Squamous differentiation is the most common histological variation in urothelial carcinoma (UC). However, the clinical significance of squamous differentiation in upper urinary tract UC is unclear. To investigate the significance of squamous differentiation, hematoxylin and eosin stained slides from 140 patients with upper urinary tract UC who underwent nephroureterectomy were reviewed by a single pathologist and the presence of squamous differentiation was recorded.
Squamous differentiation was observed in 23 out of 140 studied cases (16%). Squamous differentiation significantly correlated with several adverse prognostic factors including histological grade 3 tumors, presence of lymphovascular invasion, concomitant carcinoma in situ, advanced tumor stage, and occurrence of lymph node metastasis. The Kaplan-Meier and univariate Cox regression analyses revealed that the presence of squamous differentiation was significantly associated with shorter metastasis-free survival [log-rank P = 0. 030; univariate hazard ratio (HR), 2. 30; 95% confidence interval (CI), 1. 06-4. 99], cancer-specific survival (log-rank P = 0. 0024; univariate HR 3. 34; 95% CI, 1. 47-7. 85), and overall survival (log-rank P = 0. 018; univariate HR 2. 39; 95% CI, 1. 13-5. 06) after nephroureterectomy. However, in multivariate analyses, squamous differentiation was not significantly associated with patient outcomes. These findings suggest that squamous differentiation is associated with disease progression, but is not an independent predictor of a worse prognosis in patients with upper urinary tract UC.
International journal of clinical and experimental pathology. 2015 Jun 01*** epublish ***
Naohiro Makise, Teppei Morikawa, Taketo Kawai, Tohru Nakagawa, Haruki Kume, Yukio Homma, Masashi Fukayama
Department of Pathology, Graduate School of Medicine, The University of Tokyo Tokyo, Japan. , Department of Pathology, Graduate School of Medicine, The University of Tokyo Tokyo, Japan. , Department of Urology, Graduate School of Medicine, The University of Tokyo Tokyo, Japan. , Department of Urology, Graduate School of Medicine, The University of Tokyo Tokyo, Japan. , Department of Urology, Graduate School of Medicine, The University of Tokyo Tokyo, Japan. , Department of Urology, Graduate School of Medicine, The University of Tokyo Tokyo, Japan. , Department of Pathology, Graduate School of Medicine, The University of Tokyo Tokyo, Japan.