Nephroureterectomy for treating upper urinary tract transitional cell carcinoma: time to change the treatment paradigm?
Nephroureterectomy for treating upper urinary tract transitional cell carcinoma: time to change the treatment paradigm?
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DOI：
10.1111/j.1464-410x.2006.06524.x
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发表时间：
2006-12-01
影响因子：
4.5
通讯作者：
Matin, Surena F.
中科院分区：
文献类型：
--
作者：
Brown, Gordon A.;Busby, J. Erik;Matin, Surena F.
目的评估与疾病复发和生存的患者接受肾输尿管切除术的上尿路移行细胞癌（UUT-TCC）在一个中心超过18 years period.Patients和方法的记录，患者有一个肾输尿管切除术的UUT-TCC在我们的机构从1986年至2004年的临床，病理和治疗期间的数据进行了审查。考克斯的比例风险回归模型被用来测试几个潜在的预后因素复发和survival.Results的统计学意义的中位数随访时间为2.5年的184例患者。单因素分析显示，肿瘤分期（P < 0.01）、肿瘤分级（P <0.01）、淋巴结阳性（P <0.01）、多灶性（P = 0.03）、既往膀胱癌史（P <0.01）和同期双侧UUT TCC（P = 0.02）是疾病特异性生存率（DSS）的显著影响因素。在多变量分析中，只有肿瘤分期（P = 0.03）和分级（P = 0.01）与DSS相关。中位无复发生存期为2.4年。在44例患者中，膀胱外复发; 15例（8.2%）局部复发，20例（10.9%）远处转移，9例（4.9%）局部和远处复发。40例（26.1%）无膀胱移行史的患者发生膀胱转流。在三个时期的研究治疗结果的评价显示没有显着的效果DSS.CONCLUSION肿瘤的阶段和等级与DSS在这个队列中，在18年的时间内评估的结果没有改善。高分期和高级别疾病患者的情况仍然很差，这表明需要改变治疗方案。明智地应用多模式的方法来管理高危患者，将新辅助化疗和手术切除可能会提供，第一次，改善患者的结果的机会。
OBJECTIVE To evaluate factors associated with disease recurrence and survival in patients undergoing nephroureterectomy for upper urinary tract transitional cell carcinoma (UUT-TCC) in one Centre over an 18-year period.PATIENTS AND METHODS The records of patients who had a nephroureterectomy for UUT-TCC at our institution from 1986 to 2004 were reviewed for clinical, pathological and treatment period data. Cox's proportional hazards regression model was used to test the statistical significance of several potential prognostic factors for recurrence and survival.RESULTS The median overall duration of follow-up was 2.5 years for 184 patients. Significant prognosticators for disease-specific survival (DSS) by univariate analysis were tumour stage (P < 0.01), tumour grade (P < 0.01), node-positive disease (P < 0.01), multifocality (P = 0.03), previous cystectomy (P < 0.01) and synchronous bilateral UUT-TCC (P = 0.02). On multivariate analysis, only tumour stage (P = 0.03) and grade (P = 0.01) correlated with DSS. The median recurrence-free survival duration was 2.4 years. In 44 patients, the disease recurred outside the bladder; 15 (8.2%) had local recurrence, 20 (10.9%) distant metastasis, and nine (4.9%) both local and distant recurrence. Bladder turnours occurred in 40 (26.1%) patients with no previous cystectomy. The evaluation of treatment outcome during three periods of the study showed no significant effect on DSS.CONCLUSION Tumour stage and grade correlated with DSS in this cohort, with no improvement in outcome over the 18-year period assessed. Patients with high-stage and high-grade disease continue to fare poorly, suggesting a need for changing the treatment protocol. Judiciously applying a multimodal approach to the management of high-risk patients by incorporating neoadjuvant chemotherapy and surgical resection might provide, for the first time, the opportunity to improve patient outcome.