Subclassification of pT3 urothelial carcinoma of the renal pelvicalyceal system is associated with recurrence-free and cancer-specific survival: Proposal for a revision of the current TNM classification

Shahrokh F. Shariat, Richard Zigeuner, Michael Rink, Vitaly Margulis, Jens Hansen, Eiji Kikuchi, Wassim Kassouf, Jay D. Raman, Mesut Remzi, Theresa M. Koppie, Karim Bensalah, Charles C. Guo, Shuji Mikami, Kanishka Sircar, Casey K. Ng, Andrea Haitel, Wareef Kabbani, Felix K. Chun, Christopher G. Wood, Douglas S. ScherrPierre I. Karakiewicz, Cord Langner

Research output: Contribution to journalArticle

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Abstract

Background: The clinical course of pT3 upper tract urothelial carcinoma (UTUC) is highly variable. Objectives: The aim of the current study was to validate the clinical and prognostic importance of pT3 subclassification in the renal pelvicalyceal system in a large international cohort of patients. Design, setting, and participants: From a multi-institutional international database, 858 renal pelvicalyceal tumors treated with radical nephroureterectomy (RNU) were systematically reevaluated by genitourinary pathologists. Category pT3 pelvic tumors were categorized as pT3a (infiltration of the renal parenchyma on a microscopic level only) versus pT3b (macroscopic infiltration of the renal parenchyma and/or infiltration of peripelvic adipose tissue). Intervention: RNU. Measurements: Associations of pT3 subclassifications with clinicopathologic features were assessed with the chi-square test. Prognostic impact was assessed with the log-rank test and multivariable Cox regression analyses. Results and limitations: Of 858 patients with renal pelvicalyceal tumors, 266 (31%) had pT3 disease. Of these, 146 (54.9%) were classified as pT3a and 120 (45.1%) as pT3b. Compared with pT3a, pT3b cancers were associated with higher tumor grade, nodal disease, and tumor necrosis. Ten-year recurrence-free (pT3a 58% vs pT3b 38%; p < 0.001) and cancer-specific (pT3a 60% vs pT3b 39%; p = 0.002) survival rates were lower for patients with pT3b disease. In multivariable analyses, classification pT3b was an independent predictor of both disease recurrence (hazard ratio [HR]: 1.8, p = 0.003) and cancer-specific mortality (HR: 1.7; p = 0.02). The major limitation is the retrospective character of the study. Conclusions: Subclassification of pT3 renal pelvicalyceal UTUC helps identify patients who are at increased risk of disease progression and cancer-related death. Further research may help assess the value of subclassification and its inclusion in future editions of the American Joint Committee on Cancer-International Union Against Cancer TNM classification system.

Original languageEnglish (US)
Pages (from-to)224-231
Number of pages8
JournalEuropean Urology
Volume62
Issue number2
DOIs
StatePublished - Aug 2012

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Neoplasm Staging
Carcinoma
Kidney
Recurrence
Survival
Neoplasms
Chi-Square Distribution
Disease Progression
Adipose Tissue
Necrosis
Survival Rate
Retrospective Studies
Regression Analysis
Databases
Mortality

Keywords

  • Prognosis
  • PT3 subclassification
  • Renal pelvicalyceal system
  • TNM classification
  • Upper urinary tract
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Subclassification of pT3 urothelial carcinoma of the renal pelvicalyceal system is associated with recurrence-free and cancer-specific survival : Proposal for a revision of the current TNM classification. / Shariat, Shahrokh F.; Zigeuner, Richard; Rink, Michael; Margulis, Vitaly; Hansen, Jens; Kikuchi, Eiji; Kassouf, Wassim; Raman, Jay D.; Remzi, Mesut; Koppie, Theresa M.; Bensalah, Karim; Guo, Charles C.; Mikami, Shuji; Sircar, Kanishka; Ng, Casey K.; Haitel, Andrea; Kabbani, Wareef; Chun, Felix K.; Wood, Christopher G.; Scherr, Douglas S.; Karakiewicz, Pierre I.; Langner, Cord.

In: European Urology, Vol. 62, No. 2, 08.2012, p. 224-231.

Research output: Contribution to journalArticle

Shariat, SF, Zigeuner, R, Rink, M, Margulis, V, Hansen, J, Kikuchi, E, Kassouf, W, Raman, JD, Remzi, M, Koppie, TM, Bensalah, K, Guo, CC, Mikami, S, Sircar, K, Ng, CK, Haitel, A, Kabbani, W, Chun, FK, Wood, CG, Scherr, DS, Karakiewicz, PI & Langner, C 2012, 'Subclassification of pT3 urothelial carcinoma of the renal pelvicalyceal system is associated with recurrence-free and cancer-specific survival: Proposal for a revision of the current TNM classification', European Urology, vol. 62, no. 2, pp. 224-231. https://doi.org/10.1016/j.eururo.2012.01.019
Shariat, Shahrokh F. ; Zigeuner, Richard ; Rink, Michael ; Margulis, Vitaly ; Hansen, Jens ; Kikuchi, Eiji ; Kassouf, Wassim ; Raman, Jay D. ; Remzi, Mesut ; Koppie, Theresa M. ; Bensalah, Karim ; Guo, Charles C. ; Mikami, Shuji ; Sircar, Kanishka ; Ng, Casey K. ; Haitel, Andrea ; Kabbani, Wareef ; Chun, Felix K. ; Wood, Christopher G. ; Scherr, Douglas S. ; Karakiewicz, Pierre I. ; Langner, Cord. / Subclassification of pT3 urothelial carcinoma of the renal pelvicalyceal system is associated with recurrence-free and cancer-specific survival : Proposal for a revision of the current TNM classification. In: European Urology. 2012 ; Vol. 62, No. 2. pp. 224-231.
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abstract = "Background: The clinical course of pT3 upper tract urothelial carcinoma (UTUC) is highly variable. Objectives: The aim of the current study was to validate the clinical and prognostic importance of pT3 subclassification in the renal pelvicalyceal system in a large international cohort of patients. Design, setting, and participants: From a multi-institutional international database, 858 renal pelvicalyceal tumors treated with radical nephroureterectomy (RNU) were systematically reevaluated by genitourinary pathologists. Category pT3 pelvic tumors were categorized as pT3a (infiltration of the renal parenchyma on a microscopic level only) versus pT3b (macroscopic infiltration of the renal parenchyma and/or infiltration of peripelvic adipose tissue). Intervention: RNU. Measurements: Associations of pT3 subclassifications with clinicopathologic features were assessed with the chi-square test. Prognostic impact was assessed with the log-rank test and multivariable Cox regression analyses. Results and limitations: Of 858 patients with renal pelvicalyceal tumors, 266 (31{\%}) had pT3 disease. Of these, 146 (54.9{\%}) were classified as pT3a and 120 (45.1{\%}) as pT3b. Compared with pT3a, pT3b cancers were associated with higher tumor grade, nodal disease, and tumor necrosis. Ten-year recurrence-free (pT3a 58{\%} vs pT3b 38{\%}; p < 0.001) and cancer-specific (pT3a 60{\%} vs pT3b 39{\%}; p = 0.002) survival rates were lower for patients with pT3b disease. In multivariable analyses, classification pT3b was an independent predictor of both disease recurrence (hazard ratio [HR]: 1.8, p = 0.003) and cancer-specific mortality (HR: 1.7; p = 0.02). The major limitation is the retrospective character of the study. Conclusions: Subclassification of pT3 renal pelvicalyceal UTUC helps identify patients who are at increased risk of disease progression and cancer-related death. Further research may help assess the value of subclassification and its inclusion in future editions of the American Joint Committee on Cancer-International Union Against Cancer TNM classification system.",
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TY - JOUR

T1 - Subclassification of pT3 urothelial carcinoma of the renal pelvicalyceal system is associated with recurrence-free and cancer-specific survival

T2 - Proposal for a revision of the current TNM classification

AU - Shariat, Shahrokh F.

AU - Zigeuner, Richard

AU - Rink, Michael

AU - Margulis, Vitaly

AU - Hansen, Jens

AU - Kikuchi, Eiji

AU - Kassouf, Wassim

AU - Raman, Jay D.

AU - Remzi, Mesut

AU - Koppie, Theresa M.

AU - Bensalah, Karim

AU - Guo, Charles C.

AU - Mikami, Shuji

AU - Sircar, Kanishka

AU - Ng, Casey K.

AU - Haitel, Andrea

AU - Kabbani, Wareef

AU - Chun, Felix K.

AU - Wood, Christopher G.

AU - Scherr, Douglas S.

AU - Karakiewicz, Pierre I.

AU - Langner, Cord

PY - 2012/8

Y1 - 2012/8

N2 - Background: The clinical course of pT3 upper tract urothelial carcinoma (UTUC) is highly variable. Objectives: The aim of the current study was to validate the clinical and prognostic importance of pT3 subclassification in the renal pelvicalyceal system in a large international cohort of patients. Design, setting, and participants: From a multi-institutional international database, 858 renal pelvicalyceal tumors treated with radical nephroureterectomy (RNU) were systematically reevaluated by genitourinary pathologists. Category pT3 pelvic tumors were categorized as pT3a (infiltration of the renal parenchyma on a microscopic level only) versus pT3b (macroscopic infiltration of the renal parenchyma and/or infiltration of peripelvic adipose tissue). Intervention: RNU. Measurements: Associations of pT3 subclassifications with clinicopathologic features were assessed with the chi-square test. Prognostic impact was assessed with the log-rank test and multivariable Cox regression analyses. Results and limitations: Of 858 patients with renal pelvicalyceal tumors, 266 (31%) had pT3 disease. Of these, 146 (54.9%) were classified as pT3a and 120 (45.1%) as pT3b. Compared with pT3a, pT3b cancers were associated with higher tumor grade, nodal disease, and tumor necrosis. Ten-year recurrence-free (pT3a 58% vs pT3b 38%; p < 0.001) and cancer-specific (pT3a 60% vs pT3b 39%; p = 0.002) survival rates were lower for patients with pT3b disease. In multivariable analyses, classification pT3b was an independent predictor of both disease recurrence (hazard ratio [HR]: 1.8, p = 0.003) and cancer-specific mortality (HR: 1.7; p = 0.02). The major limitation is the retrospective character of the study. Conclusions: Subclassification of pT3 renal pelvicalyceal UTUC helps identify patients who are at increased risk of disease progression and cancer-related death. Further research may help assess the value of subclassification and its inclusion in future editions of the American Joint Committee on Cancer-International Union Against Cancer TNM classification system.

AB - Background: The clinical course of pT3 upper tract urothelial carcinoma (UTUC) is highly variable. Objectives: The aim of the current study was to validate the clinical and prognostic importance of pT3 subclassification in the renal pelvicalyceal system in a large international cohort of patients. Design, setting, and participants: From a multi-institutional international database, 858 renal pelvicalyceal tumors treated with radical nephroureterectomy (RNU) were systematically reevaluated by genitourinary pathologists. Category pT3 pelvic tumors were categorized as pT3a (infiltration of the renal parenchyma on a microscopic level only) versus pT3b (macroscopic infiltration of the renal parenchyma and/or infiltration of peripelvic adipose tissue). Intervention: RNU. Measurements: Associations of pT3 subclassifications with clinicopathologic features were assessed with the chi-square test. Prognostic impact was assessed with the log-rank test and multivariable Cox regression analyses. Results and limitations: Of 858 patients with renal pelvicalyceal tumors, 266 (31%) had pT3 disease. Of these, 146 (54.9%) were classified as pT3a and 120 (45.1%) as pT3b. Compared with pT3a, pT3b cancers were associated with higher tumor grade, nodal disease, and tumor necrosis. Ten-year recurrence-free (pT3a 58% vs pT3b 38%; p < 0.001) and cancer-specific (pT3a 60% vs pT3b 39%; p = 0.002) survival rates were lower for patients with pT3b disease. In multivariable analyses, classification pT3b was an independent predictor of both disease recurrence (hazard ratio [HR]: 1.8, p = 0.003) and cancer-specific mortality (HR: 1.7; p = 0.02). The major limitation is the retrospective character of the study. Conclusions: Subclassification of pT3 renal pelvicalyceal UTUC helps identify patients who are at increased risk of disease progression and cancer-related death. Further research may help assess the value of subclassification and its inclusion in future editions of the American Joint Committee on Cancer-International Union Against Cancer TNM classification system.

KW - Prognosis

KW - PT3 subclassification

KW - Renal pelvicalyceal system

KW - TNM classification

KW - Upper urinary tract

KW - Urothelial carcinoma

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