Masson-Lecomte Alexandra, Colin Pierre, Bozzini Gregory, Nison Laurent, de La Taille Alexandre, Comperat Eva, Zerbib Marc, Rozet François, Cathelineau Xavier, Valeri Antoine, Ruffion Alain, Guy Laurent, Droupy Stéphane, Cussenot Olivier, Rouprêt Morgan
Department of Urology, Henri Mondor Academic Hospital, Paris Est Creteil University, Créteil, France.
World J Urol. 2014 Apr;32(2):531-7. doi: 10.1007/s00345-013-1141-0. Epub 2013 Aug 2.
To assess the impact of micropapillary histological variant on oncological outcome after radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinomas (UTUCs).
A French multicenter retrospective study was performed on patients who underwent RNU between 1995 and 2010. Pathological reports were reviewed to identify patients with pure urothelial carcinomas (PUC) and those with micropapillary histological variant (MPC). Uni- and multivariate Cox regression analyses were performed to identify factors predictive of survival.
Overall, 519 patients were included and divided into two groups: 480 PUC and 39 MPC. Median follow-up were 28 and 19 months, respectively (p = 0.63). There was no difference between the two groups for gender, age and tumor location (pelvicalyceal or ureteral). MPC was associated with high-stage and high-grade UTUC (p < 0.001 and 0.04). No difference was observed between the two groups for 5-year cancer-specific survival (76.1 vs. 88.2 %; p = 0.54). The 5-year metastasis-free survival was significantly lower in the MPC group (48.9 vs. 73.8 %; p = 0.037). In multivariate analysis, pT stage, lymphovascular invasion, margin status and adjuvant chemotherapy administration were independent predictors of specific survival (p = 0.002; 0.001; 0.02; 0.01), contrary to histological variant (p = 0.94).
Micropapillary histological variant was associated with advanced UTUC and reduced metastasis-free survival after RNU. It should be considered as an aggressive tumor and thus be stated in any pathological report after radical surgery.
评估微乳头组织学亚型对上尿路尿路上皮癌（UTUC）根治性肾输尿管切除术（RNU）后肿瘤学结局的影响。
对1995年至2010年间接受RNU的患者进行了一项法国多中心回顾性研究。回顾病理报告以识别纯尿路上皮癌（PUC）患者和具有微乳头组织学亚型（MPC）的患者。进行单因素和多因素Cox回归分析以确定生存预测因素。
总体而言，纳入了519例患者并分为两组：480例PUC和39例MPC。中位随访时间分别为28个月和19个月（p = 0.63）。两组在性别、年龄和肿瘤位置（肾盂或输尿管）方面无差异。MPC与高级别和高分期UTUC相关（p < 0.001和0.04）。两组的5年癌症特异性生存率无差异（76.1%对88.2%；p = 0.54）。MPC组的5年无转移生存率显著较低（48.9%对73.8%；p = 0.037）。在多因素分析中，pT分期、淋巴管浸润、切缘状态和辅助化疗的使用是特异性生存的独立预测因素（p = 0.002；0.001；0.02；0.01），与组织学亚型相反（p = 0.94）。
微乳头组织学亚型与晚期UTUC相关，且RNU后无转移生存率降低。应将其视为侵袭性肿瘤，因此在根治性手术后的任何病理报告中都应注明。
