Liu Hui-Ying, Chen Yen Ta, Huang Shun-Chen, Wang Hung-Jen, Cheng Yuan-Tso, Kang Chih Hsiung, Lee Wei Ching, Su Yu-Li, Huang Chun-Chieh, Chang Yin-Lun, Chuang Yao-Chi, Luo Hao Lun, Chiang Po Hui
Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Front Oncol. 2021 Feb 25;11:613696. doi: 10.3389/fonc.2021.613696. eCollection 2021.
To assess the association of tumor architecture with cancer recurrence, metastasis, and cancer-specific survival (CSS) in patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC) in Taiwan.
Data were collected from 857 patients treated with RNU between January 2005 and August 2016 in our hospital. Pathologic slides were reviewed by genitourinary pathologists. Propensity score weighting was performed for data analysis.
Sessile growth pattern was observed in 212 patients (24.7%). Tumor architecture exhibited a significant association with bladder cancer history, chronic kidney disease (CKD), tumor stage, lymph node status, histological grade, lymphovascular invasion, concomitant carcinoma , and the variant type [standardized mean difference (SMD) > 0.1 for all variables before weighting]. In the propensity score analysis, 424 papillary and sessile tumor architecture were analyzed to balance the baseline characteristics between the groups. Tumor architecture was an independent predictor of metastatic disease and CSS (p = 0.033 and p = 0.002, respectively). However, the associations of tumor architecture with bladder and contralateral recurrence were nonsignificant (p = 0.956 and p = 0.844, respectively).
Tumor architecture of UTUC after RNU is associated with established features of aggressive disease and predictors of metastasis and CSS. Assessment of tumor architecture may help identify patients who could benefit from close follow-up or early administration of systemic therapy after RNU. Tumor architecture should be included in UTUC staging after further confirmation.
评估在台湾接受根治性肾输尿管切除术（RNU）治疗上尿路尿路上皮癌（UTUC）的患者中，肿瘤结构与癌症复发、转移及癌症特异性生存（CSS）之间的关联。
收集2005年1月至2016年8月在我院接受RNU治疗的857例患者的数据。泌尿生殖病理学家对病理切片进行了复查。采用倾向评分加权法进行数据分析。
212例患者（24.7%）观察到无蒂生长模式。肿瘤结构与膀胱癌病史、慢性肾脏病（CKD）、肿瘤分期、淋巴结状态、组织学分级、淋巴管浸润、伴发癌及变异类型显著相关[加权前所有变量的标准化均值差（SMD）>0.1]。在倾向评分分析中，对424例乳头状和无蒂肿瘤结构进行分析以平衡组间基线特征。肿瘤结构是转移疾病和CSS的独立预测因素（分别为p = 0.033和p = 0.002）。然而，肿瘤结构与膀胱和对侧复发的关联不显著（分别为p = 0.956和p = 0.844）。
RNU术后UTUC的肿瘤结构与侵袭性疾病的既定特征以及转移和CSS的预测因素相关。评估肿瘤结构可能有助于识别RNU术后可能从密切随访或早期全身治疗中获益的患者。在进一步确认后，肿瘤结构应纳入UTUC分期。
