Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan.
Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Sci Rep. 2024 Aug 23;14(1):19633. doi: 10.1038/s41598-024-70785-w.
The prognostic value of central pathology review in upper urinary tract cancer (UTUC) remains inadequately addressed in existing literature. In this study, we conducted an extensive central pathology review and presented its influence on multi-center UTUC studies. We conducted a retrospective review of patients who underwent radical nephroureterectomy or segmental resection for UTUC to determine eligibility for central pathology review. In the Taiwan UTUC Collaboration cohort, 377 cases met the criteria for pathology review. We assessed agreement between pathologists using both the total percentage of agreement and simple kappa statistics. The prognostic implications of original and review pathology for various parameters were examined using the Cox regression model. This study included 209 female and 168 male participants. Pathology review revealed substantial interobserver variability in pT staging, with a particularly high rate of pT2 cases being upgraded to pT3 upon central review (17/70 pT2 stage made by local pathologists were finally confirmed as pT3 disease by the review pathologist). The local pathologist cohort identified fewer significant histological predictors in survival models compared to the review pathology cohort. Advanced pT stage, perineural invasion (PNI), and positive surgical margin were independent predictors of poorer overall survival and cancer-specific survival. PNI, lymphatic vascular invasion, and positive surgical margin were independent predictors of disease recurrence. Substantial interobserver variability in histological assessment underscores the importance of centralized pathology review for both multi-center studies and accurate post-operative management of UTUC patients. Advanced stage, perineural invasion, and margin status were significant histological predictors of oncological outcomes.
中央病理学审查在上尿路尿路上皮癌（UTUC）中的预后价值在现有文献中仍未得到充分解决。在这项研究中，我们进行了广泛的中央病理学审查，并展示了其对多中心 UTUC 研究的影响。我们对接受根治性肾输尿管切除术或节段切除术治疗 UTUC 的患者进行了回顾性审查，以确定是否有资格进行中央病理学审查。在台湾 UTUC 协作队列中，有 377 例符合病理审查标准。我们使用总一致性百分比和简单 kappa 统计来评估病理学家之间的一致性。使用 Cox 回归模型检查原始和审查病理学对各种参数的预后意义。本研究包括 209 名女性和 168 名男性参与者。病理学审查显示 pT 分期存在明显的观察者间变异性，尤其是局部病理学家诊断为 pT2 期的病例中有相当高的比例在中央审查后升级为 pT3 期（70 例局部病理学家诊断为 pT2 期的病例中，有 17 例最终被审查病理学家确认为 pT3 期疾病）。与审查病理学队列相比，局部病理学家队列在生存模型中确定的显著组织学预测因素较少。高级 pT 分期、神经周围侵犯（PNI）和阳性手术切缘是总生存率和癌症特异性生存率较差的独立预测因素。PNI、淋巴血管侵犯和阳性手术切缘是疾病复发的独立预测因素。组织学评估存在明显的观察者间变异性，强调了中央病理学审查对于多中心研究和 UTUC 患者术后管理的重要性。高级别分期、PNI 和切缘状态是肿瘤学结果的重要组织学预测因素。
