title: Tumour architecture is an independent predictor of outcomes after nephroureterectomy: a multi-institutional analysis of 1363 patients.
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.
  
  
  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.
authors.affiliation: Medical University of Vienna, Vienna, Austria.
authors.forename: Mesut
authors.initials: M
authors.lastname: Remzi
authors.forename: Andrea
authors.initials: A
authors.lastname: Haitel
authors.forename: Vitaly
authors.initials: V
authors.lastname: Margulis
authors.forename: Pierre
authors.initials: P
authors.lastname: Karakiewicz
authors.forename: Pierre
authors.initials: P
authors.lastname: Karakiewizc
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Alon
authors.initials: A
authors.lastname: Weizer
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.forename: Jay D
authors.initials: JD
authors.lastname: Raman
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Matthias
authors.initials: M
authors.lastname: Waldert
authors.forename: Casey K
authors.initials: CK
authors.lastname: Ng
authors.forename: Mario
authors.initials: M
authors.lastname: Fernández
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Koppie
authors.forename: Philipp
authors.initials: P
authors.lastname: Ströbel
authors.forename: Wareef
authors.initials: W
authors.lastname: Kabbani
authors.forename: Masaru
authors.initials: M
authors.lastname: Murai
authors.forename: Cord
authors.initials: C
authors.lastname: Langner
authors.forename: Marco
authors.initials: M
authors.lastname: Roscigno
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wheat
authors.forename: Charles C
authors.initials: CC
authors.lastname: Guo
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: 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