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Tumour front inflammation and necrosis are independent prognostic predictors in high-grade urothelial carcinoma of the bladder
  1. Anjelica Hodgson1,2,
  2. Bin Xu1,2,
  3. Raj Satkunasivam3,
  4. Michelle R Downes1,2
  1. 1Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  2. 2Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
  3. 3Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  1. Correspondence to Dr Michelle R Downes, E417, Anatomic Pathology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto ON M4N 3M5, Canada; michelle.downes{at}sunnybrook.ca

Abstract

Aims Inflammation and necrosis have been associated with prognosis in multiple epithelial malignancies. Our objective was to evaluate inflammation and necrosis in a cohort of patients with high-grade urothelial carcinomas of the bladder to determine their association with pathological parameters and their prognostic effect on relapse-free and disease-specific survival.

Methods A retrospective cohort that underwent radical cystectomy for urothelial carcinomas (n=235) was evaluated for invasive front and central inflammation using the Klintrup-Makinen assessment method. Necrosis was scored using a four-point scale. The relationship of inflammation and necrosis with stage, nodal status, carcinoma in situ, tumour size, margin status and vascular space invasion and the impact on relapse-free and disease-specific survival were calculated using appropriate statistical tests.

Results On multivariate analysis, invasive front inflammation (p=0.003) and necrosis (p=0.000) were independent predictors of relapse-free survival. Both invasive front inflammation (p=0.009) and necrosis (p=0.002) again were independent predictors of disease-specific survival. For pathological features, low invasive front inflammation was associated with lymphovascular space invasion (p=0.008), a positive soft tissue margin (p=0.028) and carcinoma in situ (p=0.042). Necrosis was statistically associated with tumours >3 cm in size (p=0.013) and carcinoma in situ (p<0.001).

Conclusions Necrosis and invasive front inflammation are additional histological variables with independent prognostic relevance in high-grade urothelial carcinoma of the bladder.

  • urothelial
  • bladder
  • inflammation
  • necrosis
  • prognosis

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Footnotes

  • Handling editor Dhirendra Govender.

  • Contributors AH: data collection and interpretation, authored manuscript. BX: study design, statistical analysis, authored manuscript. RS: study design, data collection, authored manuscript. MRD: study design, data collection and interpretation, authored manuscript.

  • Competing interests None declared.

  • Ethics approval Sunnybrook Health Sciences Centre Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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