Risk factors for subsequent development of bladder cancer after primary transitional cell carcinoma of the upper urinary tract
Risk factors for subsequent development of bladder cancer after primary transitional cell carcinoma of the upper urinary tract
复制标题
DOI：
10.1016/j.urology.2004.09.021
复制
发表时间：
2005-02-01
期刊：
影响因子：
2.1
通讯作者：
Arai, Y
中科院分区：
文献类型：
--
作者：
Matsui, Y;Utsunomiya, N;Arai, Y
目标。确定上尿路移行细胞癌患者膀胱内肿瘤复发的独立危险因素，并建立风险分层模型，以便更准确地预测复发风险。对141例临床局限性上尿路移行细胞癌行全肾输尿管切除术的患者的临床资料进行了回顾分析。既往有膀胱癌病史或伴有膀胱癌和/或随访期不到1年的患者被排除在本研究之外。采用Cox比例风险模型进行多因素分析，确定膀胱癌复发的独立危险因素。在89例患者中，37例(41.6%)在平均39.7个月(12.0~186.6个月)的随访期内发生了膀胱内肿瘤复发。多因素分析显示，肿瘤多发性、病理分期、肿瘤大小和手术方式对膀胱癌复发的风险有统计学意义(P=0.0075、P=0.0221、P=0.0377和P=0.0413)。病理分期和肿瘤大小与风险呈负相关。根据提出的预后因素建立膀胱内复发风险评分系统，根据评分将患者分为三组，两组间预后差异有统计学意义(P=0.0018)。肿瘤的多发性、病理分期、肿瘤大小和手术方式都对膀胱内肿瘤复发的发生率有显著影响。根据肿瘤生物学因素构建的风险分层模型可能对上尿路移行细胞癌患者的随访有用。(C)2005年爱思唯尔公司。
Objectives. To determine the independent risk factors for intravesical tumor recurrence in patients with primary transitional cell carcinoma of the upper urinary tract, and to develop a risk-stratification model to allow more accurate prediction of recurrence risk.Methods. Of 141 patients who underwent total nephroureterectomy for clinically localized transitional cell carcinoma of the upper urinary tract, the data from 89 patients were retrospectively reviewed. Patients with a previous history or concomitance of bladder cancer and/or a follow-up period of less than 1 year were excluded from this study. Multivariate analysis by Cox's proportional hazards model was used to determine independent risk factors for intravesical tumor recurrence.Results. Of 89 patients, 37 (41.6%) experienced subsequent intravesical tumor recurrence during a median follow-up period of 39.7 months (range 12.0 to 186.6). On multivariate analysis, tumor multiplicity, pathologic stage, tumor size, and surgical modality had a statistically significant impact on the risk of intravesical tumor recurrence (P = 0.0075, P = 0.0221, P = 0.0377, and P = 0.0413, respectively). Pathologic stage and tumor size were inversely correlated to the risk. A scoring system for the risk of intravesical recurrence was developed from the proposed prognostic factors, and the patients were stratified into three groups according to their scores, with statistically significant prognostic differences between them (P = 0.0018).Conclusions. Tumor multiplicity, pathologic stage, tumor size, and surgical modality all had a significant impact on the incidence of intravesical tumor recurrence. A risk stratification model constructed from tumor biologic factors may be useful in the follow-up of patients with transitional cell carcinoma of the upper urinary tract. (C) 2005 Elsevier Inc.