title: Tumor necrosis as prognostic indicator in transitional cell carcinoma of the upper urinary tract.
abstract: OBJECTIVE
  The clinicopathological features predictive of outcome in patients with upper urinary tract transitional cell carcinoma are not clearly established. We analyzed the prognostic impact of tumor necrosis with respect to metastasis-free survival.
  
  
  METHODS
  The presence of focal (10% or less of the tumor area) and extensive (greater than 10% of the tumor area) coagulative tumor necrosis was retrospectively reevaluated in 268 cases of consecutive upper urinary tract transitional cell carcinoma and correlated with outcome.
  
  
  RESULTS
  Overall tumor necrosis was noted in 113 of 268 (42.2%) cases of transitional cell carcinoma with 63 (23.5%) showing focal and 50 (18.7%) showing extensive necrosis, respectively. Tumor necrosis was associated with high tumor stage (p <0.001) and high tumor grade (p <0.001). In addition, tumor necrosis was more common in pelvic tumors compared with ureteral tumors (p <0.001). Actuarial 5-year metastasis-free survival rates for patients with transitional cell carcinoma with extensive, focal and lacking necrosis were 24%, 45% and 78%, respectively (log rank test p <0.001). Multivariate analysis proved pT stage greater than 1 (p <0.001, RR 6.04, 95% CI 2.82-12.93), high tumor grade (p <0.001, RR 3.37, 95% CI 1.65-6.89) and extensive tumor necrosis as independent predictors of poor patient outcome (p = 0.02, RR 1.82, 95% CI 1.09-3.05).
  
  
  CONCLUSIONS
  The presence of extensive tumor necrosis proved to be an additional histological variable with an independent influence on metastasis-free survival in patients with upper urinary tract transitional cell carcinoma. Its assessment is readily applicable in routine sections and should thus be commented upon separately in the pathology report.
authors.affiliation: Institute of Pathology, Medical University Graz, Auenbruggerplatz 25, A-8036 Graz, Austria. cord.langner@medunigraz.at
authors.forename: Cord
authors.initials: C
authors.lastname: Langner
authors.forename: Georg
authors.initials: G
authors.lastname: Hutterer
authors.forename: Thomas
authors.initials: T
authors.lastname: Chromecki
authors.forename: Sebastian
authors.initials: S
authors.lastname: Leibl
authors.forename: Peter
authors.initials: P
authors.lastname: Rehak
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011379:Prognosis; D012189:Retrospective Studies; D014516:Ureteral Neoplasms / Q000473:pathology*