Small Cluster Invasion Is an Efficient Pathological Predictor for Extraurothelial Recurrence-Free and Overall Survival in Patients With Upper Urinary Tract Urothelial Carcinoma
Year: 2025
Type: article
Study design: Observational Study
Abstract: Histological parameters of tumor invasiveness, including tumor budding (BD), are effective prognostic indicators in various cancer types; however, it is difficult to assess single cancer cells. This study aimed to define small cluster invasions (SCIs) as larger cell clusters than BD, which are observed in the invasive frontal region, and investigate their prognostic effects in upper urinary tract urothelial carcinoma (UUTUC). This retrospective study included 157 patients with invasive UUTUCs (86 and 71 with renal pelvic and ureteral cancers, respectively) who underwent total nephroureterectomy or partial ureteral resection at our institution between 1999 and 2021. The cutoff point for the number of cancer cells composing a single SCI was set at ≥5 and <15, and high-grade SCI was defined as ≥10 SCIs at ×20 objective magnification. The median observation period was 58.8 months. High-grade SCI was observed in 53 (34%) tumors and was significantly associated with ureteral location, postoperative chemotherapy, higher pathological T category, lymphovascular invasion, pathological lymph node metastasis, non-papillary gross finding, positive surgical margin, concomitant subtype histology, and high-grade BD. In multivariate analysis, only high-grade SCI was independently associated with shorter extraurothelial recurrence-free survival (p < 0.0001, hazard ratio [HR] = 11.0) and overall survival (p < 0.0001, HR = 10.7). In conclusion, SCI may be a novel prognostic factor in patients with invasive UUTUC.
Source: JU Open Plus
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4407750308