Clinical implications of intravesical recurrence after radical nephroureterectomy for upper urinary tract urothelial carcinoma
Clinical implications of intravesical recurrence after radical nephroureterectomy for upper urinary tract urothelial carcinoma
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DOI：
10.1111/iju.13054
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发表时间：
2016-05-01
影响因子：
2.6
通讯作者：
Arai, Yoichi
中科院分区：
文献类型：
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作者：
Yamashita, Shinichi;Ito, Akihiro;Arai, Yoichi
目的：为探讨上尿路尿路上皮癌根治性肾输尿管切除术后膀胱内复发的部位和临床意义，选取2000年至2011年在东北地区泌尿系循证医学研究组的12家机构接受根治性肾输尿管切除术的上尿路上皮癌患者作为研究对象。排除既往或同时接受根治性膀胱切除术的患者。采用Kaplan-Meier法分析膀胱内复发的部位和根治性肾输尿管切除术后的生存曲线。结果：共534例患者符合本研究的条件。中位随访47个月，205例（38.4%）患者膀胱内复发。术后1、2、5年膀胱内无复发生存率分别为74.6%、62.5%、56.3%。在137例膀胱内复发的患者中，在诊断上尿路尿路上皮癌之前或诊断时没有膀胱癌，膀胱内复发的最常见部位是膀胱切开术周围（52.6%），其次是后壁（39.4%）和膀胱颈（35.8%）。共有36名患者（17.6%）在根治性肾输尿管切除术后发生肌层浸润性膀胱癌。非肌肉侵入性患者亚组的多变量分析（
Objectives: To characterize the site and clinical implications of intravesical recurrence after radical nephroureterectomy for upper urinary tract urothelial carcinoma.Methods: Patients who underwent radical nephroureterectomy for upper urinary tract urothelial carcinoma between 2000 and 2011 at 12 institutions participating in the Tohoku Urological Evidence-Based Medicine Study Group were included in the present study. Those who underwent prior or simultaneous radical cystectomy were excluded. The site of intravesical recurrence was investigated, and the survival curves after radical nephroureterectomy were analyzed retrospectively using the Kaplan-Meier method. Multivariate analyses of factors predicting survival were carried out.Results: A total of 534 patients were eligible for the present study. With a median follow up of 47 months, 205 patients (38.4%) had intravesical recurrence. The intravesical recurrence-free survival rates at 1, 2, and 5 years were 74.6%, 62.5% and 56.3%, respectively. In a subset of 137 patients with intravesical recurrence who did not have bladder cancer before or at the diagnosis of upper urinary tract urothelial carcinoma, the most frequent site of intravesical recurrence was around the cystotomy (52.6%), followed by at the posterior wall (39.4%) and at the bladder neck (35.8%). A total of 36 patients (17.6%) developed muscle-invasive bladder cancer after radical nephroureterectomy. On multivariate analyses for the subset of patients with non-muscle invasive (