Sorbonne University, GRC 5 Predictive ONCO-URO, AP-HP, Urology, Pitie-Salpetriere Hospital, F-75013 PARIS, France.
Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
Eur Urol Focus. 2021 Sep;7(5):1075-1083. doi: 10.1016/j.euf.2020.10.004. Epub 2020 Oct 24.
The current pathological tumour-node-metastasis (pTNM) classification for upper tract urothelial carcinoma (UTUC) does not include any risk stratification of pT3 renal pelvicalyceal tumours.
To assess the prognostic impact of pT3 subclassification in a multicentre cohort of patients with UTUC of the renal pelvicalyceal system undergoing radical nephroureterectomy (RNU).
DESIGN, SETTING, AND PARTICIPANTS: Data from all consecutive patients treated with RNU for pT3 renal pelvicalyceal UTUC at 14 French centres from 1995 to 2013 were reviewed retrospectively.
A central pathology review (CPR) was used to stratify pT3 patients into those with infiltration of the renal parenchyma on a microscopic level (pT3a) versus those with infiltration of the renal parenchyma visible on gross inspection of the resection specimen and/or invasion of peripelvic fat (pT3b).
Inverse probability weighting (IPW)-adjusted Cox regression analyses were used to compare recurrence-free survival (RFS) and cancer-specific survival (CSS) between pT3a and pT3b patients.
Overall, 202 patients were included and further stratified into pT3a (n = 98; 48.5%) and pT3b (n = 104; 51.5%) subgroups. Median time to follow-up in the weighted population was 68 (interquartile range, 50-95) mo. In IPW-adjusted Cox regression analyses, pT3b versus pT3a substage was associated with a significant adverse effect on RFS (hazard ratio [HR] = 2.02; 95% confidence interval [CI] = [1.36-3.01]; p < 0.001) and CSS (HR = 1.84; 95% CI = [1.20-2.82]; p = 0.005). The study is limited by its retrospective design.
Using IPW-adjusted analyses after the CPR, we observed that RNU patients with pT3b renal pelvicalyceal UTUC had adverse prognosis as compared with those with pT3a disease. As such, this subclassification could help refine the current pTNM system for UTUC.
In this report, we looked at the prognostic interest of stratifying patients with pT3 renal pelvicalyceal upper tract urothelial carcinoma based on the extent of local invasion. We found that those with extensive infiltration (pT3b) had adverse prognosis as compared with those with limited infiltration (pT3a). This information could be provided on pathology reports to further guide clinical decision making.
目前的上尿路上皮癌（UTUC）的病理肿瘤-淋巴结-转移（pTNM）分类不包括对 pT3 肾盂肾盏肿瘤的任何风险分层。
评估在接受根治性肾输尿管切除术（RNU）的肾盂肾盏系统 UTUC 患者的多中心队列中，pT3 亚组分类的预后影响。
设计、地点和参与者：回顾性分析了 1995 年至 2013 年期间，14 个法国中心连续接受 RNU 治疗的所有 pT3 肾盂肾盏 UTUC 患者的数据。
使用中央病理复查（CPR）将 pT3 患者分为显微镜下肾实质浸润（pT3a）与肉眼检查标本肾实质浸润可见和/或侵犯肾周脂肪（pT3b）的患者。
使用逆概率加权（IPW）调整的 Cox 回归分析比较 pT3a 和 pT3b 患者的无复发生存率（RFS）和癌症特异性生存率（CSS）。
共有 202 例患者被纳入，并进一步分为 pT3a（n = 98；48.5%）和 pT3b（n = 104；51.5%）亚组。加权人群的中位随访时间为 68（四分位距，50-95）个月。在 IPW 调整的 Cox 回归分析中，pT3b 与 pT3a 分期与 RFS（危险比[HR] = 2.02；95%置信区间[CI] = [1.36-3.01]；p < 0.001）和 CSS（HR = 1.84；95% CI = [1.20-2.82]；p = 0.005）显著不良影响相关。该研究受到回顾性设计的限制。
在 CPR 后使用 IPW 调整的分析，我们观察到与 pT3a 疾病相比，接受 RNU 治疗的 pT3b 肾盂肾盏 UTUC 患者预后不良。因此，这种分类可以帮助完善目前的 UTUC pTNM 系统。
在本报告中，我们研究了根据局部浸润程度对 pT3 肾盂肾盏上尿路上皮癌患者进行分层的预后意义。我们发现，广泛浸润（pT3b）的患者与局限性浸润（pT3a）的患者相比预后不良。这些信息可以在病理报告中提供，以进一步指导临床决策。
