Is pT3 urothelial carcinoma of the renal pelvis a homogeneous disease entity? Proposal for a new subcategory of the pT3 classification.
OBJECTIVE
The prognosis of urothelial carcinoma of the renal pelvis (UCRP) is heterogeneous, especially in pT3 patients. The degree of tumour parenchymal invasion is not considered for pathological tumour (pT) staging. The aim of this study was to investigate whether quantitative assessment of invasion provides a better estimation of prognosis for UCRP in pT3 patients.


RESULTS
We reclassified pT3 cases into two subcategories: pT3a, in which UCRP extended only into the renal medulla; and pT3b, in which UCRP extended into the renal cortex and/or in which UCRP exhibited peripelvic fat invasion. We examined our proposed pT classification and other pathological parameters, including necrosis, lymph-vascular invasion (LVI), 1973 World Health Organization (WHO) grading, WHO/International Society of Urological Pathology grading, adjuvant chemotherapy, and pathological lymph node metastasis (pN). The study included 275 patients. Among 96 patients with pT3, there was a statistically significant difference between the pT3a and pT3b subcategories in cancer-specific survival (P < 0.001). Our proposed pT classification, as well as necrosis, LVI, 1973 WHO grading, and pN, demonstrated prognostic differences in univariate analysis, whereas in multivariate analysis, only our proposed classification (P = 0.008) and pN (P = 0.002) were statistically significant.


CONCLUSIONS
The pT3b subcategories should be regarded as true pT3, having the established features of that stage, whereas pT3a has a better prognosis.
Department of Urology, Graduate School of Medicine, Nagoya UniversityDepartment of Pathology, Nagoya Daini Red Cross Hospital, NagoyaDepartment of Urology, Komaki City Hospital, KomakiDepartment of Urology, Okazaki City Hospital, Okazaki, AichiDepartment of Urology, Chukyo HospitalDepartment of Urology, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
Naoto
N
Sassa
Toyonori
T
Tsuzuki
Akitoshi
A
Fukatsu
Tsuyoshi
T
Majima
Tohoru
T
Kimura
Toshinori
T
Nishikimi
Yasushi
Y
Yoshino
Ryohei
R
Hattori
Momokazu
M
Gotoh
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000145:classification* / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000145:classification* / Q000401:mortality / Q000473:pathology*; D007682:Kidney Pelvis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*