- 作者：Shahrokh F. Shariat ; Richard Zigeuner ; Michael Rink ; Vitaly Margulis ; Jens Hansen ; Eiji Kikuchi ; Wassim Kassouf ; Jay D. Raman ; Mesut Remzi ; Theresa M. Koppie ; Karim Bensalah ; Charles C. Guo ; Shuji Mikami ; Kanishka Sircar ; Casey K. Ng ; Andrea Haitel ; Wareef Kabbani ; Felix K. Chun ; Christopher G. Wood ; Douglas S. Scherr ; et al.
- 关键词：Urothelial carcinoma ; Upper urinary tract ; Renal pelvicalyceal system ; TNM classification ; pT3 subclassification ; Prognosis
- 刊名：European Urology
- 出版年：2012
- 出版时间：August, 2012
- 年：2012
- 卷：62
- 期：2
- 页码：224-231
- 全文大小：970 K
Background
The clinical course of pT3 upper tract urothelial carcinoma (UTUC) is highly variable.Objectives
The aim of the current study was to validate the clinical and prognostic importance of pT3 subclassification in the renal pelvicalyceal system in a large international cohort of patients.
Design, setting, and participants
From a multi-institutional international database, 858 renal pelvicalyceal tumors treated with radical nephroureterectomy (RNU) were systematically reevaluated by genitourinary pathologists. Category pT3 pelvic tumors were categorized as pT3a (infiltration of the renal parenchyma on a microscopic level only) versus pT3b (macroscopic infiltration of the renal parenchyma and/or infiltration of peripelvic adipose tissue).
Intervention
RNU.
Measurements
Associations of pT3 subclassifications with clinicopathologic features were assessed with the chi-square test. Prognostic impact was assessed with the log-rank test and multivariable Cox regression analyses.
Results and limitations
Of 858 patients with renal pelvicalyceal tumors, 266 (31 % ) had pT3 disease. Of these, 146 (54.9 % ) were classified as pT3a and 120 (45.1 % ) as pT3b. Compared with pT3a, pT3b cancers were associated with higher tumor grade, nodal disease, and tumor necrosis. Ten-year recurrence-free (pT3a 58 % vs pT3b 38 % ; p < 0.001) and cancer-specific (pT3a 60 % vs pT3b 39 % ; p = 0.002) survival rates were lower for patients with pT3b disease. In multivariable analyses, classification pT3b was an independent predictor of both disease recurrence (hazard ratio [HR]: 1.8, p = 0.003) and cancer-specific mortality (HR: 1.7; p = 0.02). The major limitation is the retrospective character of the study.
Conclusions
Subclassification of pT3 renal pelvicalyceal UTUC helps identify patients who are at increased risk of disease progression and cancer-related death. Further research may help assess the value of subclassification and its inclusion in future editions of the American Joint Committee on Cancer-International Union Against Cancer TNM classification system.