Impact of Tumor Location on Prognosis for Patients with Upper Tract Urothelial Carcinoma Managed by Radical Nephroureterectomy
Impact of Tumor Location on Prognosis for Patients with Upper Tract Urothelial Carcinoma Managed by Radical Nephroureterectomy
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DOI：
10.1016/j.eururo.2009.07.002
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发表时间：
2010-06-01
期刊：
影响因子：
23.4
通讯作者：
Shariat, Shahrokh F.
中科院分区：
文献类型：
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作者：
Raman, Jay D.;Ng, Casey K.;Shariat, Shahrokh F.
背景：对于输尿管和肾盆腔上皮癌(UTUC)的预后意义尚缺乏共识。目的：在一组接受根治性肾输尿管切除术(RNU)的国际队列患者中，研究肿瘤位置与UTUC预后的关系。设计、背景和对象：对来自全球10个机构的机构数据库进行回顾性回顾，确定UTUC患者。干预：在1987至2007年间，1249名患者接受了同侧膀胱袖带切除术。测量：收集的数据包括年龄、性别、种族、手术入路(开腹与腹腔镜相比)、肿瘤病理(分期、分级、淋巴结状况)、肿瘤位置、肿瘤部位、肿瘤病理(分期、分级、淋巴结状况)、肿瘤的病理类型(分期、分级、淋巴结状况)。围手术期化疗的使用、先前的内窥镜治疗、尿路上皮癌复发和尿路上皮癌的死亡率。根据主要肿瘤的位置，肿瘤的位置被分为两组(肾盆和输尿管)。结果和局限性：该队列的5年无复发和癌症特异性生存率估计分别为75%和78%。在多变量分析中，只有病理肿瘤的分类(p<；0.001)、分级(p<；0.02)和淋巴结状况(p<；0.001)与疾病复发和癌症特异性生存有关。调整这些变量后，输尿管和肾盆肿瘤在疾病复发(风险比[HR]：1.22；p=0.133)或癌症死亡(HR：1.23；p=0.25)的概率上没有差异。将肿瘤部位添加到包括PT分期、肿瘤分级和淋巴结状况在内的疾病复发和癌症死亡的基本预后模型中，仅将该模型的预测准确率提高了0.1%。本研究受限于与其回顾设计相关的偏差。结论：肾盆部肿瘤和输尿管肿瘤患者在肾输尿管切除术后的预后没有差异。这些数据支持目前的TNM分期系统，根据该系统，肾盆癌和输尿管癌被归类为一个完整的肿瘤组。(C)欧洲泌尿外科协会。爱思唯尔出版，版权所有。
Background: There is a lack of consensus regarding the prognostic significance of ureteral versus renal pelvic upper tract urothelial carcinoma (UTUC).Objective: To investigate the association of tumor location on outcomes for UTUC in an international cohort of patients managed by radical nephroureterectomy (RNU).Design, setting, and participants: A retrospective review of institutional databases from 10 institutions worldwide identified patients with UTUC.Intervention: The 1249 patients in the study underwent RNU with ipsilateral bladder cuff resection between 1987 and 2007.Measurements: Data accrued included age, gender, race, surgical approach (open vs laparoscopic), tumor pathology (stage, grade, lymph node status), tumor location, use of perioperative chemotherapy, prior endoscopic therapy, urothelial carcinoma recurrence, and mortality from urothelial carcinoma. Tumor location was divided into two groups (renal pelvis and ureter) based on the location of the dominant tumor.Results and limitations: The 5-yr recurrence-free and cancer-specific survival estimates for this cohort were 75% and 78%, respectively. On multivariate analysis, only pathologic tumor (pT) classification (p < 0.001), grade (p < 0.02), and lymph node status (p < 0.001) were associated with disease recurrence and cancer-specific survival. When adjusting for these variables, there was no difference in the probability of disease recurrence (hazard ratio [HR]: 1.22; p = 0.133) or cancer death (HR: 1.23; p = 0.25) between ureteral and renal pelvic tumors. Adding tumor location to a base prognostic model for disease recurrence and cancer death that included pT stage, tumor grade, and lymph node status only improved the predictive accuracy of this model by 0.1%. This study is limited by biases associated with its retrospective design.Conclusions: There is no difference in outcomes between patients with renal pelvic tumors and with ureteral tumors following nephroureterectomy. These data support the current TNM staging system, whereby renal pelvic and ureteral carcinomas are classified as one integral group of tumors. (c) European Association of Urology. Published by Elsevier B.V. All rights reserved.