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Comparative Study
, 18 (1), 22

Comparison of Clinicopathologic Characteristics, Epigenetic Biomarkers and Prognosis Between Renal Pelvic and Ureteral Tumors in Upper Tract Urothelial Carcinoma

Comparative Study

Comparison of Clinicopathologic Characteristics, Epigenetic Biomarkers and Prognosis Between Renal Pelvic and Ureteral Tumors in Upper Tract Urothelial Carcinoma

Dong Fang et al. BMC Urol.


Background: There's no consensus about the difference between renal pelvic and ureteral tumors in terms of clinical features, pathological outcomes, epigenetic biomarkers and prognosis.

Methods: The data of 341 patients with renal pelvic tumors and 271 patients with ureteral tumors who underwent radical nephroureterectomy between 1999 and 2011 were retrospectively reviewed. The clinicopathologic features, gene promoters methylation status and oncologic outcomes were compared. Regression analysis was performed to identify oncologic prognosticators.

Results: Patients with ureteral tumors were relatively older (p = 0.002), and had higher likelihood of pre-operative renal insufficiency (p < 0.001), hypertension (p = 0.038) and hydronephrosis (P < 0.001), while in patients with renal pelvic tumors gross hematuria was more prevalent (p < 0.001). Renal pelvic tumors tended to exhibit non-organ-confined disease (p = 0.004) and larger tumor diameter (p = 0.001), while ureteral tumors had a higher likelihood of exhibiting high grade (p < 0.001) and sessile architecture (p = 0.023). Hypermethylated gene promoters were significantly more prevalent in renal pelvic tumors (p < 0.001), specifically for TMEFF2, GDF15, RASSF1A, SALL3 and ABCC6 (all p < 0.05). Tumor location failed to independently predict cancer-specific survival, overall survival, intravesical or contralateral recurrence (all p > 0.05), while gene methylation status was demonstrated to be an independent prognostic factor.

Conclusion: Renal pelvic tumors and ureteral tumors exhibited significant differences in clinicopathologic characteristics and epigenetic biomarkers. Gene promoter methylation might be an important mechanism in explaining distinct tumor patterns and behaviors in UTUC.

Keywords: Methylation; Prognosis; Radical nephroureterectomy (RNU); Renal pelvis; Upper tract urothelial carcinomas (UTUC); Ureter.

Conflict of interest statement

Ethics approval and consent to participate

The study received the ethics approval by the Ethic Committee of Peking University First Hospital (No. 2016–1253).

All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

All patients agreed and signed the informed consent to participate into the study, and they agreed that their information (including clinical information, surgical related data, pathological data and surveillance) would be collected for scientific study and by published in professional medical journals.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


Fig. 1
Fig. 1
Distribution of aberrant methylated genes in renal pelvic and ureteral tumors (a) and the cumulative numbers of aberrant methylated genes (b)
Fig. 2
Fig. 2
Estimated Kaplan-Meier overall survival (a) (p = 0.104), cancer specific survival (b) (p = 0.071), bladder recurrence-free survival (c) (p = 0.294) and contralateral carcinoma-free survival (d) (p = 0.871) curves stratified by tumor location
Fig. 3
Fig. 3
Estimated Kaplan-Meier cancer specific survival (a) (p = 0.001) and bladder recurrence-free survival (b) (p = 0.081) curves stratified by numbers of methylated genes (0–2 versus 3–5 versus 6–10)

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