title: Impact of micropapillary histological variant on survival after radical nephroureterectomy for upper tract urothelial carcinoma.
abstract: OBJECTIVE
  To assess the impact of micropapillary histological variant on oncological outcome after radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinomas (UTUCs).
  
  
  METHODS
  A French multicenter retrospective study was performed on patients who underwent RNU between 1995 and 2010. Pathological reports were reviewed to identify patients with pure urothelial carcinomas (PUC) and those with micropapillary histological variant (MPC). Uni- and multivariate Cox regression analyses were performed to identify factors predictive of survival.
  
  
  RESULTS
  Overall, 519 patients were included and divided into two groups: 480 PUC and 39 MPC. Median follow-up were 28 and 19 months, respectively (p = 0.63). There was no difference between the two groups for gender, age and tumor location (pelvicalyceal or ureteral). MPC was associated with high-stage and high-grade UTUC (p < 0.001 and 0.04). No difference was observed between the two groups for 5-year cancer-specific survival (76.1 vs. 88.2 %; p = 0.54). The 5-year metastasis-free survival was significantly lower in the MPC group (48.9 vs. 73.8 %; p = 0.037). In multivariate analysis, pT stage, lymphovascular invasion, margin status and adjuvant chemotherapy administration were independent predictors of specific survival (p = 0.002; 0.001; 0.02; 0.01), contrary to histological variant (p = 0.94).
  
  
  CONCLUSIONS
  Micropapillary histological variant was associated with advanced UTUC and reduced metastasis-free survival after RNU. It should be considered as an aggressive tumor and thus be stated in any pathological report after radical surgery.
authors.affiliation: Department of Urology, Henri Mondor Academic Hospital, Paris Est Creteil University, Créteil, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Masson-Lecomte
authors.forename: Pierre
authors.initials: P
authors.lastname: Colin
authors.forename: Gregory
authors.initials: G
authors.lastname: Bozzini
authors.forename: Laurent
authors.initials: L
authors.lastname: Nison
authors.forename: Alexandre
authors.initials: A
authors.lastname: de La Taille
authors.forename: Eva
authors.initials: E
authors.lastname: Comperat
authors.forename: Marc
authors.initials: M
authors.lastname: Zerbib
authors.forename: François
authors.initials: F
authors.lastname: Rozet
authors.forename: Xavier
authors.initials: X
authors.lastname: Cathelineau
authors.forename: Antoine
authors.initials: A
authors.lastname: Valeri
authors.forename: Alain
authors.initials: A
authors.lastname: Ruffion
authors.forename: Laurent
authors.initials: L
authors.lastname: Guy
authors.forename: Stéphane
authors.initials: S
authors.lastname: Droupy
authors.forename: Olivier
authors.initials: O
authors.lastname: Cussenot
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D007682:Kidney Pelvis / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000601:surgery; D009392:Nephrectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D014513:Ureter / Q000473:pathology* / Q000601:surgery; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery
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