Risk Factors for Unfavorable Pathological Types of Intravesical Recurrence in Patients With Upper Urinary Tract Urothelial Carcinoma Following Radical Nephroureterectomy.
Risk Factors for Unfavorable Pathological Types of Intravesical Recurrence in Patients With Upper Urinary Tract Urothelial Carcinoma Following Radical Nephroureterectomy.
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上尿路尿路上皮癌根治性肾输尿管切除术后膀胱内复发不良病理类型的危险因素
DOI：
10.3389/fonc.2022.834692
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发表时间：
2022
影响因子：
4.7
通讯作者：
中科院分区：
文献类型：
--
作者：
许多研究调查了上尿路尿路上皮癌（UTUC）患者根治性肾输尿管切除术（RNU）后膀胱内复发（IVR）的危险因素。然而，很少有研究探索 RNU 后 IVR 不利病理类型的预测因素。我们回顾性分析了 155 名接受 RNU 治疗后诊断为膀胱癌 (BC) 的患者。二元逻辑回归用于单变量和多变量分析。列线图是根据多变量分析开发的。一致性指数（C 指数）用于评估列线图的性能。我们通过生成校准图来进行内部验证。肌层浸润性 BC (MIBC) 与手术间隔 (p = 0.004) 和 UTUC T 分期 (p = 0.016) 显着相关。手术间隔 (p = 0.002) 和 UTUC T 分期 (p = 0.028) 也是 BC > 3 cm 的危险因素。 UTUC 分级 (p = 0.015)、手术间隔 (p = 0.003) 和肾积水 (p = 0.049) 是高级别 BC (HGBC) 的独立预测因子。 MIBC (p = 0.018) 和手术方法 (p = 0.003) 与多焦点 IVR 相关。此外，MIBC和HGBC与UTUC分级（p = 0.009）、手术间隔（p = 0.001）和肾积水（p = 0.023）相关。此外，只有手术间隔（p = 0.036）是具有至少一种不利病理类型的 BC 的预测因子。我们开发了 MIBC、HGBC、BC > 3 cm 以及 MIBC 和/或 HGBC 的列线图。列线图的校准曲线显示观察情况和预测情况之间具有良好的一致性。列线图的 C 指数分别为 0.820 (95% CI, 0.747–0.894)、0.728 (95% CI, 0.649–0.809)、0.770 (95% CI, 0.679–0.861) 和 0.749 (95% CI, 0.671–0.827)，分别。目前的研究发现，手术间隔、UTUC T分期、UTUC分级、手术入路和肾积水是RNU后IVR不良病理类型的独立预测因素。基于这些预测因子的列线图被开发并进行内部验证，以评估发生不利的 IVR 病理类型的风险。此外，患有不良病理类型 BC 的高风险患者可能会受益于 RNU 后 1 年后通过早期检测 IVR 进行更积极的随访。
Numerous studies have investigated the risk factors of intravesical recurrence (IVR) after radical nephroureterectomy (RNU) in patients with upper urinary tract urothelial carcinoma (UTUC). However, few studies explore the predictors for unfavorable pathological types of IVR following RNU. We retrospectively reviewed 155 patients diagnosed with bladder cancer (BC) following RNU. Binary logistic regression was used for the univariable and multivariable analyses. Nomograms were developed based on the multivariable analysis. The concordance index (C-index) was used to assess the performance of the nomograms. We performed internal validation by generating calibration plots. Muscle-invasive BC (MIBC) was significantly correlated with operation interval (p = 0.004) and UTUC T-stage (p = 0.016). Operation interval (p = 0.002) and UTUC T-stage (p = 0.028) were also risk factors for BC > 3 cm. UTUC grade (p = 0.015), operation interval (p = 0.003), and hydronephrosis (p = 0.049) were independent predictors for high-grade BC (HGBC). MIBC (p = 0.018) and surgical approach (p = 0.003) were associated with multifocal IVR. Besides, MIBC and HGBC were associated with UTUC grade (p = 0.009), operation interval (p = 0.001), and hydronephrosis (p = 0.023). Moreover, only operation interval (p = 0.036) was a predictor for BC with at least one unfavorable pathological type. We developed nomograms for MIBC, HGBC, BC > 3 cm, and MIBC and/or HGBC. The calibration curves of the nomograms showed good agreement between the observation and prediction cases. The C-indexes of the nomograms were 0.820 (95% CI, 0.747–0.894), 0.728 (95% CI, 0.649–0.809), 0.770 (95% CI, 0.679–0.861), and 0.749 (95% CI, 0.671–0.827), respectively. The current study found that operation interval, UTUC T-stage, UTUC grade, surgical approach, and hydronephrosis are independent predictors for unfavorable pathological types of IVR following RNU. Nomograms based on these predictors were developed and internally validated to assess the risk of developing unfavorable pathological types of IVR. Furthermore, patients at high risk of developing unfavorable pathological types BC may benefit from more active follow-up 1 year after RNU by early detection of IVR.
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影响因子：
23.4
作者：
Roupret, Morgan;Babjuk, Marko;Shariat, Shahrokh F.
通讯作者：
Shariat, Shahrokh F.
影响因子：
3.2
作者：
Sato, Goro;Yoshida, Takashi;Matsuda, Tadashi
通讯作者：
Matsuda, Tadashi
影响因子：
4.5
作者：
Kates, Max;Badalato, Gina M.;McKiernan, James M.
通讯作者：
McKiernan, James M.
影响因子：
3.4
作者：
Cosentino, Marco;Palou, Joan;Villavicencio-Mavrich, Humberto
通讯作者：
Villavicencio-Mavrich, Humberto
影响因子：
23.4
作者：
Simone, Giuseppe;Papalia, Rocco;Gallucci, Michele
通讯作者：
Gallucci, Michele