Upper Urinary Tract Recurrence After Radical Cystectomy for Bladder Cancer-Who is at Risk?
Upper Urinary Tract Recurrence After Radical Cystectomy for Bladder Cancer-Who is at Risk?
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DOI：
10.1016/j.juro.2009.08.046
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发表时间：
2009-12-01
影响因子：
6.6
通讯作者：
Hautmann, Richard E.
中科院分区：
文献类型：
--
作者：
Volkmer, Bjoern G.;Schnoeller, Thomas;Hautmann, Richard E.
目的：因膀胱癌接受根治性膀胱切除术的患者存在上尿路复发的风险。我们确定了上尿路复发风险较高的患者亚组。材料和方法：1986 年 1 月至 2008 年 10 月期间在我们中心因膀胱癌接受根治性膀胱切除术的所有 1,420 名患者均纳入本研究。所有患者均获得输尿管边缘的阴性冰冻切片。数据分析包括术前肿瘤病史、膀胱切除标本的病理结果和完整随访。采用Kaplan-Meier法计算生存率。结果：截至2008年10月，观察到25例上尿路复发。 5年、10年和15年上尿路复发率总体分别为2.4%、3.9%和4.9%。其中 3 名患者患有肾盂浅表肿瘤，22 名患者患有浸润性上尿路移行细胞癌。任何非移行细胞癌患者均未出现上尿路复发。确定了上尿路复发的四个危险因素，包括原位癌病史（RR 2.3）、复发性膀胱癌病史（RR 2.6）、非微浸润性膀胱癌膀胱切除术（RR 3.8）和膀胱切除标本中远端输尿管肿瘤受累（RR 2.7）。没有这些危险因素的移行细胞癌患者 15 年上尿路复发率仅为 0.8%。这一比率随着阳性危险因素的数量而增加，即具有 1 至 2 种危险因素的患者为 8.4%，具有 3 至 4 种危险因素的患者为 13.5%。结论：因移行细胞癌接受膀胱切除术且至少有 1 个上尿路复发危险因素的患者应比非移行细胞癌或无任何这些危险因素的患者有更密切的随访方案。
Purpose: Patients who underwent radical cystectomy for bladder cancer are at risk for upper urinary tract recurrence. We identified subgroups of patients at increased risk for upper urinary tract recurrence.Materials and Methods: All 1,420 patients who underwent radical cystectomy for bladder cancer at our center between January 1986 and October 2008 were included in the study. Negative frozen sections of the ureteral margins were obtained from all patients. Data analysis included preoperative tumor history, pathological findings of the cystectomy specimen and complete followup. Survival was calculated using the Kaplan-Meier method.Results: Until October 2008, 25 cases of upper urinary tract recurrence were observed. The overall rate of upper urinary tract recurrence at 5, 10 and 15 years was 2.4%, 3.9% and 4.9%, respectively. Of the patients 3 had superficial tumors of the renal pelvis and 22 had invasive upper tract transitional cell carcinoma. Upper urinary tract recurrence did not develop in any patients with nontransitional cell carcinoma. Four risk factors for upper urinary tract recurrence were identified including history of carcinoma in situ (RR 2.3), history of recurrent bladder cancer (RR 2.6), cystectomy for nommiscle invasive bladder cancer (RR 3.8) and tumor involvement of the distal ureter in the cystectomy specimen (RR 2.7). Patients with transitional cell carcinoma who had none of these risk factors had an upper urinary tract recurrence rate of only 0.8% at 15 years. This rate increased with the number of positive risk factors, ie 8.4% in patients with 1 to 2 risk factors and 13.5% in those with 3 to 4 risk factors.Conclusions: Patients who underwent cystectomy for transitional cell carcinoma and with at least 1 risk factor for upper urinary tract recurrence should have closer followup regimens than those with nontransitional cell carcinoma or without any of these risk factors.