Annular-shaped stenosis in the ureter: Caution should be taken

To draw the attention of clinicians and avoid the misdiagnosis, we investigate the relationship between annular-shaped stenosis under ureteroscopy and the clinicopathological features and prognosis in patients with primary urothelial carcinoma of the ureter that have been treated by radical nephroureterectomy.

We reviewed the records of patients with primary urothelial carcinoma of the ureter who had received radical nephroureterectomy in our hospital between January 2014 and June 2020. Based on the luminal morphology of the ureteral lesion, patients were divided into two groups: Group A for annular stenosis and Group B for non-annular stenosis. The logistic regression and Cox proportional-hazards models were used to explore the relationship between annular stenosis and clinicopathological findings.

We investigated a total of 147 patients in this study, including 30 patients (20.4%) in Group A and 117 (79.6%) patients in Group B. The proportion of patients with diabetes mellitus was significantly higher in group A than in group B (66.6% vs. 38.5%, P = 0.006), and the percentage of patients undergoing ureteroscopy with biopsy was also significantly higher in group A than in group B (100% vs. 35.9%, P < 0.001). Besides, the logistic regression model revealed that annular-shaped stenosis was correlated to advanced T-stage (P = 0.002) and worse tumour grade (P < 0.001). During a median follow-up of 35 months (range: 6-73), 45 (30.6%) patients died, including 35 (23.8%) who died of ureteral carcinoma. The 5-year overall survival rate in Group A was significantly lower than in Group B (33.7% vs. 56.1%, P = 0.004). Similarly, the 5-year cancer-specific survival rate in Group A was also considerably lower than Group B (36.7% vs. 64.8%, P = 0.009). According to the multivariate Cox regression analysis that included only preoperative parameters, annular-shaped stenosis was an independent risk factor for both overall survival and cancer-specific survival (P = 0.006, P = 0.012, respectively).

Annular-shaped stenosis indicates high carcinoma invasiveness and poor prognosis for patients with primary transitional cell carcinoma of the ureter. This condition can be easily misidentified, so clinicians should pay more attention when making diagnoses. Additionally, we discovered that diabetes mellitus may contribute to the development of annular stenosis.