Squamous differentiation and prognosis in upper urinary tract urothelial carcinoma.
Squamous differentiation is the most common histological variation in urothelial carcinoma (UC). However, the clinical significance of squamous differentiation in upper urinary tract UC is unclear. To investigate the significance of squamous differentiation, hematoxylin and eosin stained slides from 140 patients with upper urinary tract UC who underwent nephroureterectomy were reviewed by a single pathologist and the presence of squamous differentiation was recorded. Squamous differentiation was observed in 23 out of 140 studied cases (16%). Squamous differentiation significantly correlated with several adverse prognostic factors including histological grade 3 tumors, presence of lymphovascular invasion, concomitant carcinoma in situ, advanced tumor stage, and occurrence of lymph node metastasis. The Kaplan-Meier and univariate Cox regression analyses revealed that the presence of squamous differentiation was significantly associated with shorter metastasis-free survival [log-rank P = 0.030; univariate hazard ratio (HR), 2.30; 95% confidence interval (CI), 1.06-4.99], cancer-specific survival (log-rank P = 0.0024; univariate HR 3.34; 95% CI, 1.47-7.85), and overall survival (log-rank P = 0.018; univariate HR 2.39; 95% CI, 1.13-5.06) after nephroureterectomy. However, in multivariate analyses, squamous differentiation was not significantly associated with patient outcomes. These findings suggest that squamous differentiation is associated with disease progression, but is not an independent predictor of a worse prognosis in patients with upper urinary tract UC.
Department of Pathology, Graduate School of Medicine, The University of Tokyo Tokyo, Japan.
Naohiro
N
Makise
Department of Pathology, Graduate School of Medicine, The University of Tokyo Tokyo, Japan.
Teppei
T
Morikawa
Department of Urology, Graduate School of Medicine, The University of Tokyo Tokyo, Japan.
Taketo
T
Kawai
Department of Urology, Graduate School of Medicine, The University of Tokyo Tokyo, Japan.
Tohru
T
Nakagawa
Department of Urology, Graduate School of Medicine, The University of Tokyo Tokyo, Japan.
Haruki
H
Kume
Department of Urology, Graduate School of Medicine, The University of Tokyo Tokyo, Japan.
Yukio
Y
Homma
Department of Pathology, Graduate School of Medicine, The University of Tokyo Tokyo, Japan.
Masashi
M
Fukayama
D000368:Aged; D001706:Biopsy; D002454:Cell Differentiation; D016009:Chi-Square Distribution; D018450:Disease Progression; D018572:Disease-Free Survival; D004847:Epithelial Cells / Q000473:pathology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018307:Neoplasms, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D019459:Urothelium / Q000473:pathology* / Q000601:surgery
Cancer; histology; pathology; prognostic marker; renal pelvis; ureter