title: Subclassification of pT3 urothelial carcinoma of the renal pelvicalyceal system is associated with recurrence-free and cancer-specific survival: proposal for a revision of the current TNM classification.
abstract: BACKGROUND
  The clinical course of pT3 upper tract urothelial carcinoma (UTUC) is highly variable.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  METHODS
  RNU.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Brady Urologic Health Center, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York 10065, USA. sfshariat@gmail.com
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Michael
authors.initials: M
authors.lastname: Rink
authors.forename: Vitaly
authors.initials: V
authors.lastname: Margulis
authors.forename: Jens
authors.initials: J
authors.lastname: Hansen
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Jay D
authors.initials: JD
authors.lastname: Raman
authors.forename: Mesut
authors.initials: M
authors.lastname: Remzi
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Koppie
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Charles C
authors.initials: CC
authors.lastname: Guo
authors.forename: Shuji
authors.initials: S
authors.lastname: Mikami
authors.forename: Kanishka
authors.initials: K
authors.lastname: Sircar
authors.forename: Casey K
authors.initials: CK
authors.lastname: Ng
authors.forename: Andrea
authors.initials: A
authors.lastname: Haitel
authors.forename: Wareef
authors.initials: W
authors.lastname: Kabbani
authors.forename: Felix K
authors.initials: FK
authors.lastname: Chun
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Scherr
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Cord
authors.initials: C
authors.lastname: Langner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000145:classification* / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000145:classification* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D019459:Urothelium / Q000473:pathology*