Te-Wei Lin1, Hsiang-Ying Lee2,3,4,5, Sheau-Fang Yang6,7, Ching-Chia Li3,4, Hung-Lung Ke3,4,8, Wei-Ming Li3,4,9,10, Chia-Yang Li8, Hung-Pin Tu11, Wen-Jeng Wu3,4,5,8,10, Hsin-Chih Yeh12,13,14,15. 1. School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan. 2. Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, 80145, Taiwan. 3. Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, 80756, Taiwan. 4. Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan. 5. Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan. 6. Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, 80756, Taiwan. 7. Department of Pathology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan. 8. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan. 9. Department of Urology, Ministry of Health and Welfare, Pingtung Hospital, Pingtung, 90054, Taiwan. 10. Cohort Research Center, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan. 11. Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan. 12. Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, 80145, Taiwan. patrick1201.tw@yahoo.com.tw. 13. Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, 80756, Taiwan. patrick1201.tw@yahoo.com.tw. 14. Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan. patrick1201.tw@yahoo.com.tw. 15. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan. patrick1201.tw@yahoo.com.tw.
Abstract
BACKGROUND: Taiwan has the highest incidence of upper tract urothelial carcinoma (UTUC) worldwide. Although many pathological factors can predict the prognosis of UTUC, previous studies have rarely discussed perineural invasion (PNI). Therefore, we aimed to investigate the effect of PNI on a well-established cohort of patients with UTUC. METHODS: This retrospective study included 803 patients with non-metastatic UTUC who underwent radical nephroureterectomy between June 2000 and August 2019. Demographic and clinicopathological parameters, including PNI, were collected for analysis. Using the Kaplan-Meier method and Cox proportional hazards model, we evaluated the significance of PNI with respect to progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS: The median follow-up was 30.9 months, and there were 83 cases of PNI (10.3%). PNI-positive patients had unfavorable pathological features, including high pT stage, positive lymph node involvement, high tumor grade, and more lymphovascular invasion (all p < 0.001). Kaplan-Meier analysis showed that PNI was significantly associated with PFS, CSS, and OS (all p < 0.00001), and when combined with lymphovascular invasion, patients could be divided into groups with distinct survival rates (all p < 0.00001). In multivariate analysis, PNI was an independent factor leading to worse PFS (hazard ratio [HR] 1.72, 95% confidence interval [CI] 1.19-2.50; p = 0.004), CSS (HR 2.54, 95% CI 1.58-4.10; p = 0.0001), and OS (HR 1.78, 95% CI 1.19-2.65; p = 0.005). CONCLUSIONS: We demonstrated an association between PNI and the prognosis of UTUC. Routine assessment of PNI in UTUC with standardized protocols may help achieve better risk stratification and subject selection for perioperative treatment.
BACKGROUND: Taiwan has the highest incidence of upper tract urothelial carcinoma (UTUC) worldwide. Although many pathological factors can predict the prognosis of UTUC, previous studies have rarely discussed perineural invasion (PNI). Therefore, we aimed to investigate the effect of PNI on a well-established cohort of patients with UTUC. METHODS: This retrospective study included 803 patients with non-metastatic UTUC who underwent radical nephroureterectomy between June 2000 and August 2019. Demographic and clinicopathological parameters, including PNI, were collected for analysis. Using the Kaplan-Meier method and Cox proportional hazards model, we evaluated the significance of PNI with respect to progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS: The median follow-up was 30.9 months, and there were 83 cases of PNI (10.3%). PNI-positive patients had unfavorable pathological features, including high pT stage, positive lymph node involvement, high tumor grade, and more lymphovascular invasion (all p < 0.001). Kaplan-Meier analysis showed that PNI was significantly associated with PFS, CSS, and OS (all p < 0.00001), and when combined with lymphovascular invasion, patients could be divided into groups with distinct survival rates (all p < 0.00001). In multivariate analysis, PNI was an independent factor leading to worse PFS (hazard ratio [HR] 1.72, 95% confidence interval [CI] 1.19-2.50; p = 0.004), CSS (HR 2.54, 95% CI 1.58-4.10; p = 0.0001), and OS (HR 1.78, 95% CI 1.19-2.65; p = 0.005). CONCLUSIONS: We demonstrated an association between PNI and the prognosis of UTUC. Routine assessment of PNI in UTUC with standardized protocols may help achieve better risk stratification and subject selection for perioperative treatment.
Authors: Morgan Rouprêt; Marko Babjuk; Maximilian Burger; Otakar Capoun; Daniel Cohen; Eva M Compérat; Nigel C Cowan; Jose L Dominguez-Escrig; Paolo Gontero; A Hugh Mostafid; Joan Palou; Benoit Peyronnet; Thomas Seisen; Viktor Soukup; Richard J Sylvester; Bas W G van Rhijn; Richard Zigeuner; Shahrokh F Shariat Journal: Eur Urol Date: 2020-06-24 Impact factor: 20.096
Authors: Lorenzo De Franco; Daniele Marrelli; Costantino Voglino; Carla Vindigni; Francesco Ferrara; Giulio Di Mare; Livio Iudici; Mario Marini; Franco Roviello Journal: Pathol Oncol Res Date: 2017-05-30 Impact factor: 3.201