Positive urinary fluorescence in situ hybridization indicates poor prognosis in patients with upper tract urothelial carcinoma

Abstract

Here, we evaluated the potential contribution of fluorescent in situ hybridization (FISH) as a prognostic risk factor of bladder recurrence and survival in patients with upper tract urothelial carcinoma (UTUC). A total of 159 UTUC patients were enrolled in this study from January 2012 to May 2016. The 159 voided urine samples before surgery were analyzed using the UroVysion^® kit to detect the copy numbers of chromosomes 3, 7, 17 and 9p21 (p16). Patients were classified using an optimal cutoff value of chromosomes 3, 7, 17, and 9p21. Cox’s proportional hazards regression model was used to assess the prognostic value of FISH for bladder recurrence and survival. We found that 27 (17.6%) patients experienced bladder recurrence and 26 (16.4%) patients died from cancer, with a median follow-up of 27 months. The patients with positive FISH result were more likely to present bladder recurrence (p = 0.077). However, positive FISH was not associated with cancer specific-free survival (CSS) (p = 0.944). Tumor multifocality, the percentage of abnormal chromosome 3 > 5%, chromosome 7 > 6%, chromosome 17 > 11% and deletion of p16 > 4% were significant prognostic risk factors for BRFS in univariate analysis. In multivariate analysis, only tumor multifocality (hazard ratio [HR] = 3.487, 95%CI: 1.605–7.576, p = 0.002) and the percentage of p16 loss > 4% were both prognostic risk factors for bladder recurrence (HR = 3.487, 95%CI: 1.605–7.576, p = 0.002). These data consider that the urinary FISH test could be a powerful tool in predicting the risk of bladder recurrence in patients with UTUC.