Presence of Concomitant Non-muscle-invasive Bladder Cancer in Chinese Patients with Upper Tract Urothelial Carcinoma: Risk Factors, Characteristics, and Predictive Value
Presence of Concomitant Non-muscle-invasive Bladder Cancer in Chinese Patients with Upper Tract Urothelial Carcinoma: Risk Factors, Characteristics, and Predictive Value
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DOI：
10.1245/s10434-014-4302-5
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发表时间：
2015-08-01
影响因子：
3.7
通讯作者：
Zhou, Liqun
中科院分区：
文献类型：
--
作者：
Fang, Dong;Zhang, Lei;Zhou, Liqun
目的探讨上尿路尿路上皮癌 (UTUC) 患者并发非肌层浸润性膀胱癌 (NMIBC) 的特征、预测危险因素和预后效果。我们对 2000 年至 2012 年在中国一个高容量中心接受根治性切除术的 727 名连续 UTUC 患者进行了评估。所有患者术前均进行膀胱镜检查。先前或同时进行全膀胱切除术的患者被排除。总体而言，73 名患者 (10.0%) 患有 NMIBC。伴随的 NMIBC 与既往膀胱癌 (p = 0.003)、肿瘤位于输尿管 (p = 0.008)、多灶性 (p < 0.001) 和术前肾功能不全 (p = 0.023) 相关。伴随的 NMIBC 的存在预示着较低的肿瘤分期 (p = 0.019)、乳头状结构 (p = 0.023) 和器官局限性疾病 (pT < 3 和 N-，p = 0.006)。中位随访时间为 57 个月。伴随 NMIBC 的存在是膀胱复发的危险因素 (p < 0.001)，特别是在非肌肉浸润性 UTUC 的患者中，它会影响癌症特异性生存（比值比 1.614，p = 0.030）和对侧复发（比值比，1.907，p = 0.016）。合并NMIBC多发生在外侧壁或膀胱颈，而膀胱内复发多发生在手术部位或后壁附近。合并NMIBC最常见的部位是外侧壁和膀胱颈，既往膀胱癌、肿瘤位于输尿管、肿瘤多灶性、术前肾功能不全是合并NMIBC的危险因素。伴随 NMIBC 的存在预示着相对较好的病理结果，但膀胱复发率较高，而早期 UTUC 患者对术后生存的影响有限。潜在的机制需要进一步研究。
To explore the characteristics, predictive risk factors, and prognostic effect of concomitant non-muscle-invasive bladder cancer (NMIBC) in patients with upper tract urothelial carcinoma (UTUC).We evaluated 727 consecutive UTUC patients treated with radical resection between 2000 and 2012 in a high-volume center of China. Preoperative cystoscopy was performed in all patients. Patients with previous or concomitant total cystectomy were excluded.Overall, 73 patients (10.0 %) had NMIBC. Concomitant NMIBC was associated with previous bladder cancer (p = 0.003), tumor located in ureter (p = 0.008), multifocality (p < 0.001), and preoperative renal insufficiency (p = 0.023). The presence of concomitant NMIBC was predictive for lower tumor stage (p = 0.019), papillary architecture (p = 0.023), and organ-confined disease (pT < 3 and N-, p = 0.006). The median follow-up duration was 57 months. The presence of concomitant NMIBC was a risk factor for bladder recurrence (p < 0.001), and particularly in patients with non-muscle-invasive UTUCs, it affects cancer-specific survival (odds ratio 1.614, p = 0.030) and contralateral recurrence (odds ratio, 1.907, p = 0.016). Most concomitant NMIBC were found at the lateral wall or bladder neck, while most intravesical recurrences occurred near the site of surgery or posterior wall.The most common site for concomitant NMIBC was lateral wall and bladder neck, and previous bladder cancer, tumor located in ureter, tumor multifocality, and preoperative renal insufficiency were risk factors for concomitant NMIBC. The presence of concomitant NMIBC is predictive for relative better pathologic outcomes but higher rate of bladder recurrence, while the effect on postoperative survival was limited with patients early-stage UTUCs. The potential mechanisms need further investigation.