Tumour architecture is an independent predictor of outcomes after nephroureterectomy: a multi-institutional analysis of 1363 patients
Tumour architecture is an independent predictor of outcomes after nephroureterectomy: a multi-institutional analysis of 1363 patients
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DOI：
10.1111/j.1464-410x.2008.08003.x
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发表时间：
2009-02-01
影响因子：
4.5
通讯作者：
Shariat, Shahrokh F.
中科院分区：
文献类型：
--
作者：
Remzi, Mesut;Haitel, Andrea;Shariat, Shahrokh F.
为了评估肿瘤结构是否有助于改善上尿路尿路上皮癌（UC）患者接受肾输尿管切除术（NU）治疗的预后，因为肿瘤结构（乳头状与无蒂）在UTUC中的预后价值仍然难以捉摸。该研究包括全球12个中心的1363例UTUC患者，并接受根治性NU治疗。所有切片均由不了解原始病理切片结果和临床结局的泌尿生殖病理学家根据严格标准重新审查。大体肿瘤结构分为无蒂和乳头状，983例（72.2%）为乳头状生长，380例（27.8%）为无蒂生长。无蒂生长方式与肿瘤分级、分期、淋巴管浸润和淋巴结转移有关（P均< 0.001）。在多变量考克斯回归分析中，调整了病理分期、分级和淋巴结状态的影响，肿瘤结构（无蒂或乳头状）是癌症复发（风险比1.5，P = 0.002）和癌症特异性死亡率（1.6，P = 0.001）的独立预测因子。添加肿瘤结构增加了模型的预测准确性，该模型包括病理分期、分级和淋巴结状态，用于预测癌症复发和癌症特异性死亡，其范围最小但具有统计学显著性（预测准确性增加1%和0.5%，均P < 0.001）UTUC的肿瘤结构与生物侵袭性疾病的既定特征相关，更重要的是，与根治性NU后的预后有关。应考虑将肿瘤结构纳入疾病进展的预测模型，旨在确定可能受益于早期全身治疗干预的患者。
To assess whether tumour architecture can help to refine the prognosis of patients treated with nephroureterectomy (NU) for urothelial carcinoma (UC) of the upper urinary tract (UT), as the prognostic value of tumour architecture (papillary vs sessile) in UTUC remains elusive.The study included 1363 patients with UTUC and treated with radical NU at 12 centres worldwide. All slides were re-reviewed according to strict criteria by genitourinary pathologists who were unaware of the findings of the original pathology slides and clinical outcomes. Gross tumour architecture was categorized as sessile vs papillary.Papillary growth was identified in 983 patients (72.2%) and sessile growth in 380 (27.8%). The sessile growth pattern was associated with higher tumour grade, more advanced stage, lymphovascular invasion, and metastasis to lymph nodes (all P < 0.001). In multivariable Cox regression analyses that adjusted for the effects of pathological stage, grade and lymph node status, tumour architecture (sessile or papillary) was an independent predictor of cancer recurrence (hazard ratio 1.5, P = 0.002) and cancer-specific mortality (1.6, P = 0.001). Adding tumour architecture increased the predictive accuracy of a model that comprised pathological stage, grade and lymph node status for predicting cancer recurrence and cancer-specific death by a minimal but statistically significant margin (gain in predictive accuracy 1% and 0.5%, both P < 0.001).The tumour architecture of UTUC is associated with established features of biologically aggressive disease, and more importantly, with prognosis after radical NU. Including tumour architecture in predictive models for disease progression should be considered, aiming to identify patients who might benefit from early systemic therapeutic intervention.