Patterns of invasion and histological growth as prognostic indicators in urothelial carcinoma of the upper urinary tract

Abstract

The biological significance of squamous and glandular differentiation and different patterns of invasion in upper urinary tract urothelial carcinoma is unclear. We reviewed 268 cases of consecutive upper urinary tract carcinomas with respect to the presence of squamous and/or glandular differentiation and different patterns of invasion (nodular, trabecular, and infiltrative) and correlated data with patient outcome. Squamous or glandular differentiation occurred in 47/268 (18%) tumors and its presence correlated with high tumor stage (P<0.001) and grade (P<0.001). Invasive patterns were nodular in 49/227 (22%), trabecular in 95/227 (42%), and infiltrative in 83/227 (37%) tumors. The nodular pattern prevailed in low stage (P<0.001) and low-grade (P<0.001) tumors, whereas the infiltrative pattern prevailed in high stage (P<0.001) and high-grade (P<0.001) tumors. Multivariate analysis proved that tumor stage (P<0.001) and the infiltrative pattern (P<0.001) are independent predictors of metastasis-free survival, whereas tumor grade and squamous and glandular differentiation lacked independent influence on patient outcome. In conclusion, the infiltrative pattern of invasion significantly correlated with advanced disease and poor patient outcome. In contrast, the presence of squamous and/or glandular invasion did not prove independent influence on patient outcome. The pattern of invasion should be commented upon separately in the pathology report.

Outcomes of radical nephroureterectomy: A series from the Upper Tract Urothelial Carcinoma Collaboration

“…18,27 Recently, Langner and colleagues have demonstrated that the infiltrative pattern was significantly associated with the development of metastatic disease and proved to be an independent prognostic marker of survival after RNU. 11 Approximately 28% of patients in our series demonstrated sessile tumor growth pattern, and this feature was independently associated with risk of tumor recurrence and cancer-specific survival, further affirming that tumor architecture is a reliable prognostic factor for patients with UTUC. We found that, at 5 years after RNU, 21% of patients with papillary growth pattern recurred and 18% died of UTUC, compared with 60% and 54% of patients whose tumors were sessile.…”

“…Whereas tumor stage and histologic grade are well established prognostic factors of outcome after RNU, the oncologic significance of other potentially relevant variables, such as tumor site, architecture, histologic tumor necrosis, lymphovascular invasion (LVI), and the presence of concomitant carcinoma-in situ (CIS), among others, has not been clearly established. 4,[8][9][10][11][12][13][14][15] Recognizing these limitations, we developed a comprehensive database incorporating the clinical and pathologic characteristics and outcomes of over 1300 patients treated with RNU for UTUC at 12 academic centers. Using this large international patient cohort, strict accrual criteria, and pathologic re-review of all slides, we sought to more clearly define the natural history, patterns of failure, and the impact of potential prognostic factors on relapse and survival after surgical management of UTUC.…”

Staging and reporting of urothelial carcinoma of the urinary bladder

“…128 The significance of assessing tumor growth pattern has been highlighted in a recent study. 129 The 5-year metastasis-free survival rates for urothelial carcinoma with nodular, trabecular, and infiltrative invasion pattern were 94, 74, and 12%, respectively. 129 …”

“…129 The 5-year metastasis-free survival rates for urothelial carcinoma with nodular, trabecular, and infiltrative invasion pattern were 94, 74, and 12%, respectively. 129 …”

Survival of patients with upper urinary tract urothelial carcinoma after nephroureterectomy and risk factors for bladder cancer

“…Pet godina nakon radikalne nefroureterektomije 40% pacijenta sa papilarnim karcinomom i 70% onih sa sesilnim je imalo recidiv [63]. Sesilni tip tumora je značajno više povezan sa nastankom metastatske bolesti i predstavlja nezavisni prediktor kancer specifičnog preživljavanja [64]. Preoperativni prognostički model koji kombinuje ovaj parametar sa histološkim gradusom i lokacijom tumora može sa tačnošću od 76,6% da predvidi ishod tumora gornjeg urotelijuma [42].…”