Department of Urology, Eulji University Hospital, Daejeon, Republic of Korea.
Department of Urology, Akita University Graduate School of Medicine, Akita, Japan.
J Urol. 2014 Oct;192(4):1064-71. doi: 10.1016/j.juro.2014.04.001. Epub 2014 Apr 13.
We determined whether the 3 pT3 subclassification systems reported by the Asan, Cornell and Nagoya groups provide an accurate estimation of patient prognosis. We also determined which subclassification is most predictive of the heterogeneous oncological outcomes of pT3 renal pelvic urothelial carcinoma.
Using a Korea-Japan multi-institutional, retrospective database 250 pT3 renal pelvic urothelial carcinomas treated with radical nephroureterectomy were assigned to the 3 pT3 subcategories by tumor location and depth of parenchymal invasion after pathological reevaluation. Recurrence-free and cancer specific survival was assessed according to the 3 pT3 subclassifications. Predictive accuracy for survival in 4 models (baseline and each of the 3 pT3 subclassifications) was quantified and predictive accuracy increments for each model were compared.
In the baseline multivariate Cox regression model nodal metastasis and high grade were significant for survival. On multivariate analysis including the pT3 subclassifications the 3 subclassifications remained significantly associated with survival rates. Of the 3 pT3 subclassification systems the Cornell subclassification had the highest predictive accuracy for discriminating the heterogeneous prognosis of pT3 renal pelvic urothelial carcinoma, followed by the Nagoya subclassification. Compared with the baseline model adding the Cornell subclassification significantly increased predictive accuracy for recurrence-free survival from 0.687 to 0.742 (p = 0.029) and for cancer specific survival from 0.713 to 0.758 (p = 0.047).
The criteria of microscopic vs macroscopic parenchymal invasion and/or peripelvic fat invasion provide the most accurate differential classification of the prognostic heterogeneity of pT3 renal pelvic urothelial carcinoma. Further studies should be performed to determine the need to modify the current pT3 renal pelvic urothelial carcinoma staging system.
我们旨在确定 Asan、Cornell 和 Nagoya 研究组报道的 3 种 pT3 亚分类系统是否能准确评估患者的预后。我们还旨在确定哪种亚分类对 pT3 肾盂尿路上皮癌异质性肿瘤学结局的预测性最强。
使用韩国-日本多机构回顾性数据库，对 250 例接受根治性肾输尿管切除术治疗的 pT3 肾盂尿路上皮癌患者，通过病理重新评估后，根据肿瘤位置和实质侵犯深度，将其分配到 3 种 pT3 亚分类中。根据 3 种 pT3 亚分类评估无复发生存和癌症特异性生存。对 4 种模型（基线和 3 种 pT3 亚分类中的每一种）的生存预测准确性进行量化，并比较各模型的预测准确性增量。
在基线多变量 Cox 回归模型中，淋巴结转移和高级别与生存相关。在包括 pT3 亚分类的多变量分析中，这 3 种亚分类与生存率仍显著相关。在 3 种 pT3 亚分类系统中，Cornell 亚分类对鉴别 pT3 肾盂尿路上皮癌的异质性预后具有最高的预测准确性，其次是 Nagoya 亚分类。与基线模型相比，加入 Cornell 亚分类后，无复发生存率的预测准确性从 0.687 提高到 0.742（p = 0.029），癌症特异性生存率从 0.713 提高到 0.758（p = 0.047）。
显微镜下与肉眼下实质侵犯和/或肾盂周围脂肪侵犯的标准为 pT3 肾盂尿路上皮癌预后异质性提供了最准确的分类。应进一步开展研究以确定是否需要修改当前的 pT3 肾盂尿路上皮癌分期系统。
