Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio 43201, USA.
Department of Urology, The Ohio State University Wexner Medical Center, Columbus, Ohio 43201, USA.
Hum Pathol. 2022 Jul;125:79-86. doi: 10.1016/j.humpath.2022.03.004. Epub 2022 Mar 17.
The American Joint Cancer Committee pT categorization in renal pelvic carcinoma defines pT3 as invasion of renal parenchyma, invasion of peripelvic fat, or both. However, survival heterogeneity within the pT3 category has been demonstrated. This investigation sought to compare survival between pT categories of renal pelvic urothelial carcinoma and identify modifications to improve correlation with survival. Pathology reports from nephroureterectomies performed at our institution from 2010 to 2019 were analyzed to identify primary renal pelvic urothelial carcinoma (n = 146). Tumors were stratified based on pT, pN, and invasion of renal parenchyma vs invasion of peripelvic fat with or without renal parenchyma invasion. Kaplan-Meier survival curves and Cox regression multivariate analysis were used to compare overall survival between groups. Similar survival curves were observed for pT2 and pT3 tumors. Multivariate analysis confirmed overlapping hazard ratios (HRs) for pT2 (HR = 2.64, 95% confidence interval [CI] = 0.69, 10.06) and pT3 (HR = 4.42, 95% CI = 2.08, 9.37). pT3 tumors with peripelvic fat invasion, regardless of renal parenchyma involvement, had a 3.3-fold worse overall survival than pT3 tumors with only renal parenchyma involvement. Additionally, pT3 tumors with only renal parenchyma invasion had similar survival compared to pT2, while pT3 tumors with peripelvic fat invasion had worse overall survival (p = 0.00091). Reclassifying renal parenchyma invasion as pT2 yielded greater survival curve separation and greater difference in HRs. For renal pelvic urothelial carcinoma, modifying the pT3 category to only include tumors with peripelvic fat invasion and expanding the pT2 category to include renal parenchyma invasion may improve pT correlation with overall survival.
美国癌症联合委员会（AJCC）的肾孟癌 pT 分类将 pT3 定义为肾实质侵犯、肾盂周脂肪侵犯或两者兼有。然而，pT3 类别中的生存异质性已经得到证实。本研究旨在比较肾盂尿路上皮癌各 pT 类别之间的生存情况，并确定改良方法以提高与生存的相关性。分析了 2010 年至 2019 年在本机构行肾输尿管切除术的患者的病理报告，以确定原发性肾盂尿路上皮癌（n=146）。根据 pT、pN 以及肾实质侵犯或肾实质合并肾盂周脂肪侵犯，对肿瘤进行分层。使用 Kaplan-Meier 生存曲线和 Cox 回归多变量分析比较各组的总生存率。pT2 和 pT3 肿瘤的生存曲线相似。多变量分析证实 pT2（危险比 [HR]=2.64，95%置信区间 [CI]：0.69-10.06）和 pT3（HR=4.42，95%CI：2.08-9.37）的危险比重叠。无论肾实质是否受累，仅伴有肾盂周脂肪侵犯的 pT3 肿瘤的总生存率比仅伴有肾实质侵犯的 pT3 肿瘤差 3.3 倍。此外，仅肾实质侵犯的 pT3 肿瘤的生存情况与 pT2 相似，而伴有肾盂周脂肪侵犯的 pT3 肿瘤的总生存率较差（p=0.00091）。将肾实质侵犯重新分类为 pT2 可使生存曲线分离度更大，HR 差异更大。对于肾盂尿路上皮癌，仅将伴有肾盂周脂肪侵犯的肿瘤归入 pT3 类别，并将伴有肾实质侵犯的肿瘤归入 pT2 类别，可能会提高 pT 与总生存率的相关性。
