Ospedali Riuniti of Bergamo, Bergamo, Italy.
BJU Int. 2012 Sep;110(5):674-81. doi: 10.1111/j.1464-410X.2012.10930.x. Epub 2012 Feb 20.
What's known on the subject? and What does the study add? Tumour stage is a powerful predictor of clinical outcomes and the most important factor driving clinical decision-making after radical nephroureterectomy (RNU) in upper tract urothelial carcinoma (UTUC). It has been suggested that renal pelvic pT3 subclassification into microscopic infiltration of the renal parenchyma (pT3a) versus macroscopic infiltration or invasion of peripelvic adipose tissue (pT3b) has strong prognostic value. This is an external validation study of the prognostic value of pT3 subclassification of renal pelvic UTUC in a large international cohort of patients treated with RNU. pT3b UTUC is associated with features of aggressive tumour biology, disease recurrence and cancer-specific mortality. However, pT3 subclassification is not an independent predictor of clinical outcomes.
To externally validate the prognostic value of subclassification of pT3 renal pelvic upper tract urothelial carcinoma (UTUC) in a large international cohort of patients treated with radical nephroureterectomy (RNU).
The RNU specimens with pT3 UTUC of the renal pelvis from 284 patients at 11 centres located in Asia, North America and Europe were retrospectively evaluated. All specimens were reviewed by genitourinary pathologists at each institution. Tumours were categorized as pT3a (microscopic infiltration of the renal parenchyma) or pT3b (macroscopic infiltration of the renal parenchyma and/or infiltration of peripelvic adipose tissue).
Overall, 148 (52%) tumours were classified as pT3a and 136 (48%) as pT3b. Patients with pT3b disease were more likely to have high-grade tumours and sessile tumour architecture (all P ≤ 0.02). Patients with pT3b tumours were at increased risk of disease recurrence (5-year estimates: 55% versus 42%, P = 0.012) and cancer-specific mortality (CSM) (5-year estimates: 48% versus 40%, P = 0.04). Lymph node status, tumour architecture and tumour grade were independently associated with disease recurrence, whereas lymph node status, tumour architecture and lymphovascular invasion were independently associated with CSM. Subclassification of pT3 tumours was not associated with recurrence or CSM in multivariable analyses.
Patients with pT3b UTUC were more likely to have tumours with aggressive pathological features and were at higher risk of disease recurrence and CSM after RNU compared with patients with pT3a disease. However, the pT3 subclassification did not remain an independent predictor of disease recurrence or CSM after controlling for tumour grade, lymph node status, tumour architecture and lymphovascular invasion.
肿瘤分期是预测临床结局的有力指标，也是根治性肾输尿管切除术（RNU）后决定上尿路上皮癌（UTUC）临床决策的最重要因素。已经有研究表明肾盂 pT3 亚分类为肾实质的显微镜下浸润（pT3a）与肾周脂肪组织的宏观浸润或侵犯（pT3b）具有很强的预后价值。本研究旨在通过对接受 RNU 治疗的大型国际患者队列的肾盂 UTUC 的 pT3 亚分类进行外部验证，评估其预后价值。
在接受根治性肾输尿管切除术（RNU）治疗的大型国际患者队列中，对肾盂 pT3 上尿路上皮癌（UTUC）的亚分类进行外部验证，评估其预后价值。
回顾性分析来自 11 个中心的 284 例患者的 RNU 标本，这些患者的肾盂存在 pT3UTUC。所有标本均由各机构的泌尿生殖病理学家进行评估。肿瘤分为 pT3a（肾实质的显微镜下浸润）或 pT3b（肾实质的宏观浸润和/或肾周脂肪组织的浸润）。
总的来说，148 例（52%）肿瘤被归类为 pT3a，136 例（48%）为 pT3b。pT3b 疾病患者更有可能患有高级别肿瘤和息肉样肿瘤结构（均 P≤0.02）。pT3b 肿瘤患者复发风险增加（5 年估计值：55%比 42%，P=0.012）和癌症特异性死亡率（CSM）（5 年估计值：48%比 40%，P=0.04）。淋巴结状态、肿瘤结构和肿瘤分级与疾病复发独立相关，而淋巴结状态、肿瘤结构和脉管侵犯与 CSM 独立相关。多变量分析中，肿瘤 pT3 亚分类与复发或 CSM 无关。
与 pT3a 疾病患者相比，pT3bUTUC 患者的肿瘤更有可能具有侵袭性的病理特征，并且在接受 RNU 后更有可能发生疾病复发和 CSM。然而，在控制肿瘤分级、淋巴结状态、肿瘤结构和脉管侵犯后，pT3 亚分类不再是疾病复发或 CSM 的独立预测因素。
