Intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinomas: predictors and impact on subsequent oncological outcomes from a national multicenter study
Intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinomas: predictors and impact on subsequent oncological outcomes from a national multicenter study
复制标题
DOI：
10.1007/s00345-012-0957-3
复制
发表时间：
2013-02-01
影响因子：
3.4
通讯作者：
Roupret, Morgan
中科院分区：
文献类型：
--
作者：
Xylinas, Evanguelos;Colin, Pierre;Roupret, Morgan
为了确定预测因素并评估上尿路上皮癌根治性肾输尿管切除术（RNU）后膀胱内复发对肿瘤学结局的影响，我们使用全国多中心回顾性数据集，确定了1995年至2010年期间接受RNU的所有UTUC患者（n = 482）。通过单变量和多变量考克斯回归分析，膀胱内复发作为生存的预后因素进行了测试。总的来说，169例患者（35%）发生膀胱内复发，中位年龄为69.2岁（IQR：60-76），中位随访时间为39.5个月（IQR：25-60）。RNU术后2年和5年的精算膀胱内无复发生存率分别为72%和45%。单因素分析显示，既往膀胱肿瘤史、肿瘤多灶性、腹腔镜手术方式、病理T分期、同时存在CIS和淋巴血管浸润均与膀胱内复发相关。在多变量分析中，既往膀胱癌病史、肿瘤多灶性和腹腔镜手术方式仍然是膀胱内复发的独立预测因素。膀胱内复发的存在与疾病复发（p = 0.075）和癌症特异性死亡率（p = 0.06）方面的最差肿瘤学结局无关。在当前研究中，35%的UTUC患者在RNU后发生膀胱内复发。既往膀胱癌史、肿瘤多灶性、同时行CIS和腹腔镜手术是膀胱内复发的独立预测因素。这些发现与最近发表的数据一致，应仔细考虑，以提供一个明确的监测方案，无论尿路上皮癌在整个尿路的位置有关的管理。
To identify predictive factors and assess the impact on oncological outcomes of intravesical recurrence after radical nephroureterectomy (RNU) in upper tract urothelial carcinoma (UTUC).Using a national multicentric retrospective dataset, we identified all patients with UTUC who underwent a RNU between 1995 and 2010 (n = 482). Intravesical recurrence was tested as a prognostic factor for survival through univariable and multivariable Cox regression analysis.Overall, intravesical recurrence occurred in 169 patients (35 %) with a median age of 69.2 years (IQR: 60-76) and after a median follow-up of 39.5 months (IQR: 25-60). Actuarial intravesical recurrence-free survival estimates at 2 and 5 years after RNU were 72 and 45 %, respectively. On univariable analyses, previous history of bladder tumor, tumor multifocality, laparoscopic approach, pathological T-stage, presence of concomitant CIS and lymphovascular invasion were all associated with intravesical recurrence. On multivariable analysis, previous history of bladder cancer, tumor multifocality and laparoscopic approach remained independent predictors of intravesical recurrence. Existence of intravesical recurrence was not correlated with worst oncological outcomes in terms of disease recurrence (p = 0.075) and cancer-specific mortality (p = 0.06).In the current study, intravesical recurrence occurred in 35 % of patients with UTUC after RNU. Previous history of bladder cancer, tumor multifocality, concomitant CIS and laparoscopic approach were independent predictors of intravesical recurrence. These findings are in line with recent published data and should be considered carefully to provide a definitive surveillance protocol regarding management of urothelial carcinomas regardless of the location of urothelial carcinomas in the whole urinary tract.