Significant Predictive Factors for Prognosis of Primary Upper Urinary Tract Cancer after Radical Nephroureterectomy in Taiwanese Patients
Significant Predictive Factors for Prognosis of Primary Upper Urinary Tract Cancer after Radical Nephroureterectomy in Taiwanese Patients
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DOI：
10.1016/j.eururo.2008.01.054
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发表时间：
2008-11-01
期刊：
影响因子：
23.4
通讯作者：
Huang, Chun-Hsiung
中科院分区：
文献类型：
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作者：
Li, Ching-Chia;Chang, Tu-Hao;Huang, Chun-Hsiung
目的：随访原发性上尿路癌（UUT）肾输尿管切除术患者的远期预后，评估肿瘤复发和生存的预测因素。方法：1990年1月至2005年6月，我院对260例原发性上尿路移行细胞癌（TCC）患者进行了根治性肾输尿管切除术。对这些患者的医疗记录进行了回顾性审查。分析临床和组织病理学数据以评估预测因素。结果：中位随访时间为 52 个月。总共有 89 名患者（34.1%）随后出现膀胱肿瘤。膀胱肿瘤复发的预测因素是男性和肾功能不全。 16 名患者（6.2%）出现局部复发；只有肿瘤分期与局部复发显着相关。 12 名患者 (4.6%) 诊断出异时性对侧 UUT 肿瘤，性别是唯一的预测因素。在 260 名患者中，167 名患者 (63.9%) 在中位随访时间 56.5 个月时无病生存，45 名患者 (17.2%) 在中位随访时间 20 个月时死于尿路上皮癌。只有肿瘤分期是预测癌症特异性生存的预后因素。结论：在根治性肾输尿管切除术后的 UUT-TCC 患者中，肿瘤分期是局部复发和癌症特异性生存的唯一预后因素。肾功能不全的男性患者应警惕膀胱肿瘤复发的可能性。由于女性患者更容易出现对侧复发，因此对于生活在高发区的女性患者，应更频繁地进行肾脏超声检查、静脉肾盂造影或逆行肾盂造影。 (C) 2008 年欧洲泌尿外科协会。由 Elsevier B.V. 出版。保留所有权利。
Objectives: To follow up the long-term prognosis of patients who under-went nephroureterectomy for primary upper urinary tract (UUT) cancer and to evaluate the predictive factors of tumour recurrence and survival.Methods: Between January 1990 and June 2005, 260 patients with primary UUT transitional cell carcinoma (TCC) underwent radical nephroureterectomy at our institution. The medical records of these patients were retrospectively reviewed. The clinical and histopathological data were analyzed to evaluate predictive factors.Results: The median follow-up time was 52 mo. In total, 89 patients (34.1%) developed subsequent bladder tumours. Predictive factors of bladder tumour recurrence were being male and having renal insufficiency. Local recurrence developed in 16 patients (6.2%); only the tumour stage was significantly associated with local recurrence. Metachronous contralateral UUT tumour was diagnosed in 12 patients (4.6%), with gender being the only predictive factor. Of the 260 patients, 167 (63.9%) were disease-free and alive at a median follow-up of 56.5 mo, and 45 (17.2%) died of urothelial cancer at a median period of 20 mo. only the tumour stage was a prognostic factor to predict cancer-specific survival.Conclusions: In patients with UUT-TCC after radical nephroureterectomy, tumour stage is the only prognostic factor for both local recurrence and cancer-specific survival. Male patients with renal insufficiency should be alerted to the possibility of bladder tumour recurrence. Because female patients were more likely to develop contralateral recurrences, renal ultrasonography, intravenous pyelography, or retrograde pyelography should be performed more frequently for female patients who live in the high-prevalence area. (C) 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.