Tumour architecture is an independent predictor of outcomes after nephroureterectomy: a multi-institutional analysis of 1363 patients.
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.


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).


CONCLUSIONS
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.
Remzi
Mesut
M
Medical University of Vienna, Vienna, Austria.
Haitel
Andrea
A
Margulis
Vitaly
V
Karakiewicz
Pierre
P
Karakiewizc
Pierre
P
Montorsi
Francesco
F
Kikuchi
Eiji
E
Zigeuner
Richard
R
Weizer
Alon
A
Bolenz
Christian
C
Bensalah
Karim
K
Suardi
Nazareno
N
Raman
Jay D
JD
Lotan
Yair
Y
Waldert
Matthias
M
Ng
Casey K
CK
Fernández
Mario
M
Koppie
Theresa M
TM
Ströbel
Philipp
P
Kabbani
Wareef
W
Murai
Masaru
M
Langner
Cord
C
Roscigno
Marco
M
Wheat
Jeffrey
J
Guo
Charles C
CC
Wood
Christopher G
CG
Shariat
Shahrokh F
SF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014571:Urologic Neoplasms / Q000473:pathology* / Q000601:surgery