腫瘤結構對上尿路尿路上皮癌的預後影響：傾向評分加權分析

劉惠瑛¹、陳彥達¹、黃純真²、王弘仁¹、鄭元佐¹、康智雄¹、李維菁¹、蘇祐立³、黃俊杰⁴、張殷綸¹、莊燿吉¹、羅浩倫¹、江博暉¹

¹高雄長庚泌尿科  ²高雄長庚病理科  ³高雄長庚血液腫瘤科  ⁴高雄長庚放射腫瘤科

The prognostic impact of tumour architecture for upper urinary tract urothelial carcinoma: A Propensity Score-Weighted Analysis

Hui-Ying Liu¹, Yen Ta Chen¹, Shun-Chen Huang², Hung-Jen Wang¹, Yuan-Tso Cheng¹, Chih Hsiung Kang¹, Wei Chin Lee¹, Yu Li Su³, Chun Chieh Huang⁴, Yin Lun Chang¹, Yao Chi Chuang¹, Hao Lun Luo^1*, Po Hui Chiang^1*

¹Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

²Department of Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

³Department of Hematology and Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

⁴Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

Abstract

Purpose

To assess the association of tumour architecture with cancer recurrence, metastasis, and cancer-specific survival (CSS) in patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC) in Taiwan.

Materials and Methods

Data were collected from 857 patients treated with RNU between January 2005 and August 2016 in our hospital. Pathologic slides were reviewed by genitourinary pathologists. Propensity score weighting was performed for data analysis.

Results

Sessile growth pattern was observed in 212 patients (24.7%). Tumour architecture exhibited a significant association with bladder cancer history, chronic kidney disease (CKD), tumour stage, lymph node status, histological grade, lymphovascular invasion, concomitant carcinoma in situ, and the variant type [SMD > 0.1 for all variables before weighting]. In the propensity score analysis, 424 papillary and sessile tumour architecture were analysed to balance the baseline characteristics between the groups. Tumour architecture was an independent predictor of metastatic disease and CSS (p = 0.033 and p = 0.002, respectively). However, the associations of tumour architecture with bladder and contralateral recurrence were nonsignificant (p = 0.956 and p = 0.844, respectively).

Conclusions

Tumour architecture of UTUC after RNU is associated with established features of aggressive disease and predictors of metastasis and CSS. Assessment of tumour architecture may help identify patients who could benefit from close follow-up or early administration of systemic therapy after RNU. Tumour architecture should be included in UTUC staging after further confirmation.