Factors impacting survival in patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy.
Factors impacting survival in patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy.
复制标题
影响接受根治性肾输尿管切除术的上尿路尿路上皮癌患者生存的因素。
DOI：
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发表时间：
2012
期刊：
影响因子：
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通讯作者：
A. Méjean
中科院分区：
文献类型：
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作者：
P. Mouracade;M. Velten;M. Gigante;O. Alenda;G. Ploussard;F. Obadia;M. Timsit;A. Méjean
介绍
本研究旨在评估不同预后因素对肾输尿管切除术治疗上尿路上皮癌（UTUC）生存率的影响，并探讨这些因素是否具有独立的预后意义。
材料和方法
一项对来自两家教学医院的机构数据库进行的回顾性审查确定了1985年至2005年期间连续269例接受肾输尿管切除术的UTUC患者。平均随访80.6个月（中位70.3个月）。随访完成至2009年1月。肿瘤位置和其他临床病理变量进行了生存分析。收集的数据包括年龄、性别、肿瘤特征（pT分期、分级、淋巴结状态）、肿瘤位置、化疗使用情况和诊断时间。根据肿瘤位置将肿瘤位置分为两组（肾盂和输尿管）。
结果
该队列的5年和10年总生存率估计值分别为71.3%和40.0%。根据肿瘤位置，肾盂的生存率分别为73.6%和47.0%，输尿管的生存率分别为67.8%和32.3%（对数秩检验：p = 0.027）。在多因素分析中，在临床病理变量中，T分期是最有意义的预后因素（p < 0.001）。淋巴结受累（p = 0.005）、高级别（p < 0.001）、首次诊断（p < 0.001）和输尿管肿瘤位置（p = 0.003）与较低的生存率显著相关。UTUC的预后随着时间的推移而改善：在最后一次诊断期间（2001-2005年），生存率明显更好（p < 0.002）。
结论
肿瘤部位和诊断时间是影响上尿路移行细胞癌预后的独立因素。
INTRODUCTION
This study aims to assess the influence of different prognostic factors on survival of upper tract urothelial carcinoma (UTUC) managed by nephroureterectomy and to investigate whether these factors have an independent prognostic significance.
MATERIALS AND METHODS
A retrospective review of institutional databases from two teaching hospitals identified 269 consecutive patients with UTUC managed with nephroureterctomy between 1985 and 2005. Mean follow up was 80.6 months (median 70.3 months). Follow up was completed until January 2009. Tumor location and other clinicopathological variables were analyzed regarding survival. Data accrued included age, gender, tumor characteristics (pT stage, grade, lymph node status), tumor location, use of chemotherapy and period of diagnosis. Tumor location was divided into two groups (renal pelvis and ureter) based on the location of the tumor.
RESULTS
Five year and 10 year overall survival estimates for this cohort were 71.3% and 40.0% respectively. According to tumor location, survival was 73.6% and 47.0% for the renal pelvis versus 67.8% and 32.3% for the ureter, respectively (log rank test: p = 0.027). In multivariate analysis, among the clinicopathological variables, T stage was the most significant prognostic factor (p < 0.001). Nodal involvement (p = 0,005), high grade (p < 0.001), first period of diagnosis (p < 0.001) and ureteral tumor location (p = 0.003) were significantly associated with lower survival rates. Prognosis of UTUC improved over time: survival was significantly better during the last period of diagnosis (2001-2005) (p < 0.002).
CONCLUSIONS
Tumor location and diagnostic period should be considered as an independent prognostic factor for upper tract transitional cell carcinoma.