Brady Urologic Health Center, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York 10065, USA.
Eur Urol. 2012 Aug;62(2):224-31. doi: 10.1016/j.eururo.2012.01.019. Epub 2012 Jan 24.
The clinical course of pT3 upper tract urothelial carcinoma (UTUC) is highly variable.
The aim of the current study was to validate the clinical and prognostic importance of pT3 subclassification in the renal pelvicalyceal system in a large international cohort of patients.
DESIGN, SETTING, AND PARTICIPANTS: From a multi-institutional international database, 858 renal pelvicalyceal tumors treated with radical nephroureterectomy (RNU) were systematically reevaluated by genitourinary pathologists. Category pT3 pelvic tumors were categorized as pT3a (infiltration of the renal parenchyma on a microscopic level only) versus pT3b (macroscopic infiltration of the renal parenchyma and/or infiltration of peripelvic adipose tissue).
RNU.
Associations of pT3 subclassifications with clinicopathologic features were assessed with the chi-square test. Prognostic impact was assessed with the log-rank test and multivariable Cox regression analyses.
Of 858 patients with renal pelvicalyceal tumors, 266 (31%) had pT3 disease. Of these, 146 (54.9%) were classified as pT3a and 120 (45.1%) as pT3b. Compared with pT3a, pT3b cancers were associated with higher tumor grade, nodal disease, and tumor necrosis. Ten-year recurrence-free (pT3a 58% vs pT3b 38%; p<0.001) and cancer-specific (pT3a 60% vs pT3b 39%; p=0.002) survival rates were lower for patients with pT3b disease. In multivariable analyses, classification pT3b was an independent predictor of both disease recurrence (hazard ratio [HR]: 1.8, p=0.003) and cancer-specific mortality (HR: 1.7; p=0.02). The major limitation is the retrospective character of the study.
Subclassification of pT3 renal pelvicalyceal UTUC helps identify patients who are at increased risk of disease progression and cancer-related death. Further research may help assess the value of subclassification and its inclusion in future editions of the American Joint Committee on Cancer-International Union Against Cancer TNM classification system.
pT3 上尿路上皮癌（UTUC）的临床病程差异很大。
本研究旨在通过多机构国际数据库，对 858 例接受根治性肾输尿管切除术（RNU）治疗的肾盂输尿管肿瘤进行系统评估，验证 pT3 亚分类在肾盏肾盂系统中的临床和预后重要性。
设计、地点和参与者：从多机构国际数据库中，对 858 例接受根治性肾输尿管切除术（RNU）治疗的肾盂输尿管肿瘤进行了系统评估，由泌尿生殖病理学家进行评估。pT3 盆部肿瘤被分类为 pT3a（显微镜下仅肾实质浸润）与 pT3b（肾实质肉眼浸润和/或肾盂周围脂肪组织浸润）。
RNU。
采用卡方检验评估 pT3 亚分类与临床病理特征的相关性。采用对数秩检验和多变量 Cox 回归分析评估预后影响。
在 858 例肾盂输尿管肿瘤患者中，266 例（31%）患有 pT3 疾病。其中，146 例（54.9%）被归类为 pT3a，120 例（45.1%）被归类为 pT3b。与 pT3a 相比，pT3b 癌症与更高的肿瘤分级、淋巴结疾病和肿瘤坏死有关。pT3b 疾病患者的 10 年无复发生存率（pT3a 为 58%，pT3b 为 38%；p<0.001）和癌症特异性生存率（pT3a 为 60%，pT3b 为 39%；p=0.002）均较低。多变量分析显示，pT3b 分类是疾病复发（风险比[HR]：1.8，p=0.003）和癌症特异性死亡（HR：1.7；p=0.02）的独立预测因子。主要局限性在于研究的回顾性。
pT3 肾盂输尿管 UTUC 的亚分类有助于识别疾病进展和癌症相关死亡风险增加的患者。进一步的研究可能有助于评估亚分类的价值及其在未来的美国癌症联合委员会-国际抗癌联盟 TNM 分类系统中的纳入。
