{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T21:29:14Z","timestamp":1790630954739,"version":"4.1.0"},"reference-count":20,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T00:00:00Z","timestamp":1667952000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Urology"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Technical limitations of ureteroscopic (URS) biopsy has been considered responsible for substantial upgrading rate in upper tract urothelial carcinoma (UTUC). However, the impact of tumor specific factors for upgrading remain uninvestigated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients who underwent URS biopsy were included between 2005 and 2020 at 13 institutions. We assessed the prognostic impact of upgrading (low\u2010grade on URS biopsy) versus same grade (high\u2010grade on URS biopsy) for high\u2010grade UTUC tumors on radical nephroureterectomy (RNU) specimens.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This study included 371 patients, of whom 112 (30%) and 259 (70%) were biopsy\u2010based low\u2010 and high\u2010grade tumors, respectively. Median follow\u2010up was 27.3\u2009months. Patients with high\u2010grade biopsy were more likely to harbor unfavorable pathologic features, such as lymphovascular invasion (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and positive lymph nodes (LNs; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). On multivariable analyses adjusting for the established risk factors, high\u2010grade biopsy was significantly associated with worse overall (hazard ratio [HR] 1.74; 95% confidence interval [CI], 1.10\u20132.75; <jats:italic>p<\/jats:italic>\u2009=\u20090.018), cancer\u2010specific (HR 1.94; 95% CI, 1.07\u20133.52; <jats:italic>p<\/jats:italic>\u2009=\u20090.03), and recurrence\u2010free survival (HR 1.80; 95% CI, 1.13\u20132.87; <jats:italic>p<\/jats:italic>\u2009=\u20090.013). In subgroup analyses of patients with pT2\u2010T4 and\/or positive LN, its significant association retained. Furthermore, high\u2010grade biopsy in clinically non\u2010muscle invasive disease significantly predicted upstaging to final pathologically advanced disease (\u2265pT2) compared to low\u2010grade biopsy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>High tumor grade on URS biopsy is associated with features of biologically and clinically aggressive UTUC tumors. URS low\u2010grade UTUC that becomes upgraded to high\u2010grade might carry a better prognosis than high\u2010grade UTUC on URS. Tumor specific factors are likely to be responsible for upgrading to high\u2010grade on RNU.<\/jats:p><\/jats:sec>","DOI":"10.1111\/iju.15061","type":"journal-article","created":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T11:04:18Z","timestamp":1667991858000},"page":"63-69","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Biological and prognostic implications of biopsy upgrading for high\u2010grade upper tract urothelial carcinoma at nephroureterectomy"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8377-2457","authenticated-orcid":false,"given":"Satoshi","family":"Katayama","sequence":"first","affiliation":[{"name":"Department of Urology, Comprehensive Cancer Center Medical University of Vienna  Vienna Austria"},{"name":"Department of Urology Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Pradere","sequence":"additional","affiliation":[{"name":"Department of Urology, Comprehensive Cancer Center Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8698-6461","authenticated-orcid":false,"given":"Nico C.","family":"Grossman","sequence":"additional","affiliation":[{"name":"Department of Urology, Comprehensive Cancer Center Medical University of Vienna  Vienna Austria"},{"name":"Department of Urology University Hospital Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4619-1773","authenticated-orcid":false,"given":"Aaron M.","family":"Potretzke","sequence":"additional","affiliation":[{"name":"Department of Urology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen A.","family":"Boorjian","sequence":"additional","affiliation":[{"name":"Department of Urology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7368-7240","authenticated-orcid":false,"given":"Alireza","family":"Ghoreifi","sequence":"additional","affiliation":[{"name":"Department of Urology, Norris Comprehensive Cancer Center University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sia","family":"Daneshmand","sequence":"additional","affiliation":[{"name":"Department of Urology, Norris Comprehensive Cancer Center University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hooman","family":"Djaladat","sequence":"additional","affiliation":[{"name":"Department of Urology, Norris Comprehensive Cancer Center University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P.","family":"Sfakianos","sequence":"additional","affiliation":[{"name":"Department of Urology Icahn School of Medicine at Mount Sinai Hospital  New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Mari","sequence":"additional","affiliation":[{"name":"Department of Urology, Careggi Hospital University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zine\u2010Eddine","family":"Khene","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital Pontchaillou CHU Rennes  Rennes France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1625-1077","authenticated-orcid":false,"given":"David","family":"D'Andrea","sequence":"additional","affiliation":[{"name":"Department of Urology, Comprehensive Cancer Center Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nozomi","family":"Hayakawa","sequence":"additional","affiliation":[{"name":"Department of Urology St. Marianna University School of Medicine  Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Breda","sequence":"additional","affiliation":[{"name":"Department of Urology, Fundaci\u00f3 Puigvert Autonoma University of Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Fontana","sequence":"additional","affiliation":[{"name":"Department of Urology, Fundaci\u00f3 Puigvert Autonoma University of Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazutoshi","family":"Fujita","sequence":"additional","affiliation":[{"name":"Department of Urology Osaka University Graduate School of Medicine  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Antonelli","sequence":"additional","affiliation":[{"name":"Urology Unit AUOI Verona, Department of Surgery, Dentistry, Pediatrics and Gynecology University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"van Doeveren","sequence":"additional","affiliation":[{"name":"Department of Urology, Erasmus MC Cancer Institute University Medical Centre Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Steinbach","sequence":"additional","affiliation":[{"name":"Department of Urology, Comprehensive Cancer Center Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6147-6569","authenticated-orcid":false,"given":"Keiichiro","family":"Mori","sequence":"additional","affiliation":[{"name":"Department of Urology, Comprehensive Cancer Center Medical University of Vienna  Vienna Austria"},{"name":"Department of Urology The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8953-0272","authenticated-orcid":false,"given":"Ekaterina","family":"Laukhtina","sequence":"additional","affiliation":[{"name":"Department of Urology, Comprehensive Cancer Center Medical University of Vienna  Vienna Austria"},{"name":"Institute for Urology and Reproductive Health Sechenov University  Moscow Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan","family":"Roupr\u00eat","sequence":"additional","affiliation":[{"name":"GRC 5 Predictive Onco\u2010Uro, AP\u2010HP, Urology, Pitie\u2010Salpetriere Hospital Sorbonne University  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vitaly","family":"Margulis","sequence":"additional","affiliation":[{"name":"Department of Urology University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre I.","family":"Karakiewicz","sequence":"additional","affiliation":[{"name":"Cancer Prognostics and Health Outcomes Unit University of Montreal Health Centre  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3172-2482","authenticated-orcid":false,"given":"Motoo","family":"Araki","sequence":"additional","affiliation":[{"name":"Department of Urology Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Comp\u00e9rat","sequence":"additional","affiliation":[{"name":"GRC 5 Predictive Onco\u2010Uro, AP\u2010HP, Urology, Pitie\u2010Salpetriere Hospital Sorbonne University  Paris France"},{"name":"Department of Pathology Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasutomo","family":"Nasu","sequence":"additional","affiliation":[{"name":"Department of Urology Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahrokh F.","family":"Shariat","sequence":"additional","affiliation":[{"name":"Department of Urology, Comprehensive Cancer Center Medical University of Vienna  Vienna Austria"},{"name":"Institute for Urology and Reproductive Health Sechenov University  Moscow Russia"},{"name":"Department of Urology University of Texas Southwestern Medical Center  Dallas Texas USA"},{"name":"Hourani Center for Applied Scientific Research Al\u2010Ahliyya Amman University  Amman Jordan"},{"name":"Department of Urology Weill Cornell Medical College  New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,11,9]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccell.2021.05.008"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2020.05.039"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2020.05.042"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2012.11066.x"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1089\/end.2020.0246"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2018.02.002"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2011.02.038"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urolonc.2012.05.010"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2018.03.040"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2013.11.056"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-014-1383-5"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2019.10.005"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2017.07.088"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2020.06.024"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e3181aec42a"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30415-3"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/RCT.0000000000000664"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00261-016-0897-2"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2017.04.015"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10147-021-01941-9"}],"container-title":["International Journal of Urology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iju.15061","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/iju.15061","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iju.15061","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T21:27:05Z","timestamp":1692480425000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/iju.15061"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,9]]},"references-count":20,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.1111\/iju.15061"],"URL":"https:\/\/doi.org\/10.1111\/iju.15061","archive":["Portico"],"relation":{},"ISSN":["0919-8172","1442-2042"],"issn-type":[{"value":"0919-8172","type":"print"},{"value":"1442-2042","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,9]]},"assertion":[{"value":"2022-05-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-09","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}