The utility of preoperative diagnostics in patients undergoing radical nephroureterectomy for suspected upper tract urothelial carcinoma: Can we justify treatment without prior histologic confirmation?

The main obstacles to the broad application of neoadjuvant chemotherapy for locally advanced upper tract urothelial cancer(UTUC) are uncertainties regarding the accuracy of preoperative diagnostics. This study aimed to examine the predictive value of preoperative diagnostic results regarding the histopathologic findings at the time of radical nephroureterectomy (RNU). An institutional dataset of patients undergoing RNU for suspected UTUC between 01/2018 and 12/2023 was analyzed. We examined the preoperative utilization of different diagnostic means and their predictive value in detecting locally advanced(i.e., ≥T2) disease. Separate uni-and multivariable logistic regression models were employed to examine the association between preoperative findings and final histology. At the time of RNU, 64.4 %(n = 74) of patients were diagnosed with ≥T2 disease. Out of 115 patients, 41.7 % underwent RNU based on cross-sectional imaging findings alone, thirty of whom had undergone a prior endourologic diagnostic workup without evidence of UTUC(62.5 %). There were no false-positive diagnoses of UTUC. On multivariable logistic regression and consecutive receiver operating characteristic(ROC) analysis, only a tumor size ≥1.9 cm during cross-sectional imaging was associated with advanced disease(OR 2.99, 95 %CI 1.65-5.43, p < 0.001). In this cohort of patients undergoing RNU for suspected UTUC, only tumor size during cross-sectional imaging was associated with advanced disease. These results support the notion of tumor size as an independent risk factor, which may, in turn, guide further treatment decisions.