Tumour Necrosis Is an Indicator of Aggressive Biology in Patients with Urothelial Carcinoma of the Upper Urinary Tract

Richard Zigeuner, Shahrokh F. Shariat, Vitaly Margulis, Pierre I. Karakiewicz, Marco Roscigno, Alon Weizer, Eiji Kikuchi, Mesut Remzi, Jay D. Raman, Christian Bolenz, Karim Bensalah, Umberto Capitanio, Theresa M. Koppie, Wassim Kassouf, Kanishka Sircar, Jean Jacques Patard, Mario I. Fernández, Christopher G. Wood, Francesco Montorsi, Philipp Ströbel & 8 others Jeffery C. Wheat, Andrea Haitel, Mototsugu Oya, Charles C. Guo, Casey Ng, Daher C. Chade, Arthur Sagalowsky, Cord Langner

Research output: Contribution to journalArticle

107 Citations (Scopus)

Abstract

Background: Prognostic factors after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) are inconclusive, because most data in the literature have been obtained from small series. Objective: To assess the association of tumour necrosis with cancer recurrence and survival in a large international series of patients treated with RNU. Design, setting, and participants: Data were collected from 1425 patients treated with RNU at 13 centres and combined into a relational database. Pathologic slides were re-reviewed by genitourinary pathologists according to strict criteria. Extensive tumour necrosis was scored as >10% of the tumour area. Intervention: Patients underwent either open or laparoscopic RNU. Lymph node dissection was performed in the presence of enlarged nodes. Measurements: Recurrence was defined as tumour relapse in the operative field, lymph node (LN) metastasis, and/or distant metastases. Bladder recurrences were not considered. Associations of extensive tumour necrosis with recurrence-free survival and cancer-specific survival were evaluated by univariate and multivariate analyses. Results and limitations: Extensive tumour necrosis was observed in 364 patients (25.5%) and was associated with advanced tumour stage, high tumour grade, sessile architecture, lymphovascular invasion (LVI), concomitant carcinoma in situ, and LN metastasis (p < 0.0001 each). Extensive tumour necrosis was independently associated with disease recurrence and survival (p = 0.037 and p = 0.046, respectively) after adjusting for the effects of pathologic stage, grade, LVI, and LN status. The addition of extensive tumour necrosis to a base model comprising standard pathologic predictors marginally improved its predictive accuracy for both cancer-specific recurrence (1.5%) and survival (1.4%). Conclusions: Extensive tumour necrosis is an independent predictor of clinical outcomes in patients who undergo RNU for UTUC. Assessment of tumour necrosis may help to identify patients who could benefit from multimodal therapy after RNU in the future. Evaluation of extensive tumour necrosis should be part of standard pathologic reporting.

Original languageEnglish
Pages (from-to)575-581
Number of pages7
JournalEuropean Urology
Volume57
Issue number4
DOIs
Publication statusPublished - 2010 Apr

Fingerprint

Urinary Tract
Necrosis
Carcinoma
Neoplasms
Recurrence
Survival
Lymph Nodes
Neoplasm Metastasis
Carcinoma in Situ
Lymph Node Excision
Urinary Bladder

Keywords

  • Prognosis
  • Survival
  • Tumour necrosis
  • Upper urinary tract cancer
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Zigeuner, R., Shariat, S. F., Margulis, V., Karakiewicz, P. I., Roscigno, M., Weizer, A., ... Langner, C. (2010). Tumour Necrosis Is an Indicator of Aggressive Biology in Patients with Urothelial Carcinoma of the Upper Urinary Tract. European Urology, 57(4), 575-581. https://doi.org/10.1016/j.eururo.2009.11.035

Tumour Necrosis Is an Indicator of Aggressive Biology in Patients with Urothelial Carcinoma of the Upper Urinary Tract. / Zigeuner, Richard; Shariat, Shahrokh F.; Margulis, Vitaly; Karakiewicz, Pierre I.; Roscigno, Marco; Weizer, Alon; Kikuchi, Eiji; Remzi, Mesut; Raman, Jay D.; Bolenz, Christian; Bensalah, Karim; Capitanio, Umberto; Koppie, Theresa M.; Kassouf, Wassim; Sircar, Kanishka; Patard, Jean Jacques; Fernández, Mario I.; Wood, Christopher G.; Montorsi, Francesco; Ströbel, Philipp; Wheat, Jeffery C.; Haitel, Andrea; Oya, Mototsugu; Guo, Charles C.; Ng, Casey; Chade, Daher C.; Sagalowsky, Arthur; Langner, Cord.

In: European Urology, Vol. 57, No. 4, 04.2010, p. 575-581.

Research output: Contribution to journalArticle

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, Fernández, MI, Wood, CG, Montorsi, F, Ströbel, 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', European Urology, vol. 57, no. 4, pp. 575-581. https://doi.org/10.1016/j.eururo.2009.11.035
Zigeuner, Richard ; Shariat, Shahrokh F. ; Margulis, Vitaly ; Karakiewicz, Pierre I. ; Roscigno, Marco ; Weizer, Alon ; Kikuchi, Eiji ; Remzi, Mesut ; Raman, Jay D. ; Bolenz, Christian ; Bensalah, Karim ; Capitanio, Umberto ; Koppie, Theresa M. ; Kassouf, Wassim ; Sircar, Kanishka ; Patard, Jean Jacques ; Fernández, Mario I. ; Wood, Christopher G. ; Montorsi, Francesco ; Ströbel, Philipp ; Wheat, Jeffery C. ; Haitel, Andrea ; Oya, Mototsugu ; Guo, Charles C. ; Ng, Casey ; Chade, Daher C. ; Sagalowsky, Arthur ; Langner, Cord. / Tumour Necrosis Is an Indicator of Aggressive Biology in Patients with Urothelial Carcinoma of the Upper Urinary Tract. In: European Urology. 2010 ; Vol. 57, No. 4. pp. 575-581.
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abstract = "Background: Prognostic factors after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) are inconclusive, because most data in the literature have been obtained from small series. Objective: To assess the association of tumour necrosis with cancer recurrence and survival in a large international series of patients treated with RNU. Design, setting, and participants: Data were collected from 1425 patients treated with RNU at 13 centres and combined into a relational database. Pathologic slides were re-reviewed by genitourinary pathologists according to strict criteria. Extensive tumour necrosis was scored as >10{\%} of the tumour area. Intervention: Patients underwent either open or laparoscopic RNU. Lymph node dissection was performed in the presence of enlarged nodes. Measurements: Recurrence was defined as tumour relapse in the operative field, lymph node (LN) metastasis, and/or distant metastases. Bladder recurrences were not considered. Associations of extensive tumour necrosis with recurrence-free survival and cancer-specific survival were evaluated by univariate and multivariate analyses. Results and limitations: Extensive tumour necrosis was observed in 364 patients (25.5{\%}) and was associated with advanced tumour stage, high tumour grade, sessile architecture, lymphovascular invasion (LVI), concomitant carcinoma in situ, and LN metastasis (p < 0.0001 each). Extensive tumour necrosis was independently associated with disease recurrence and survival (p = 0.037 and p = 0.046, respectively) after adjusting for the effects of pathologic stage, grade, LVI, and LN status. The addition of extensive tumour necrosis to a base model comprising standard pathologic predictors marginally improved its predictive accuracy for both cancer-specific recurrence (1.5{\%}) and survival (1.4{\%}). Conclusions: Extensive tumour necrosis is an independent predictor of clinical outcomes in patients who undergo RNU for UTUC. Assessment of tumour necrosis may help to identify patients who could benefit from multimodal therapy after RNU in the future. Evaluation of extensive tumour necrosis should be part of standard pathologic reporting.",
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T1 - Tumour Necrosis Is an Indicator of Aggressive Biology in Patients with Urothelial Carcinoma of the Upper Urinary Tract

AU - Zigeuner, Richard

AU - Shariat, Shahrokh F.

AU - Margulis, Vitaly

AU - Karakiewicz, Pierre I.

AU - Roscigno, Marco

AU - Weizer, Alon

AU - Kikuchi, Eiji

AU - Remzi, Mesut

AU - Raman, Jay D.

AU - Bolenz, Christian

AU - Bensalah, Karim

AU - Capitanio, Umberto

AU - Koppie, Theresa M.

AU - Kassouf, Wassim

AU - Sircar, Kanishka

AU - Patard, Jean Jacques

AU - Fernández, Mario I.

AU - Wood, Christopher G.

AU - Montorsi, Francesco

AU - Ströbel, Philipp

AU - Wheat, Jeffery C.

AU - Haitel, Andrea

AU - Oya, Mototsugu

AU - Guo, Charles C.

AU - Ng, Casey

AU - Chade, Daher C.

AU - Sagalowsky, Arthur

AU - Langner, Cord

PY - 2010/4

Y1 - 2010/4

N2 - Background: Prognostic factors after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) are inconclusive, because most data in the literature have been obtained from small series. Objective: To assess the association of tumour necrosis with cancer recurrence and survival in a large international series of patients treated with RNU. Design, setting, and participants: Data were collected from 1425 patients treated with RNU at 13 centres and combined into a relational database. Pathologic slides were re-reviewed by genitourinary pathologists according to strict criteria. Extensive tumour necrosis was scored as >10% of the tumour area. Intervention: Patients underwent either open or laparoscopic RNU. Lymph node dissection was performed in the presence of enlarged nodes. Measurements: Recurrence was defined as tumour relapse in the operative field, lymph node (LN) metastasis, and/or distant metastases. Bladder recurrences were not considered. Associations of extensive tumour necrosis with recurrence-free survival and cancer-specific survival were evaluated by univariate and multivariate analyses. Results and limitations: Extensive tumour necrosis was observed in 364 patients (25.5%) and was associated with advanced tumour stage, high tumour grade, sessile architecture, lymphovascular invasion (LVI), concomitant carcinoma in situ, and LN metastasis (p < 0.0001 each). Extensive tumour necrosis was independently associated with disease recurrence and survival (p = 0.037 and p = 0.046, respectively) after adjusting for the effects of pathologic stage, grade, LVI, and LN status. The addition of extensive tumour necrosis to a base model comprising standard pathologic predictors marginally improved its predictive accuracy for both cancer-specific recurrence (1.5%) and survival (1.4%). Conclusions: Extensive tumour necrosis is an independent predictor of clinical outcomes in patients who undergo RNU for UTUC. Assessment of tumour necrosis may help to identify patients who could benefit from multimodal therapy after RNU in the future. Evaluation of extensive tumour necrosis should be part of standard pathologic reporting.

AB - Background: Prognostic factors after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) are inconclusive, because most data in the literature have been obtained from small series. Objective: To assess the association of tumour necrosis with cancer recurrence and survival in a large international series of patients treated with RNU. Design, setting, and participants: Data were collected from 1425 patients treated with RNU at 13 centres and combined into a relational database. Pathologic slides were re-reviewed by genitourinary pathologists according to strict criteria. Extensive tumour necrosis was scored as >10% of the tumour area. Intervention: Patients underwent either open or laparoscopic RNU. Lymph node dissection was performed in the presence of enlarged nodes. Measurements: Recurrence was defined as tumour relapse in the operative field, lymph node (LN) metastasis, and/or distant metastases. Bladder recurrences were not considered. Associations of extensive tumour necrosis with recurrence-free survival and cancer-specific survival were evaluated by univariate and multivariate analyses. Results and limitations: Extensive tumour necrosis was observed in 364 patients (25.5%) and was associated with advanced tumour stage, high tumour grade, sessile architecture, lymphovascular invasion (LVI), concomitant carcinoma in situ, and LN metastasis (p < 0.0001 each). Extensive tumour necrosis was independently associated with disease recurrence and survival (p = 0.037 and p = 0.046, respectively) after adjusting for the effects of pathologic stage, grade, LVI, and LN status. The addition of extensive tumour necrosis to a base model comprising standard pathologic predictors marginally improved its predictive accuracy for both cancer-specific recurrence (1.5%) and survival (1.4%). Conclusions: Extensive tumour necrosis is an independent predictor of clinical outcomes in patients who undergo RNU for UTUC. Assessment of tumour necrosis may help to identify patients who could benefit from multimodal therapy after RNU in the future. Evaluation of extensive tumour necrosis should be part of standard pathologic reporting.

KW - Prognosis

KW - Survival

KW - Tumour necrosis

KW - Upper urinary tract cancer

KW - Urothelial carcinoma

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