Effects of Previous or Synchronous Non-Muscle Invasive Bladder Cancer on Clinical Results after Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Multi-Institutional Study.
Effects of Previous or Synchronous Non-Muscle Invasive Bladder Cancer on Clinical Results after Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Multi-Institutional Study.
复制标题
既往或同时发生的非肌层浸润性膀胱癌对上尿路尿路上皮癌根治性肾输尿管切除术后临床结果的影响：一项多机构研究。
DOI：
10.22037/uj.v12i4.2831
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发表时间：
2015
期刊：
影响因子：
1.5
通讯作者：
T. Kwon
中科院分区：
文献类型：
--
作者：
B. Kim;Y. Ha;J. N. Lee;H. T. Kim;Tae;Jung Keun Lee;S. Byun;Y. Choi;H. Kang;S. Yun;Wun;Y. Kwon;T. Kwon
目的
评估既往或同时患有非肌层浸润性膀胱癌 (NMIBC) 对上尿路尿路上皮癌 (UTUC) 患者根治性肾输尿管切除术肿瘤学结果的影响。
材料和方法
总共有 505 名 UTUC 患者来自四个不同的机构。比较既往或同期患有和不患有 NMIBC 的患者的临床病理参数，并进行 Kaplan-Meier 估计和多变量 Cox 回归分析。
结果
中位随访时间为 38.4 个月。总共有 408 名患者患有原发性 UTUC，45 名患者 (8.9%) 有 NMIBC 病史，59 名患者 (11.7%) 患有膀胱癌，7 名患者 (1.4%) 患有这两种疾病。相关 NMIBC 患者的肿瘤更常见为多灶性 (P = .001)，并且与手术切缘阳性相关 (P = .001)。 Kaplan-Meier 估计显示，既往或同时发生的 NMIBC 与膀胱复发 (P < .001) 和局部复发/远处转移 (P = .008) 显着相关。多变量 Cox 回归模型将既往或同步 NMIBC 确定为膀胱复发的独立预测因子 (P < .001)。然而，既往或同步发生 NMIBC 并不是局部复发/远处转移的预后指标。
结论
在 UTUC 患者中，既往或同时发生 NMIBC 与根治性肾输尿管切除术后膀胱癌症复发风险增加显着相关。目前的研究结果表明，对于既往或并发 NMIBC 的患者应进行密切监测。
PURPOSE
To evaluate the effects of the presence of previous or synchronous non-muscle invasive bladder cancer (NMIBC) on the oncologic outcomes of radical nephroureterectomy in patients with upper tract urothelial carcinoma (UTUC).
MATERIALS AND METHODS
In total, 505 patients with UTUC were enrolled from four different institutions. The clinicopathologic parameters of patients with and without previous or synchronous NMIBC were compared, and Kaplan-Meier estimates and multivariate Cox regression analyses were performed.
RESULTS
The median follow-up period was 38.4 months. In all, 408 patients had primary UTUC, 45 (8.9%) had a history of NMIBC, 59 (11.7%) had concomitant bladder cancer, and seven (1.4%) had experienced both. Tumors in patients with associated NMIBC were more commonly multifocal (P = .001) and associated with surgical margin positivity (P = .001). Kaplan-Meier estimates revealed that previous or synchronous NMIBC was significantly associated with bladder recurrence (P < .001) and locoregional recurrence/distant metastasis (P = .008). A multivariate Cox regression model identified previous or synchronous NMIBC as an independent predictor of bladder recurrence (P < .001). However, the presence of previous or synchronous NMIBC was not a prognostic indicator of locoregional recurrence/distant metastasis.
CONCLUSION
In patients with UTUC, previous or synchronous NMIBC was significantly associated with an increased risk of cancer recurrences in the bladder after radical nephroureterectomy. The present findings suggest that a close monitoring should be required for the patients with previous or concomitant NMIBC.