria, microscopic hematuria, stage
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