Impact of tumor architecture on disease recurrence and cancer-specific mortality of upper tract urothelial carcinoma treated with radical nephroureterectomy

Abstract

Upper tract urinary carcinoma (UTUC) is a relatively uncommon but aggressive disease. Recent publications have assessed the prognostic significance of tumor architecture in UTUC, but there is still controversy regarding the significance and importance of tumor architecture on disease recurrence. We retrospectively reviewed the medical records of 101 patients with clinical UTUC who had undergone surgery. Univariate and multivariate analyses were conducted to identify factors associated with disease recurrence and cancer-specific mortality. As our single center study and the limited sample size may influence the clinical significance, we further quantitatively combined the results with those of existing published literature through a meta-analysis compiled from searching several databases. At a median follow-up of 41.3 months, 25 patients experienced disease recurrence. Spearman's correlation analysis showed that tumor architecture was found to be positively correlated with the tumor location and the histological grade. Kaplan-Meier curves showed that patients with sessile tumor architecture had significantly poor recurrence free survival (RFS) and cancer specific survival (CSS). Furthermore, multivariate analysis suggested that tumor architecture was independent prognostic factors for RFS (Hazard ratio, HR = 2.648) and CSS (HR = 2.072) in UTUC patients. A meta-analysis of investigating tumor architecture and its effects on UTUC prognosis was conducted. After searching PubMed, Medline, Embase, Cochrane Library and Scopus databases, 17 articles met the eligibility criteria for this analysis. The eligible studies included a total of 14,368 patients and combined results showed that sessile tumor architecture was associated with both disease recurrence with a pooled HR estimate of 1.454 and cancer-specific mortality with a pooled HR estimate of 1.416. Tumor architecture is an independent predictor for disease recurrence after radical nephroureterectomy for UTUC. Therefore, closer surveillance is necessary, especially in patients with sessile tumor architecture.

The prognostic value of tumor architecture in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy

“…After punctilious reading, 358 studies were excluded; of these, 279 studies were excluded because they did not provide sufficient data, 56 articles were excluded as the same participants were included in other studies, and 23 articles were excluded as there were of low quality. Finally, 17 studies [ 12 , 16 – 31 ] published from 2014 to 2019, which met all of the inclusion and exclusion criteria, were enrolled in this meta-analysis.…”

“…Accumulating evidence indicates that tumor architecture may indicate a more advanced stage and it may be associated with more aggressive oncological behavior in UTUC patients. Fan et al [ 12 ] and Margulis et al [ 38 ] showed that sessile tumor architecture was significantly associated with the risk of disease recurrence and it was proved to be a reliable prognostic factor in patients with UTUC. Remzi et al [ 13 ] provided evidence that sessile tumor architecture was associated with more aggressive behavior and was an independent risk factor for tumor recurrence and CSS after RNU.…”

“…Patients with UTUC in the same stage or grade may experience different comes, which urges us to identify more precise biomarkers to assess the prognosis of UTUC. Actually, urothelial carcinoma with different tumor architectures, is a phenomenon that is well recognized by pathologists [ 12 ] . The prognostic value of tumor architecture remains controversial [ 13 ] .…”

The clinicopathological features and prognostic value of lymphovascular invasion in patients with upper tract urinary carcinoma after radical nephroureterectomy: an updated systematic review and meta-analysis.

“…To date, many studies have been conducted to identify the significant prognostic factors of UTUC. Some traditional prognostic predictors, such as pathologic characteristics of RNU specimens including tumor stage and grade [39], tumor architecture [20], tumour size [23] and CIS [42] had been found as significant prognostic variables for CSS and RFS in different studies.…”

The predictive value of preoperative positive urine cytology for development of bladder cancer after nephroureterectomy in patients with upper urinary tract urothelial carcinoma: A retrospective multi-center case-control study and meta-analysis

“…Previously, there were controversial predictive factors that resulted in poor prognosis for UUT-UC and intravesical recurrence, such as patient-speci c factors (age, sex, diabetes mellitus or history of bladder cancer), tumor-related factors (location, size, T stage or architecture) and environmental factors (smoking, long-term use of aristolochic acid, etc.) [9][10][11][12][13]. It is worth noting that the 2-year recurrence-free survival rate is less than 56% for stage ≥pT1 cancer, and the 5-year speci c survival rate is less than 50% for stage ≥pT2 [14].…”