Tumour architecture is an independent predictor of outcomes after nephroureterectomy: a multi‐institutional analysis of 1363 patients
Open Access
- 16 January 2009
- journal article
- research article
- Published by Wiley in BJU International
- Vol. 103 (3), 307-311
- https://doi.org/10.1111/j.1464-410x.2008.08003.x
Abstract
OBJECTIVE 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. PATIENTS AND METHODS 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. RESULTS 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). CONCLUSION 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.Keywords
This publication has 12 references indexed in Scilit:
- Independent predictors of cancer‐specific survival in transitional cell carcinoma of the upper urinary tractCancer, 2007
- 794 MID-TERM FOLLOW UP (5 YEARS) OF LAPAROSCOPIC NEPHROURETERECTOMY COMPARED TO OPEN NEPHROURETERECTOMY FOR UPPER URINARY TRACT TRANSITIONAL CELL CANCEREuropean Urology Supplements, 2007
- Patterns of invasion and histological growth as prognostic indicators in urothelial carcinoma of the upper urinary tractVirchows Archiv A Pathological Anatomy and Histopathology, 2006
- Reproducibility and Prognostic Variability of Grade and Lamina Propria Invasion in Stages Ta, T1 Urothelial Carcinoma of the BladderJournal of Urology, 2003
- Grading the Invasive Component of Urothelial Carcinoma of the Bladder and Its Relationship With Progression-Free SurvivalThe American Journal of Surgical Pathology, 2000
- Clinical significance of interobserver differences in the staging and grading of superficial bladder cancerBJU International, 2000
- The World Health Organization/International Society of Urological Pathology Consensus Classification of Urothelial (Transitional Cell) Neoplasms of the Urinary BladderThe American Journal of Surgical Pathology, 1998
- MULTIVARIABLE PROGNOSTIC MODELS: ISSUES IN DEVELOPING MODELS, EVALUATING ASSUMPTIONS AND ADEQUACY, AND MEASURING AND REDUCING ERRORSStatistics in Medicine, 1996
- Renal pelvic cancer: A review of 611 patients treated in Illinois 1975–1985Urology, 1992