Purpose: Tumor necrosis is associated with a poor oncological outcome in patientswith upper tract urothelial carcinoma and other malignancies. We validatedthe association of tumor necrosis with pathological features and clinicaloutcomes in a large international cohort of patients with upper tract urothelialcarcinoma treated with radical nephroureterectomy.Material and Methods: This retrospective study included 754 patients treatedwith radical nephroureterectomy at a total of 9 centers. Tumor necrosis wasscored as greater than 10% of tumor area based on microscopic evaluation.Results: Tumor necrosis was present in 165 specimens (21.9%). The prevalenceof tumor necrosis increased with advancing pathological stage, including 7%,10.6% and 50% for T1, T2 and T3–4, respectively (p 0.001). Tumor necrosis wasassociated with features of aggressive upper tract urothelial carcinoma, such ashigh grade, lymph node metastasis, lymphovascular invasion, sessile tumorarchitecture and concomitant carcinoma in situ (p 0.002). Median followupin censored patients was 40 months (IQR 18 to 75). On univariate Coxregression analysis tumor necrosis was significantly associated with diseaserecurrence and cancer specific mortality (HR 2.4 and 2.7, p 0.001). However,on multivariate Cox regression analysis including patient age, stage, grade,lymph node status, lymphovascular invasion and adjuvant chemotherapytumor necrosis was not associated with disease recurrence (HR 1.1, p 0.49)or cancer specific mortality (HR 1.1, p 0.51). Excluding 63 patients whoreceived adjuvant chemotherapy and/or 49 with positive lymph nodes did notsubstantially change these results.Conclusions: In this large, multicenter international study tumor necrosis wasassociated with pathological features of biologically aggressive upper tracturothelial carcinoma. However, tumor necrosis was not an independent predictorof clinical outcomes.
Association of Tumor Necrosis With Pathological Features andClinical Outcome in 754 Patients Undergoing RadicalNephroureterectomy for Upper Tract Urothelial Carcinoma:An International Validation Study
ARTIBANI, Walter;
2010-01-01
Abstract
Purpose: Tumor necrosis is associated with a poor oncological outcome in patientswith upper tract urothelial carcinoma and other malignancies. We validatedthe association of tumor necrosis with pathological features and clinicaloutcomes in a large international cohort of patients with upper tract urothelialcarcinoma treated with radical nephroureterectomy.Material and Methods: This retrospective study included 754 patients treatedwith radical nephroureterectomy at a total of 9 centers. Tumor necrosis wasscored as greater than 10% of tumor area based on microscopic evaluation.Results: Tumor necrosis was present in 165 specimens (21.9%). The prevalenceof tumor necrosis increased with advancing pathological stage, including 7%,10.6% and 50% for T1, T2 and T3–4, respectively (p 0.001). Tumor necrosis wasassociated with features of aggressive upper tract urothelial carcinoma, such ashigh grade, lymph node metastasis, lymphovascular invasion, sessile tumorarchitecture and concomitant carcinoma in situ (p 0.002). Median followupin censored patients was 40 months (IQR 18 to 75). On univariate Coxregression analysis tumor necrosis was significantly associated with diseaserecurrence and cancer specific mortality (HR 2.4 and 2.7, p 0.001). However,on multivariate Cox regression analysis including patient age, stage, grade,lymph node status, lymphovascular invasion and adjuvant chemotherapytumor necrosis was not associated with disease recurrence (HR 1.1, p 0.49)or cancer specific mortality (HR 1.1, p 0.51). Excluding 63 patients whoreceived adjuvant chemotherapy and/or 49 with positive lymph nodes did notsubstantially change these results.Conclusions: In this large, multicenter international study tumor necrosis wasassociated with pathological features of biologically aggressive upper tracturothelial carcinoma. However, tumor necrosis was not an independent predictorof clinical outcomes.
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