Hashimoto Takeshi, Nakashima Jun, Inoue Rie, Gondo Tatsuo, Ohno Yoshio, Tachibana Masaaki
Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan,
Int J Clin Oncol. 2014 Apr;19(2):373-8. doi: 10.1007/s10147-013-0548-3. Epub 2013 Apr 3.
To investigate the prognostic significance of infiltrative growth pattern (INF) and to develop a novel risk stratification model for disease-specific survival (DSS) in patients with upper urinary tract urothelial carcinoma (UTUC).
This study included 113 patients with UTUC treated with radical nephroureterectomy. Pathological features, including INF, were compared with DSS. INF was classified into 3 patterns (INFa, INFb, and INFc). The prognostic factors of DSS were evaluated with univariate and multivariate Cox proportional hazard model analyses. A risk stratification model based on the relative risks of DSS was then established.
Univariate analysis revealed that patients with high-grade tumor, pathological T stage ≥T3, a non-expanding infiltration pattern (INF ≥b), sessile-type carcinoma, the presence of lymphovascular invasion and positive lymph node involvement showed significantly lower survival rates than their respective counterparts. In the multivariate analysis, high grade tumor, positive lymph node involvement and INF ≥b were independent predictors for DSS (p < 0.05). The patients were stratified into 3 risk groups. The 5-year DSS rates were 94.4 % in the low-risk group, 67.5 % in the intermediate-risk group and 20.5 % in the high-risk group.
In addition to lymph node involvement and pathological tumor grade, INF is a novel independent prognostic factor in patients with UTUC treated with radical nephroureterectomy. Our risk stratification model developed using these 3 factors may help clinicians identify patients with a poor prognosis who might be good candidates for clinical trials of innovative therapies.
探讨浸润性生长模式（INF）的预后意义，并为上尿路尿路上皮癌（UTUC）患者建立一种新的疾病特异性生存（DSS）风险分层模型。
本研究纳入113例行根治性肾输尿管切除术治疗的UTUC患者。将包括INF在内的病理特征与DSS进行比较。INF分为3种模式（INFa、INFb和INFc）。采用单因素和多因素Cox比例风险模型分析评估DSS的预后因素。然后基于DSS的相对风险建立风险分层模型。
单因素分析显示，高级别肿瘤、病理T分期≥T3、非扩展性浸润模式（INF≥b）、无蒂型癌、存在淋巴管浸润和阳性淋巴结转移的患者生存率明显低于各自对应的患者。多因素分析中，高级别肿瘤、阳性淋巴结转移和INF≥b是DSS的独立预测因素（p<0.05）。患者被分为3个风险组。低风险组、中风险组和高风险组的5年DSS率分别为94.4%、67.5%和20.5%。
除淋巴结转移和病理肿瘤分级外，INF是行根治性肾输尿管切除术治疗的UTUC患者的一种新的独立预后因素。我们使用这3个因素建立的风险分层模型可能有助于临床医生识别预后不良的患者，这些患者可能是创新疗法临床试验的合适人选。
