Olgac Semra, Mazumdar Madhu, Dalbagni Guido, Reuter Victor E
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Am J Surg Pathol. 2004 Dec;28(12):1545-52. doi: 10.1097/00000478-200412000-00001.
Urothelial carcinomas of the renal pelvis are relatively rare tumors, and large series that include clinicopathologic and outcome data are few. We reviewed 130 consecutive nephroureterectomies performed for urothelial carcinoma of the renal pelvis at our institution. Tumors were graded using the World Health Organization/International Society of Urologic Pathologists (WHO/ISUP) grading system and were staged according to the 2002 TNM classification; 83 (63.6%) of the patients were men and 47 (36.4%) were women. The mean age at diagnosis was 67 years (range, 41-93 years). The average tumor size was 3.7 cm; 36 of the cases were multifocal and 5 were bilateral. Lower tract disease occurred in 50.7% (66 cases); 38 of the cases (29.3%) were low grade and the remaining 92 (70.7%) were high grade. A total of 50% of the cases were pTis, pTa, or pT1, while 45% invaded deeply (pT2 or more). Depth of invasion could not be assessed with certainty in 7 cases (5%). Regional lymph nodes were identified/submitted in only 50 cases. Of those, 12 cases (24%) had lymph node metastasis. Follow-up information was available in 125 (96%) patients. The period of follow-up ranged from 1 week to 176 months (mean, 48.9 months). At last follow-up, 47 patients (36%) had died of other causes, 18 (13.8%) were dead of disease, 8 patients (6%) were alive with disease, and 52 patients (40%) were alive with no evidence of disease. In univariate analysis, histologic grade (P = 0.001), TNM stage (P = 0.0001), vascular invasion (P = 0.001), margin status (P = 0.021), and size (P = 0.0003) were significantly associated with survival. On multivariate analysis, TNM stage (P = 0.03) was the only variable associated with survival. In conclusion, our study shows that a high percentage of the urothelial carcinoma of the renal pelvis present with locally advanced (pT2 or more) disease at the time of nephroureterectomy. Pathologic stage is the most potent predictor of survival, similar to lower tract disease. A subset of the cases could not be staged due to processing issues; we thus recommend fixation prior to prosecting.
肾盂尿路上皮癌是相对罕见的肿瘤，包含临床病理和预后数据的大型系列研究较少。我们回顾了在我们机构连续进行的130例因肾盂尿路上皮癌而行肾输尿管切除术的病例。肿瘤采用世界卫生组织/国际泌尿病理学会（WHO/ISUP）分级系统进行分级，并根据2002年TNM分类进行分期；83例（63.6%）患者为男性，47例（36.4%）为女性。诊断时的平均年龄为67岁（范围41 - 93岁）。肿瘤平均大小为3.7 cm；36例为多灶性，5例为双侧性。50.7%（66例）出现下尿路疾病；其中38例（29.3%）为低级别，其余92例（70.7%）为高级别。总共50%的病例为pTis、pTa或pT1期，而45%侵犯较深（pT2及以上）。7例（5%）病例无法确定浸润深度。仅50例送检了区域淋巴结。其中12例（24%）有淋巴结转移。125例（96%）患者有随访信息。随访时间从1周到176个月不等（平均48.9个月）。在最后一次随访时，47例（36%）患者死于其他原因，18例（13.8%）死于疾病，8例（6%）带瘤生存，52例（40%）无疾病生存。单因素分析中，组织学分级（P = 0.001）、TNM分期（P = 0.0001）、血管侵犯（P = 0.001）、切缘状态（P = 0.021）和肿瘤大小（P = 0.0003）与生存显著相关。多因素分析中，TNM分期（P = 0.03）是与生存相关的唯一变量。总之，我们的研究表明，在肾输尿管切除时，相当比例的肾盂尿路上皮癌呈现为局部晚期（pT2及以上）疾病。病理分期是生存的最强预测因素，与下尿路疾病相似。部分病例因处理问题无法分期；因此我们建议在取材前进行固定。
