Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
Urol Oncol. 2012 Sep;30(5):666-72. doi: 10.1016/j.urolonc.2010.07.010. Epub 2010 Oct 8.
Macroscopic sessile tumor architecture was associated with adverse outcomes after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Before inclusion in daily clinical decision-making, the prognostic value of tumor architecture needs to be validated in an independent, external dataset. We tested whether macroscopic tumor architecture improves outcome prediction in an international cohort of patients.
We retrospectively studied 754 patients treated with RNU for UTUC without neoadjuvant chemotherapy at 9 centers located in Asia, Canada, and Europe. Tumor architecture was macroscopically categorized as either papillary or sessile. Univariable and multivariable Cox regression analyses were used to address recurrence-free (RFS) and cancer-specific survival (CSS) estimates.
Macroscopic sessile architecture was present in 20% of the patients. Its prevalence increased with advancing pathologic stage and it was significantly associated with established features of biologically aggressive UTUC, such as tumor grade, lymph node metastasis, lymphovascular invasion, and concomitant CIS (all P values < 0.02). The median follow-up for patients who were alive at last follow-up was 40 months (IQR: 18-75 months, range: 1-271 months). Two-year RFS and CSS for tumors with papillary architecture were 85% and 90%, compared with 58% and 66% for those with macroscopic sessile architecture, respectively (P values < 0.0001). On multivariable Cox regression analyses, macroscopic sessile architecture was an independent predictor of both RFS (hazard ratio {HR}: 1.5; P = 0.036) and CSS (HR: 1.5; P = 0.03).
We confirmed the independent prognostic value of macroscopic tumor architecture in a large, independent, multicenter UTUC cohort. It should be reported in every pathology report and included in post-RNU predictive models in order to refine current clinical decision making regarding follow-up protocol and adjuvant therapy.
根治性肾输尿管切除术（RNU）治疗上尿路上皮癌（UTUC）后，宏观无蒂肿瘤结构与不良结局相关。在将肿瘤结构纳入日常临床决策之前，需要在独立的外部数据集中验证其预后价值。我们测试了宏观肿瘤结构是否能改善国际患者队列的预后预测。
我们回顾性研究了 9 个位于亚洲、加拿大和欧洲的中心的 754 例未接受新辅助化疗的 UTUC 患者接受 RNU 治疗的病例。肿瘤结构宏观上分为乳头状或无蒂状。使用单变量和多变量 Cox 回归分析来解决无复发生存（RFS）和癌症特异性生存（CSS）估计。
20%的患者存在宏观无蒂结构。随着病理分期的进展，其患病率增加，并且与生物侵袭性 UTUC 的既定特征显著相关，如肿瘤分级、淋巴结转移、脉管侵犯和同时存在 CIS（所有 P 值均<0.02）。最后一次随访时存活患者的中位随访时间为 40 个月（IQR：18-75 个月，范围：1-271 个月）。具有乳头状结构的肿瘤的 2 年 RFS 和 CSS 分别为 85%和 90%，而具有宏观无蒂结构的肿瘤分别为 58%和 66%（P 值均<0.0001）。多变量 Cox 回归分析显示，宏观无蒂结构是 RFS（危险比 {HR}：1.5；P = 0.036）和 CSS（HR：1.5；P = 0.03）的独立预测因素。
我们在一个大型的、独立的多中心 UTUC 队列中证实了宏观肿瘤结构的独立预后价值。它应该在每个病理报告中报告，并纳入 RNU 后预测模型中，以细化当前关于随访方案和辅助治疗的临床决策。
