The prognostic value of central pathology review in upper urinary tract cancer (UTUC) remains inadequately addressed in existing literature. In this study, we conducted an extensive central pathology review and presented its influence on multi-center UTUC studies. We conducted a retrospective review of patients who underwent radical nephroureterectomy or segmental resection for UTUC to determine eligibility for central pathology review. In the Taiwan UTUC Collaboration cohort, 377 cases met the criteria for pathology review. We assessed agreement between pathologists using both the total percentage of agreement and simple kappa statistics. The prognostic implications of original and review pathology for various parameters were examined using the Cox regression model. This study included 209 female and 168 male participants. Pathology review revealed substantial interobserver variability in pT staging, with a particularly high rate of pT2 cases being upgraded to pT3 upon central review (17/70 pT2 stage made by local pathologists were finally confirmed as pT3 disease by the review pathologist). The local pathologist cohort identified fewer significant histological predictors in survival models compared to the review pathology cohort. Advanced pT stage, perineural invasion (PNI), and positive surgical margin were independent predictors of poorer overall survival and cancer-specific survival. PNI, lymphatic vascular invasion, and positive surgical margin were independent predictors of disease recurrence. Substantial interobserver variability in histological assessment underscores the importance of centralized pathology review for both multi-center studies and accurate post-operative management of UTUC patients. Advanced stage, perineural invasion, and margin status were significant histological predictors of oncological outcomes.
Scientific reports. 2024 Aug 23*** epublish ***
Yung-Tai Chen, Hsiang Ying Lee, Wen-Jeng Wu, Ching-Chia Li, Chih-Hung Lin, Chung-Tai Yue, Yuan-Hong Jiang, Yu-Khun Lee, Kuan Hsun Huang, Yao-Chou Tsai
Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan., Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan., Department of Pathology, Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung, Taiwan., Department of Anatomic Pathology, Taipei TzuChi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan., Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan., Department of Urology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Chiayi, Taiwan., Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, 23142, Taiwan. .