Prognostic Impact of pT3 Subclassification in a Multicentre Cohort of Patients with Urothelial Carcinoma of the Renal Pelvicalyceal System Undergoing Radical Nephroureterectomy: A Propensity Score-weighted Analysis After Central Pathology Review.

The current pathological tumour-node-metastasis (pTNM) classification for upper tract urothelial carcinoma (UTUC) does not include any risk stratification of pT3 renal pelvicalyceal tumours.

To assess the prognostic impact of pT3 subclassification in a multicentre cohort of patients with UTUC of the renal pelvicalyceal system undergoing radical nephroureterectomy (RNU).

Data from all consecutive patients treated with RNU for pT3 renal pelvicalyceal UTUC at 14 French centres from 1995 to 2013 were reviewed retrospectively.

A central pathology review (CPR) was used to stratify pT3 patients into those with infiltration of the renal parenchyma on a microscopic level (pT3a) versus those with infiltration of the renal parenchyma visible on gross inspection of the resection specimen and/or invasion of peripelvic fat (pT3b).

Inverse probability weighting (IPW)-adjusted Cox regression analyses were used to compare recurrence-free survival (RFS) and cancer-specific survival (CSS) between pT3a and pT3b patients.

Overall, 202 patients were included and further stratified into pT3a (n = 98; 48.5%) and pT3b (n = 104; 51.5%) subgroups. Median time to follow-up in the weighted population was 68 (interquartile range, 50-95) mo. In IPW-adjusted Cox regression analyses, pT3b versus pT3a substage was associated with a significant adverse effect on RFS (hazard ratio [HR] = 2.02; 95% confidence interval [CI] = [1.36-3.01]; p < 0.001) and CSS (HR = 1.84; 95% CI = [1.20-2.82]; p = 0.005). The study is limited by its retrospective design.

Using IPW-adjusted analyses after the CPR, we observed that RNU patients with pT3b renal pelvicalyceal UTUC had adverse prognosis as compared with those with pT3a disease. As such, this subclassification could help refine the current pTNM system for UTUC.

In this report, we looked at the prognostic interest of stratifying patients with pT3 renal pelvicalyceal upper tract urothelial carcinoma based on the extent of local invasion. We found that those with extensive infiltration (pT3b) had adverse prognosis as compared with those with limited infiltration (pT3a). This information could be provided on pathology reports to further guide clinical decision making.

European urology focus. 2020 Oct 23 [Epub ahead of print]

Thomas Seisen, Andrea Mari, Riccardo Campi, Benoit Peyronnet, Karim Bensalah, Nathalie Rioux-Leclercq, Christian Pfister, Françoise Gobet, Alexandre De La Taille, Yves Allory, Evanguelos Xylinas, Yann Neuzillet, Camelia Radulescu, Jean-Luc Descotes, Géraldine Saada-Sebag, Jacques Irani, Céline Delpech-Debiais, Pierre Bigot, Caroline Eymerit, Sebastien Crouzet, Florence Mege-Lechevallier, Alain Ruffion, Myriam Decaussin-Petrucci, Stéphane Droupy, Pascal Roger, Xavier Durand, Philippe Camparo, Olivier Cussenot, Eva Compérat, Morgan Rouprêt

Sorbonne University, GRC 5 Predictive ONCO-URO, AP-HP, Urology, Pitie-Salpetriere Hospital, F-75013 PARIS, France., Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Department of Urology, Rennes University Hospital, Rennes, France., Department of Pathology, Rennes University Hospital, Rennes, France., Department of Urology, Rouen University Hospital, Rouen, France., Department of Pathology, Rouen University Hospital, Rouen, France., Department of Urology, Henri Mondor Hospital, Créteil, France., Department of Pathology, Henri Mondor Hospital, Créteil, France., Department of Urology, Cochin Hospital, Paris, France., Department of Urology, Foch Hospital, Surenes, France., Department of Pathology, Foch Hospital, Surenes, France., Department of Urology, Grenoble University Hospital, Grenoble, France., Department of Pathology, Grenoble University Hospital, Grenoble, France., Department of Urology, Poitier University Hospital, Poitier, France., Department of Pathology, Poitier University Hospital, Poitier, France., Department of Urology, Angers University Hospital, Angers, France., Department of Pathology, Angers University Hospital, Angers, France., Department of Urology, Edouard Henriot Hospital, Lyon, France., Department of Pathology, Edouard Henriot Hospital, Lyon, France., Department of Urology, Lyon Sud University Hospital, Pierre Bénite, France., Department of Pathology, Lyon Sud University Hospital, Pierre Bénite, France., Department of Urology, Nîmes University Hospital, Nîmes, France., Department of Pathology, Nîmes University Hospital, Nîmes, France., Department of Urology, Val-de-Grâce Hospital, Paris, France., Department of Pathology, Val-de-Grâce Hospital, Paris, France., Department of Urology, Tenon Hospital, Paris, France., Department of Pathology, Tenon Hospital, Paris, France., Sorbonne University, GRC 5 Predictive ONCO-URO, AP-HP, Urology, Pitie-Salpetriere Hospital, F-75013 PARIS, France. Electronic address: .