Tumour Necrosis Is an Indicator of Aggressive Biology in Patients with Urothelial Carcinoma of the Upper Urinary Tract
Tumour Necrosis Is an Indicator of Aggressive Biology in Patients with Urothelial Carcinoma of the Upper Urinary Tract
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DOI：
10.1016/j.eururo.2009.11.035
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发表时间：
2010-04-01
期刊：
影响因子：
23.4
通讯作者：
Langner, Cord
中科院分区：
文献类型：
--
作者：
Zigeuner, Richard;Shariat, Shahrokh F.;Langner, Cord
背景资料：根治性肾输尿管切除术（RNU）治疗上尿路上皮癌（UTUC）后的预后因素尚不确定，因为文献中的大多数数据都来自于小样本研究。目的：评估一个大型国际研究系列中接受RNU治疗的患者的肿瘤坏死与癌症复发和生存的关系。设计、设置和参与者：数据收集自13个中心的1425例接受RNU治疗的患者，并合并到一个关系数据库中。病理切片由泌尿生殖道病理学家根据严格的标准重新审查。广泛的肿瘤坏死评分为> 10%的肿瘤area.Intervention：患者接受开放或腹腔镜RNU。淋巴结清扫术中存在的扩大nodes.Measurements：复发被定义为肿瘤复发的手术领域，淋巴结（LN）转移，和/或远处转移。未考虑膀胱复发。通过单变量和多变量分析评估广泛肿瘤坏死与无复发生存率和癌症特异性生存率的关系。364例患者观察到广泛的肿瘤坏死（25.5%），并与晚期肿瘤分期、高肿瘤分级、无蒂结构、淋巴血管浸润（LVI）、伴随原位癌，和LN转移（p均< 0.0001）。在调整了病理分期、分级、LVI和LN状态的影响后，广泛的肿瘤坏死与疾病复发和生存独立相关（分别为p = 0.037和p = 0.046）。除了广泛的肿瘤坏死的基础模型，包括标准的病理预测略有提高其预测准确性的癌症特异性复发（1.5%）和生存（1.4%）。结论：广泛的肿瘤坏死是一个独立的预测临床结果的患者接受RNU的UTUC。肿瘤坏死的评估可能有助于确定哪些患者在未来的RNU后可以从多模式治疗中受益。广泛肿瘤坏死的评估应作为标准病理报告的一部分。(c)2009年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
Background: Prognostic factors after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) are inconclusive, because most data in the literature have been obtained from small series.Objective: To assess the association of tumour necrosis with cancer recurrence and survival in a large international series of patients treated with RNU.Design, setting, and participants: Data were collected from 1425 patients treated with RNU at 13 centres and combined into a relational database. Pathologic slides were re-reviewed by genitourinary pathologists according to strict criteria. Extensive tumour necrosis was scored as > 10% of the tumour area.Intervention: Patients underwent either open or laparoscopic RNU. Lymph node dissection was performed in the presence of enlarged nodes.Measurements: Recurrence was defined as tumour relapse in the operative field, lymph node (LN) metastasis, and/or distant metastases. Bladder recurrences were not considered. Associations of extensive tumour necrosis with recurrence-free survival and cancer-specific survival were evaluated by univariate and multivariate analyses.Results and limitations: Extensive tumour necrosis was observed in 364 patients (25.5%) and was associated with advanced tumour stage, high tumour grade, sessile architecture, lymphovascular invasion (LVI), concomitant carcinoma in situ, and LN metastasis (p < 0.0001 each). Extensive tumour necrosis was independently associated with disease recurrence and survival (p = 0.037 and p = 0.046, respectively) after adjusting for the effects of pathologic stage, grade, LVI, and LN status. The addition of extensive tumour necrosis to a base model comprising standard pathologic predictors marginally improved its predictive accuracy for both cancer-specific recurrence (1.5%) and survival (1.4%).Conclusions: Extensive tumour necrosis is an independent predictor of clinical outcomes in patients who undergo RNU for UTUC. Assessment of tumour necrosis may help to identify patients who could benefit from multimodal therapy after RNU in the future. Evaluation of extensive tumour necrosis should be part of standard pathologic reporting. (c) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.