Influence of previous or synchronous bladder cancer on oncologic outcomes after radical nephroureterectomy for upper urinary tract urothelial carcinoma
Influence of previous or synchronous bladder cancer on oncologic outcomes after radical nephroureterectomy for upper urinary tract urothelial carcinoma
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DOI：
10.1016/j.urolonc.2012.08.010
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发表时间：
2014-01-01
影响因子：
2.7
通讯作者：
Roupret, Morgan
中科院分区：
文献类型：
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作者：
Pignot, Geraldine;Colin, Pierre;Roupret, Morgan
目的探讨膀胱癌（BC）病史或同期BC对根治性肾输尿管切除术（RNU）患者预后和生存的影响。使用多机构的回顾性数据库，我们确定了662例接受根治性肾输尿管切除术的上尿路尿路上皮癌（UUT-UC）患者，在1995年到2010年间。我们根据诊断时的BC或伴随BC或两者的病史分析临床病理特征和结局。BC被评估为膀胱复发和survival.Results的预后因素：总体而言，83（12.5%）例患者有以前的BC，62（9.4%）表现出伴随BC，和75（11.3%）与以前和当前的BC。女性和非吸烟者的BC病史较少见（分别为P < 0.0001和P = 0.013）。合并膀胱癌患者输尿管肿瘤多见（P <1.0001），上尿路多见（P < 0.0001）。无BC的肿瘤更可能与局部晚期相关（P = 0.024）。中位随访时间为37.3个月，31.4%的患者出现BC复发，2.9%的患者出现对侧上尿路肿瘤。多因素分析显示，既往或同期乳腺癌（P = 0.01）和手术切缘阳性（P = 0.03）是乳腺癌复发的独立预后因素。无转移生存率和癌症特异性生存率没有显着差异，根据相关的BC status.Conclusions：在没有以前或伴随BC的患者，上尿路肿瘤更频繁地定位于肾盂，并与一个更具侵入性的状态在诊断时。然而，没有先前或同步BC的ilUT-LIC的存在对肾输尿管切除术后的存活率没有显著影响。(C)2014 Elsevier Inc. All rights reserved.
Objective The objective of the study was to evaluate the effect of a history of bladder cancer (BC) or synchronous BC on the prognosis and survival of patients who have undergone radical nephroureterectomy (RNU).Methods and materials: Using a multi-institutional, retrospective database, we identified 662 patients with upper urinary tract urothelial carcinoma (UUT-UC) treated by radical nephroureterectomy, between 1995 and 2010. We analyzed clinicopathologic characteristics and outcomes according to the history of BC or concomitant BC or both, at the time of diagnosis. BC was evaluated as a prognostic factor for bladder recurrence and survival.Results: Overall, 83 (12.5%) patients had previous BC, 62 (9.4%) exhibited concomitant BC, and 75 (11.3%) presented with both previous and current BC. A history of BC was less seen in women and nonsmokers (P < 0.0001 and P = 0.013, respectively). The patients with associated BC had more tumors located in the ureter (P < (1.0001), as well as more multiple locations in the upper tract (P < 0.0001). The tumors without concomitant BC were more likely to be associated with locally advanced stages (P = 0.024). At a median follow-up time of 37.3 months, 31.4% of patients experienced BC recurrence and 2.9% developed contralateral upper tract tumor. Using multivariate analyses, the previous or synchronous BC (P = 0.01) and positive surgical margins (P = 0.03) are independent prognostic factors for BC recurrence. The metastasis-free survival and cancer-specific survival rates did not significantly differ according to the associated BC status.Conclusions: In patients without previous or concomitant BC, the upper tract tumors are more frequently localized in the renal pelvis and are associated with a more invasive status at the time of diagnosis. Nevertheless, the presence of ilUT-LIC without previous or synchronous BC did not significantly affect the suivival rates after nephroureterectomy. (C) 2014 Elsevier Inc. All rights reserved.