학술논문
Prognostic role of decreased E-cadherin expression in patients with upper tract urothelial carcinoma: a multi-institutional study
Document Type
Original Paper
Author
Favaretto, Ricardo L.; Bahadori, Atessa; Mathieu, Romain; Haitel, Andrea; Grubmüller, Bernhard; Margulis, Vitaly; Karam, Jose A.; Rouprêt, Morgan; Seitz, Christian; Karakiewicz, Pierre I.; Cunha, Isabela W.; Zequi, Stenio C.; Wood, Christopher G.; Weizer, Alon Z.; Raman, Jay D.; Remzi, Mesut; Rioux-Leclercq, Nathalie; Jacquet-Kammerer, Solene; Bensalah, Karim; Lotan, Yair; Bachmann, Alexander; Rink, Michael; Briganti, Alberto; Shariat, Shahrokh F.
Source
World Journal of Urology. January 2017 35(1):113-120
Subject
Language
English
ISSN
0724-4983
1433-8726
1433-8726
Abstract
Purpose: To assess the role of E-cadherin as prognostic biomarker in upper tract urothelial carcinoma (UTUC) in a large multi-institutional cohort of patients.Methods: Immunohistochemistry technique was used to evaluate E-cadherin expression in 678 patients with unilateral, sporadic UTUC treated with RNU. E-cadherin expression was considered decreased if 10 % or more cells had decreased expression (<90 %).Results:Decreased E-cadherin expression was observed in 353 patients (52.1 %) and was associated with advanced pathological stage (P < 0.001), higher grade (P < 0.001), lymph node metastasis (P = 0.006), lymphovascular invasion (P < 0.001), concomitant carcinoma in situ (P < 0.001), multifocality (P = 0.004), tumor necrosis (P = 0.020) and sessile architecture (P < 0.001). Within a median follow-up of 30 months (interquartile range 15–57), 171 patients (25.4 %) experienced disease recurrence and 150 (21.9 %) died from UTUC. In univariable analyses, decreased E-cadherin expression was significantly associated with worse recurrence-free survival (P < 0.001) and cancer-specific survival CSS (P = 0.006); however, in multivariable analyses, it was not (P = 0.74 and 0.84, respectively). The lack of independent prognostic value of E-cadherin remained true in all subgroup analyses.Conclusion:In UTUC patients treated with RNU, decreased E-cadherin expression is associated with features of biologically and clinically aggressive disease and worse outcome in univariable, but not multivariable, analyses. If E-cadherin’s association with factors of advanced disease is confirmed on UTUC biopsy specimens, it could be used to help in the clinical decision-making regarding kidney-sparing approaches and/or neo-adjuvant chemotherapy.