Abstract
PurposeTo assess the association of tumor architecture with cancer recurrence, metastasis, and cancer-specific survival (CSS) in patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC) in Taiwan.Materials and MethodsData were collected from 857 patients treated with RNU between January 2005 and August 2016 in our hospital. Pathologic slides were reviewed by genitourinary pathologists. Propensity score weighting was performed for data analysis.ResultsSessile growth pattern was observed in 212 patients (24.7%). Tumor architecture exhibited a significant association with bladder cancer history, chronic kidney disease (CKD), tumor stage, lymph node status, histological grade, lymphovascular invasion, concomitant carcinoma in situ, and the variant type [standardized mean difference (SMD) > 0.1 for all variables before weighting]. In the propensity score analysis, 424 papillary and sessile tumor architecture were analyzed to balance the baseline characteristics between the groups. Tumor architecture was an independent predictor of metastatic disease and CSS (p = 0.033 and p = 0.002, respectively). However, the associations of tumor architecture with bladder and contralateral recurrence were nonsignificant (p = 0.956 and p = 0.844, respectively).ConclusionsTumor architecture of UTUC after RNU is associated with established features of aggressive disease and predictors of metastasis and CSS. Assessment of tumor architecture may help identify patients who could benefit from close follow-up or early administration of systemic therapy after RNU. Tumor architecture should be included in UTUC staging after further confirmation.
Highlights
Upper urinary tract urothelial carcinoma (UTUC), referred to as renal pelvic and ureteral tumors, comprises approximately 5% of all urothelial tumors and 10% of renal tumors [1,2,3,4,5,6,7]
The sessile tumor architecture has been reported to be a predictor of poor outcomes in patients with bladder urothelial carcinoma (UC), and several studies have investigated the significance of tumor architecture in patients with UTUC [3, 5, 6]. Recognising these limitations, we report a large series from Taiwan, an endemic area of UTUC, to assess whether tumor architecture could be a valuable parameter for refining the prognosis of patients with UTUC
The present study demonstrated that factors associated with the probability of tumor recurrence and death among patients with UTUC include pathological stage, histological grade, tumor architecture, lymphovascular invasion (LVI), and lymph node status [2, 3, 8, 9, 21]
Summary
Upper urinary tract urothelial carcinoma (UTUC), referred to as renal pelvic and ureteral tumors, comprises approximately 5% of all urothelial tumors and 10% of renal tumors [1,2,3,4,5,6,7]. The incidence and disease presentation of UTUCs in the Asian population, in Taiwan, differ from those in the Western population [9,10,11,12]. UTUC accounts for 20%– 30% of urothelial tumors and is more common in Asian than in Western populations [9, 12]. UTUCs are more common in female than in male patients [9, 12, 13]. In Asian countries, female patients with UTUC are less likely to develop late stage, large-sized tumor, and lymph node metastasis (LNM) than male patients, whereas this difference is not observed in Western countries [9]
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