Prognostic pathological factors in radical cystectomy after neoadjuvant chemotherapy

Autor:	Kiril Trpkov, Wassim Kassouf, David M. Berman, Kash Visram, Robert Siemens, Daniel Athanazio, Shraddha Solanki, Fadi Brimo, Elan Hahn, Tamara Jamaspishvili, Asli Yilmaz, Schuharazad Abro, Michelle R Downes, Güliz A. Barkan
Rok vydání:	2018
Předmět:	Adult Male medicine.medical_specialty Histology Invasive urothelial carcinoma Lymphovascular invasion medicine.medical_treatment 030232 urology & nephrology Kaplan-Meier Estimate Cystectomy Gastroenterology Disease-Free Survival Pathology and Forensic Medicine 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Carcinoma Humans Stage (cooking) Pathological Aged Aged 80 and over Carcinoma Transitional Cell Chemotherapy business.industry Chemoradiotherapy Adjuvant General Medicine Middle Aged Prognosis medicine.disease Neoadjuvant Therapy Treatment Outcome Urinary Bladder Neoplasms 030220 oncology & carcinogenesis T-stage Female business
Zdroj:	Histopathology. 73:732-740
ISSN:	0309-0167
DOI:	10.1111/his.13654
Popis:	AIMS We undertook a systematic evaluation of the prognostic value of numerous histological factors in 165 radical cystectomies (RCs) of patients with invasive urothelial carcinoma (UC) who underwent surgery after neoadjuvant chemotherapy (NAC). METHODS AND RESULTS Tumour regression grade (TRG) and therapy-related stromal and epithelial changes were also recorded. Locally advanced disease (≥pT2 and/or pN+) was present in 64% of patients, 22% had no evidence of residual carcinoma (pT0 + pN0), and 28% had no evidence of residual muscle-invasive carcinoma (≤pT1 + N0). TRG1, TRG2 and TRG3 were found in 32%, 15% and 50% of patients, respectively. Histological variants of UC were reported in 25% of cases. The most common therapy-related stromal change was fibroblastic reaction (78%), and the most common epithelial change in residual UC was smudgy and poorly preserved chromatin (28%). Prominent stromal and epithelial changes were noted in 41% and 5% of RCs, respectively. Progression was found in 45% of patients, and cancer-related deaths occurred in 30%. Multivariate analysis showed that the only independent prognostic parameters for progression were T stage, N stage, lymphovascular invasion, and margin status. Similarly, only T stage, N stage and margin status correlated with cancer-related deaths. Neither TRG nor any of the stromal-related or epithelial-related variables correlated with outcome. CONCLUSIONS We confirm that the traditional and routinely reported histological parameters in RC post-NAC remain the most powerful prognosticators of disease course. The significance of TRG in the bladder remains unconfirmed.
Databáze:	OpenAIRE
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