Intravesical Recurrence after Surgical Management of Urothelial Carcinoma of the Upper Urinary Tract
Intravesical Recurrence after Surgical Management of Urothelial Carcinoma of the Upper Urinary Tract
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DOI：
10.1159/000338644
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发表时间：
2012-01-01
影响因子：
1.6
通讯作者：
Henmi, Akihiro
中科院分区：
文献类型：
--
作者：
Hirano, Daisaku;Okada, Yasuhiro;Henmi, Akihiro
目的：探讨上尿路尿路上皮癌（UUT-UC）患者行肾输尿管切除术后膀胱内复发（IVR）的临床病理危险因素。研究方法：我们确定了151例既往或并发膀胱癌的连续患者，这些患者因UUT-UC接受了肾输尿管切除术。评估IVR与肿瘤位置、大小和多灶性、手术方式和时间、分期、分级、淋巴血管浸润、区域淋巴结转移、术前尿细胞学检查和围手术期化疗的关系。中位随访时间为24个月。结果：151例患者中，51例（34%）在肾输尿管切除术后发生IVR，其中50例（98%）在2年内发生IVR。通过单因素分析确定肿瘤多灶性和部位（位于输尿管）为IVR的危险因素。在多变量分析中，只有肿瘤多灶性（相对风险：4.024，p = 0.001）是IVR的独立预测因子。有和没有IVR的患者的十年癌症特异性生存率分别为68%和52%（p = 0.06）。结论：肿瘤多灶性是UUT-UC术后发生IVR的重要危险因素。这些结果表明，尽管大多数IVR发生在治疗后2年内，但有必要使用膀胱镜更密切地随访此类患者。然而，IVR不太可能表明预后较差。版权所有（C）2012 S. Karger AG，巴塞尔
Objectives: To elucidate clinicopathological risk factors for intravesical recurrence (IVR) in patients undergoing nephroureterectomy for upper urinary tract urothelial carcinoma (UUT-UC). Methods: We identified a study population of 151 consecutive patients without previous or concurrent bladder cancer who underwent nephroureterectomy for UUT-UC. IVR was assessed in relation to tumor location, size, and multifocality, operation modality and time, stage, grade, lymphovascular invasion, regional lymph node metastasis, preoperative urinary cytology, and perioperative chemotherapy. The median follow-up time was 24 months. Results: Of 151 patients, 51(34%) developed IVR after nephroureterectomy, and 50 (98%) of the patients presented with IVR within 2 years. Tumor multifocality and site (located in ureter) were determined as risk factors for IVR by univariate analysis. In a multivariate analysis, only tumor multifocality (relative risk: 4.024, p = 0.001) was an independent predictor of IVR. Ten-year cancer-specific survival rates for the patients with and without IVR were 68 and 52%, respectively (p = 0.06). Conclusions: Tumor multifocality is a significant risk factor in developing IVR after surgery for UUT-UC. These results indicate that despite most IVR occurring within 2 years of treatment, it is necessary to follow such patients more closely using cystoscopy. However, IVR is unlikely to indicate a poorer prognosis. Copyright (C) 2012 S. Karger AG, Basel