Prognostic implicationsof morphometry stromal parameters of renal pelvis and ureteraltransitional cell carcinomas

To evaluate prognostic value of morphometric studies of the stroma
of transitional cell carcinomas of the renal pelvis and ureter, we
studied retrospectively the data of primary examination and follow-up
of 75 patients (49 males, 65% and 26 females, 35%; mean age
61.9+1.2 years) given radical surgical treatment for cancer of the renal
pelvis and ureter. Five-year survival in the absence of tumor progression
was 23%. Morphological examination diagnosed transitional cell
carcinoma with invasion pTl, pT2, pT3 and pT4 in 3(4%), 15(20%),
47(63%) and 10(13%) cases and differentiation degree Gl, G2, G3
in 31(41%), 15(20%) and 29(39%) cases, respectively. In addition to
the standard morphological examination of the tumor, we made morphometry
of stromal and tumor area, analysed composition and count
of stromal effector cells (lymphocytes, eosinophilic and neutrophilic
leukocytes, macrophages, mast and plasmic cells), the degree of stromal
vascularization. Prognostic value of the above parameters was estimated
according to significance of their correlation with postoperative
survival of the patients. The survival correlated with the depth
of cancer invasion (p = 0.005) and differentiation of tumor tissue
(p = 0.006), high cell infiltration of tumor stroma is prognostically
unfavourable (ft, = 0.03; F= 3.41; p = 0.069) as well as weak presentation
of stromal component of the tumor (p = 0.056). The lowest
survival was observed in patients with cancer of the renal pelvis and
ureter with a great number of mast cells (p = 0.056), macrophages
(p = 0.037) and neutrophils (p = 0.029) in the tumor stroma. According
to the results of multiple regression analysis (R2 ~ 0.0&; F= 5.42;
p = 0.024), five-year postoperative survival most closely correlated
with cancer invasion depth (p < 0.001), degree of tumor cells differentiation
(p < 0.001) and number of macrophages infiltrating tumor
stroma (p < 0.001). Significance of survival prognosis for patients with
cancer of renal pelvis and ureter can be raised by estimation of mean
number of free stromal cells and expression of stromal component.