The prognostic impact of squamous and glandular differentiation for upper tract urothelial carcinoma patients after radical nephroureterectomy
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To evaluate the association between tumor squamous and/or glandular differentiation and tumor biological characteristics and to validate the impact of these histologic variants on oncologic outcomes of UTUC patients.
We retrospectively analyzed the data of 687 UTUC patients who underwent radical nephroureterectomy in our institute, from Aug 1, 1999, to Dec 31, 2011. All pathologic sections were reevaluated for histologic differentiation variations (squamous and glandular). The clinicopathological variables of patients were reviewed.
Among the 687 UTUC patients in our study, 53 (7.7 %) had squamous differentiation, 20 (2.9 %) had glandular differentiation and 8 (1.2 %) had both histologic variants. Patients with mixed histologic variant tended to have significant larger percentage of sessile tumor architecture (58.0 vs 18.2 %), presence of CIS (7.4 vs 2.3 %), advanced T stage, advanced tumor grade and lymph node metastasis (17.3 vs 6.6 %; all p < 0.05). Patients with squamous and/or glandular differentiation had significant worse cancer-specific survival than pure UTUC patients (p < 0.001), while significant difference of recurrence-free survival between two groups was not observed (p = 0.126). Patients with both squamous and glandular differentiation did not show significantly worse CSS than those with single histologic variant. Univariate analyses revealed that tumor squamous and/or glandular differentiation was a significant factor on survival (p < 0.001). However, the influence did not remain significant after adjusted for other factors in the multivariate analyses (p = 0.076, HR 1.42).
UTUC patients with squamous and/or glandular differentiation are more likely to have aggressive tumor biological features and tend to have worse postoperative outcomes.
KeywordsUpper tract urothelial carcinoma Histologic differentiation Prognosis
This work was supported by grants from the Clinical Features Research of Capital (No. Z151100004015173), the Natural Science Foundation of Beijing (7152146) and the Collaborative Research Foundation of Peking University Health Science Center and National Taiwan University, College of Medicine (BMU20120318).
Qi Tang involved in protocol/project development, data collection and management, drafting the manuscript and data analysis. Gengyan Xiong involved in protocol/project development, data collection or management, drafting the manuscript and data analysis. Xuesong Li involved in protocol/project development, revision of the manuscript and supervision. Dong Fang involved in data collection and management and revision of the manuscript. Chenguang Xi involved in data collection and management. Lei Zhang involved in data collection and management. Kaiwei Yang involved in data collection and management. Lin Yao involved in revision of the manuscript. Cuijian Zhang involved in revision of the manuscript. Wei Yu involved in revision of the manuscript. Qun He involved in protocol/project development. Kan Gong involved in protocol/project development. Zhisong He involved in protocol/project development. Liqun Zhou involved in protocol/project development and supervision.
Compliance with ethical standards
Conflict of interest
The authors declare that there is no conflict of interests regarding the publication of this paper.
Research involving human participants and/or animals
All patients had signed consent forms to authorize the analysis of their medical records. The institutional review board approved this study.
- 6.Zigeuner R, Shariat SF, Margulis V, Karakiewicz PI, Roscigno M, Weizer A, Kikuchi E, Remzi M, Raman JD, Bolenz C, Bensalah K, Capitanio U, Koppie TM, Kassouf W, Sircar K, Patard JJ, Fernandez MI, Wood CG, Montorsi F, Strobel P, Wheat JC, Haitel A, Oya M, Guo CC, Ng C, Chade DC, Sagalowsky A, Langner C (2010) Tumour necrosis is an indicator of aggressive biology in patients with urothelial carcinoma of the upper urinary tract. Eur Urol 57:575–581CrossRefPubMedGoogle Scholar
- 7.Seitz C, Gupta A, Shariat SF, Matsumoto K, Kassouf W, Walton TJ, Fritsche HM, Otto W, Tritschler S, Bastian PJ, Carballido J, Ficarra V, Karakiewicz PI, Artibani W, Mazzoleni G, Novara G (2010) Association of tumor necrosis with pathological features and clinical outcome in 754 patients undergoing radical nephroureterectomy for upper tract urothelial carcinoma: an international validation study. J Urol 184:1895–1900CrossRefPubMedGoogle Scholar
- 10.Sobin LH, Wittekind C (2002) TNM Classification of malignant tumours. Wiley, New YorkGoogle Scholar
- 11.Mostofi FK, Sobin LH, Tosoni I (1973) Histological typing of urinary bladder tumours. International histological classification of tumours, No 19. World Health Organisation, GenevaGoogle Scholar
- 12.Eble JN, Sauter G, Epstein JI, Sesterhenn IA (2004) World Health Organisation classification of tumours. Tumours of the urinary system and male genital organs. IARC Press, LyonGoogle Scholar
- 15.Xylinas E, Rink M, Robinson BD, Lotan Y, Babjuk M, Brisuda A, Green DA, Kluth LA, Pycha A, Fradet Y, Faison T, Lee RK, Karakiewicz PI, Zerbib M, Scherr DS, Shariat SF (2013) Impact of histological variants on oncological outcomes of patients with urothelial carcinoma of the bladder treated with radical cystectomy. Eur J Cancer 49:1889–1897CrossRefPubMedGoogle Scholar
- 16.Rink M, Robinson BD, Green DA, Cha EK, Hansen J, Comploj E, Margulis V, Raman JD, Ng CK, Remzi M, Bensalah K, Kabbani W, Haitel A, Rioux-Leclercq N, Guo CC, Chun FK, Kikuchi E, Kassouf W, Sircar K, Sun M, Sonpavde G, Lotan Y, Pycha A, Karakiewicz PI, Scherr DS, Shariat SF (2012) Impact of histological variants on clinical outcomes of patients with upper urinary tract urothelial carcinoma. J Urol 188:398–404CrossRefPubMedGoogle Scholar
- 25.Abdollah F, Sun M, Jeldres C, Schmitges J, Thuret R, Djahangirian O, Tian Z, Shariat SF, Perrotte P, Montorsi F, Karakiewicz PI (2012) Survival after radical cystectomy of non-bilharzial squamous cell carcinoma vs urothelial carcinoma: a competing-risks analysis. BJU Int 109:564–569CrossRefPubMedGoogle Scholar
- 26.Lughezzani G, Sun M, Jeldres C, Alasker A, Budaus L, Shariat SF, Latour M, Widmer H, Duclos A, Jolivet-Tremblay M, Montorsi F, Perrotte P, Karakiewicz PI (2010) Adenocarcinoma versus urothelial carcinoma of the urinary bladder: comparison between pathologic stage at radical cystectomy and cancer-specific mortality. Urology 75:376–381CrossRefPubMedGoogle Scholar
- 28.Scosyrev E, Ely BW, Messing EM, Speights VO, Grossman HB, Wood DP, de Vere WR, Vogelzang NJ, Trump DL, Natale RB, Tangen CM, Crawford ED, Thompson IM (2011) Do mixed histological features affect survival benefit from neoadjuvant platinum-based combination chemotherapy in patients with locally advanced bladder cancer? A secondary analysis of Southwest Oncology Group-Directed Intergroup Study (S8710). BJU Int 108:693–699CrossRefPubMedPubMedCentralGoogle Scholar