Stage-Specific Impact of Tumor Location on Oncologic Outcomes in Patients With Upper and Lower Tract Urothelial Carcinoma Following Radical Surgery
Stage-Specific Impact of Tumor Location on Oncologic Outcomes in Patients With Upper and Lower Tract Urothelial Carcinoma Following Radical Surgery
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DOI：
10.1016/j.eururo.2012.02.018
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发表时间：
2012-10-01
期刊：
影响因子：
23.4
通讯作者：
Shariat, Shahrokh F.
中科院分区：
文献类型：
--
作者：
Rink, Michael;Ehdaie, Behfar;Shariat, Shahrokh F.
背景：上尿路尿路上皮癌 (UTUC) 和膀胱尿路上皮癌 (UCB) 的治疗和结果存在差异。目的：本研究的目的是分析上尿路肿瘤位置或下尿路肿瘤位置对肿瘤结果的阶段特异性影响。设计、设置和参与者：数据收集自 4335 名接受根治性膀胱切除术 (RC) 和双侧盆腔淋巴结切除术 (PLND) 治疗的 UCB 患者，其中 877 名患者第1615章 输尿管UTUC，以及接受根治性肾输尿管切除术（RNU）治疗的盆腔UTUC。没有患者接受术前化疗或放疗。 干预措施：患者接受 RC 和双侧 PLND 或 RNU 治疗。 测量：根据原发肿瘤位置评估结果。 结果和局限性：与 UTUC 患者相比，UCB 患者的肿瘤分期更晚，级别更高，并且更容易出现淋巴管侵犯（LVI）和淋巴结转移（p < 0.001）。在非肌层浸润性肿瘤阶段，与肾盂肾肿瘤患者相比，UCB 患者更容易出现疾病复发和死亡 (p < 0.002)，但输尿管肿瘤患者则不然 (p > 0.05)。在 pT2 和 pT3 肿瘤中，三个肿瘤位置之间的结果没有差异。在 pT4 肿瘤中，与 UCB 患者相比，输尿管和盆腔肿瘤患者更容易出现疾病复发和死亡 (p < 0.004)。在调整年龄、性别、肿瘤分级、LVI、淋巴结状态和辅助化疗的影响后，这些阶段特异性结果没有变化。这项研究因其回顾性和多中心性质而受到限制。结论：UCB 和 UTUC 之间存在不同阶段的结局差异。 UCB 和 UTUC 患者之间不同阶段的较差结果突显了这两种癌症实体之间的差异以及对每位患者进行个体化阶段特定管理的需要。 (C) 2012 年欧洲泌尿外科协会。由 Elsevier B.V 出版。保留所有权利。
Background: Dissimilarities in management and outcomes exist between upper tract urothelial carcinoma (UTUC) and urothelial carcinoma of the bladder (UCB).Objective: The aim of this study was to analyze the stage-specific impact of upper or lower urinary tract tumor location on oncologic outcomes.Design, setting, and participants: Data were collected from 4335 patients with UCB treated with radical cystectomy (RC) and bilateral pelvic lymphadenectomy (PLND), 877 patients with ureteral UTUC, and 1615 with pelvicalyceal UTUC treated with radical nephroureterectomy (RNU). No patient received preoperative chemotherapy or radiation therapy.Interventions: Patients were treated with RC and bilateral PLND or RNU.Measurements: Outcomes were assessed according to primary tumor location.Results and limitations: Compared to UTUC patients, UCB patients had more advanced tumor stage and higher grade, and they were more likely to harbor lymphovascular invasion (LVI) and lymph node metastasis (p < 0.001). In non-muscle-invasive tumor stages, UCB patients were more likely to experience disease recurrence and mortality compared to renal pelvicalyceal tumor patients (p < 0.002) but not ureteral tumors (p > 0.05). In pT2 and pT3 tumors, there was no difference in outcomes between the three tumor locations. In pT4 tumors, patients with ureteral and pelvicalyceal tumors were more likely to experience disease recurrence and mortality compared to UCB patients (p < 0.004). These stage-specific findings were unchanged after adjustment for the effects of age, gender, tumor grade, LVI, lymph node status, and adjuvant chemotherapy. This study is limited by its retrospective and multicenter nature.Conclusions: Stage-specific differences in outcomes exist between UCB and UTUC. The differentially worse outcomes by stage between UCB and UTUC patients underline the differences between both cancer entities and the need for individualized stage-specific management for each patient. (C) 2012 European Association of Urology. Published by Elsevier B. V. All rights reserved.