Prognostic implication of infiltrative growth pattern and establishment of novel risk stratification model for survival in patients with upper urinary tract urothelial carcinoma

• Published in: International journal of clinical oncology Vol. 19; no. 2; pp. 373 - 378
• Main Authors: Hashimoto, Takeshi, Nakashima, Jun, Inoue, Rie, Gondo, Tatsuo, Ohno, Yoshio, Tachibana, Masaaki
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.04.2014; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Bladder cancer; Cancer Research; Female; Humans; Lymphatic Metastasis; Lymphatic system; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Nephrectomy; Oncology; Original Article; Prognosis; Proportional Hazards Models; Risk factors; Surgical Oncology; Survival analysis; Ureter - surgery; Urologic Neoplasms - mortality; Urologic Neoplasms - pathology; Urologic Neoplasms - surgery; Infiltrative growth pattern; Prognostic factor; Upper urinary tract urothelial carcinoma; Lymph node involvement; Pathological tumor grade
• ISSN: 1341-9625; 1437-7772
• DOI: 10.1007/s10147-013-0548-3

Purpose To investigate the prognostic significance of infiltrative growth pattern (INF) and to develop a novel risk stratification model for disease-specific survival (DSS) in patients with upper urinary tract urothelial carcinoma (UTUC). Methods This study included 113 patients with UTUC treated with radical nephroureterectomy. Pathological features, including INF, were compared with DSS. INF was classified into 3 patterns (INFa, INFb, and INFc). The prognostic factors of DSS were evaluated with univariate and multivariate Cox proportional hazard model analyses. A risk stratification model based on the relative risks of DSS was then established. Result Univariate analysis revealed that patients with high-grade tumor, pathological T stage ≥T3, a non-expanding infiltration pattern (INF ≥b), sessile-type carcinoma, the presence of lymphovascular invasion and positive lymph node involvement showed significantly lower survival rates than their respective counterparts. In the multivariate analysis, high grade tumor, positive lymph node involvement and INF ≥b were independent predictors for DSS ( p  < 0.05). The patients were stratified into 3 risk groups. The 5-year DSS rates were 94.4 % in the low-risk group, 67.5 % in the intermediate-risk group and 20.5 % in the high-risk group. Conclusion In addition to lymph node involvement and pathological tumor grade, INF is a novel independent prognostic factor in patients with UTUC treated with radical nephroureterectomy. Our risk stratification model developed using these 3 factors may help clinicians identify patients with a poor prognosis who might be good candidates for clinical trials of innovative therapies.