Tumour architecture is an independent predictor of outcomes after nephroureterectomy: a multi‐institutional analysis of 1363 patients

BJU International - Tập 103 Số 3 - Trang 307-311 - 2009
Mesut Remzi1, Andrea Haitel1, Vitaly Margulis1, Pierre Karakiewizc2, Francesco Montorsi3, Eiji Kikuchi4, Richard Zigeuner5, Alon Z. Weizer6, Christian Bolenz7, Karim Bensalah8, Nazareno Suardi2, Jeffrey A. Cadeddu9, Yair Lotan10, Matthias Waldert1, Casey K. Ng9, Mario I. Fernández11, Theresa M. Koppie12, Philipp Ströbel7, Wareef Kabbani10, Masaru Murai4, Cord Langner5, Marco Roscigno3, Jeffrey Wheat6, Charles C. Guo1, Christopher G. Wood1, Shahrokh F. Shariat10
1Medical University of Vienna, Vienna, Austria, University of Texas MD Anderson Cancer Center, Houston, TX, USA,
2University of Montreal, Montreal, Quebec, Canada
3Vita-Salute University, Milan, Italy
4Keio University School of Medicine, Tokyo, Japan
5Medical University Graz, Graz, Austria
6University of Michigan, Ann Arbor, MI USA
7Universitätsklinikum Mannheim, Mannheim, Germany,
8University of Rennes, Rennes, France
9Cornell University, New York, NY, USA,
10University of Texas Southwestern, Dallas, TX, USA
11Clinica Alemana de Santiago, Santiago de Chile, Chile
12University of California, Davis, Sacramento, CA, USA

Tóm tắt

OBJECTIVETo assess whether tumour architecture can help to refine the prognosis of patients treated with nephroureterectomy (NU) for urothelial carcinoma (UC) of the upper urinary tract (UT), as the prognostic value of tumour architecture (papillary vs sessile) in UTUC remains elusive.PATIENTS AND METHODSThe study included 1363 patients with UTUC and treated with radical NU at 12 centres worldwide. All slides were re‐reviewed according to strict criteria by genitourinary pathologists who were unaware of the findings of the original pathology slides and clinical outcomes. Gross tumour architecture was categorized as sessile vs papillary.RESULTSPapillary growth was identified in 983 patients (72.2%) and sessile growth in 380 (27.8%). The sessile growth pattern was associated with higher tumour grade, more advanced stage, lymphovascular invasion, and metastasis to lymph nodes (all P < 0.001). In multivariable Cox regression analyses that adjusted for the effects of pathological stage, grade and lymph node status, tumour architecture (sessile or papillary) was an independent predictor of cancer recurrence (hazard ratio 1.5, P = 0.002) and cancer‐specific mortality (1.6, P = 0.001). Adding tumour architecture increased the predictive accuracy of a model that comprised pathological stage, grade and lymph node status for predicting cancer recurrence and cancer‐specific death by a minimal but statistically significant margin (gain in predictive accuracy 1% and 0.5%, both P < 0.001).CONCLUSIONThe tumour architecture of UTUC is associated with established features of biologically aggressive disease, and more importantly, with prognosis after radical NU. Including tumour architecture in predictive models for disease progression should be considered, aiming to identify patients who might benefit from early systemic therapeutic intervention.

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Tài liệu tham khảo

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BJU International

Tập 103 Số 3

307-311

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