Remzi Mesut, Haitel Andrea, Margulis Vitaly, Karakiewicz Pierre, Montorsi Francesco, Kikuchi Eiji, Zigeuner Richard, Weizer Alon, Bolenz Christian, Bensalah Karim, Suardi Nazareno, Raman Jay D, Lotan Yair, Waldert Matthias, Ng Casey K, Fernández Mario, Koppie Theresa M, Ströbel Philipp, Kabbani Wareef, Murai Masaru, Langner Cord, Roscigno Marco, Wheat Jeffrey, Guo Charles C, Wood Christopher G, Shariat Shahrokh F
Medical University of Vienna, Vienna, Austria.
BJU Int. 2009 Feb;103(3):307-11. doi: 10.1111/j.1464-410X.2008.08003.x. Epub 2008 Oct 16.
To 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.
The 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.
Papillary 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).
The 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.
评估肿瘤结构是否有助于细化接受上尿路尿路上皮癌（UC）根治性肾输尿管切除术（NU）患者的预后，因为上尿路尿路上皮癌（UTUC）中肿瘤结构（乳头状与无柄状）的预后价值仍不明确。
该研究纳入了全球12个中心的1363例UTUC患者，均接受了根治性NU治疗。所有切片均由泌尿生殖病理学家按照严格标准重新评估，这些病理学家对原始病理切片的结果和临床结局并不知情。大体肿瘤结构分为无柄状与乳头状。
983例患者（72.2%）为乳头状生长，380例（27.8%）为无柄状生长。无柄状生长模式与更高的肿瘤分级、更晚期别、淋巴管侵犯以及淋巴结转移相关（均P<0.001）。在对病理分期、分级和淋巴结状态的影响进行校正的多变量Cox回归分析中，肿瘤结构（无柄状或乳头状）是癌症复发（风险比1.5，P=0.002）和癌症特异性死亡（1.6，P=0.001）的独立预测因素。纳入肿瘤结构使一个包含病理分期、分级和淋巴结状态的模型预测癌症复发和癌症特异性死亡的预测准确性有了虽微小但具有统计学意义的提高（预测准确性提高1%和0.5%，均P<0.001）。
UTUC的肿瘤结构与生物学侵袭性疾病的既定特征相关，更重要的是，与根治性NU后的预后相关。应考虑将肿瘤结构纳入疾病进展的预测模型中，以识别可能从早期全身治疗干预中获益的患者。
