Ureteral Involvement Is Associated with Poor Prognosis in Upper Urinary Tract Urothelial Carcinoma Patients Treated by Nephroureterectomy: A Multicenter Database Study
Ureteral Involvement Is Associated with Poor Prognosis in Upper Urinary Tract Urothelial Carcinoma Patients Treated by Nephroureterectomy: A Multicenter Database Study
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DOI：
10.1016/j.euf.2015.10.008
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发表时间：
2016-08-01
影响因子：
5.4
通讯作者：
Kihara, Kazunori
中科院分区：
文献类型：
--
作者：
Waseda, Yuma;Saito, Kazutaka;Kihara, Kazunori
背景：肿瘤部位对上尿路尿路上皮癌(UUT-UC)患者预后的影响一直存在争议。目的：探讨输尿管肿瘤在UUT-UC根治性肾输尿管切除术(RNU)患者中的预后意义。设计、背景和参与者：在这项多中心的回顾性研究中，1068名符合条件的患者(中位随访：40mo[四分位数范围：17-77mo])根据肿瘤的位置分为三组：肾盆、输尿管和两个区域(同时有肾盆和输尿管肿瘤)。随后将输尿管和输尿管双区域组纳入输尿管受累组，以评估其对预后的影响。干预：所有患者都接受了RNU测量和统计分析：分析了肿瘤位置对生存的预后影响。结果和局限性：肾盆组、输尿管组和双区域组分别包括507例(47.5%)、430例(40.3%)和131例(12.3%)患者。与肾盆组相比，输尿管组和双区域组淋巴血管侵犯和淋巴结转移率较高。与输尿管肿瘤相比，局部晚期(PT3/T4)的肾盆部肿瘤和双区域肿瘤更常见。输尿管组和双区域组患者的5年肿瘤特异性生存率(CS)和无进展生存率(PFS)分别为70.5%和66.7%、64.8%和57.8%，明显低于肾盆组(分别为81.9%和78.1%)。在多变量分析中，输尿管受累是CS(风险比：1.5；p=0.006)和PFS(风险比：1.35；p=0.023)的重要预后因素。结论：输尿管受累对接受手术治疗的UUT-UC患者的存活率有显著影响，且预后较差。患者概述：与仅在接受肾输尿管切除术的上尿路尿路肿瘤患者中，输尿管受累与较差的存活率相关。(C)2015年欧洲泌尿外科协会。爱思唯尔出版，版权所有。
Background: The prognostic significance of tumor location for patients with upper urinary tract urothelial carcinoma (UUT-UC) has been disputed. Several papers have reported that ureteral cancer is associated with worse prognosis.Objective: To investigate the prognostic significance of the presence of ureteral tumors in UUT-UC patients who underwent radical nephroureterectomy (RNU).Design, setting, and participants: In this multicenter retrospective study, 1068 eligible patients (median follow-up: 40 mo [interquartile range: 17-77 mo]) were divided into three groups based on tumor location: renal pelvic, ureteral, and both-regional (having both renal pelvic and ureteral tumors). The ureteral and both-regional groups were subsequently integrated into the ureteral involvement group to evaluate its prognostic impact.Intervention: All patients underwent RNU.Outcome measurements and statistical analysis: The prognostic impact of tumor location on survival was analyzed.Results and limitations: The renal pelvic, ureteral, and both-regional groups consisted of 507 (47.5%), 430 (40.3%), and 131 (12.3%) patients, respectively. The ureteral and both-regional groups had a higher rate of lymphovascular invasion and lymph node metastasis compared with the renal pelvic group. The renal pelvic and both-regional tumors presented more frequently with locally advanced stages (pT3/T4) compared with the ureteral tumors. The 5-yr cancer-specific survival (CSS) and progression-free survival (PFS) rates of patients in the ureteral (70.5% and 66.7%, respectively) and both-regional groups (64.8% and 57.8%, respectively) were significantly worse than those in the renal pelvic group (81.9% and 78.1%, respectively). In a multivariate analysis, the presence of ureteral involvement was a significant prognostic factor for CSS (hazard ratio [HR]: 1.50; p = 0.006) and PFS (HR: 1.35; p = 0.023). This study is inherently limited by the biases associated with its retrospective and multicenter design.Conclusions: The presence of ureteral involvement had a significant impact on the survival of surgically treated UUT-UC patients associated with a poor prognosis.Patient summary: We demonstrated that the ureteral involvement was associated with poor survival compared with patients with renal pelvic tumor only in upper urinary tract urothelial patients treated by nephroureterectomy. (C) 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.