Raman Jay D, Ng Casey K, Boorjian Stephen A, Vaughan E Darracott, Sosa R Ernest, Scherr Douglas S
Department of Urology, The New York-Presbyterian Hospital, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021, USA.
BJU Int. 2005 Nov;96(7):1031-5. doi: 10.1111/j.1464-410X.2005.05804.x.
To evaluate patients with a history of transitional cell carcinoma (TCC) of the upper urinary tract (UUT) to determine the incidence, pathological distribution, and risk factors for developing subsequent bladder tumours.
Between 1993 and 2003, 103 patients were treated at our institution for UUT-TCC. We reviewed demographic, clinical, surgical, and pathological data from these patients at a median follow-up of 38.7 months, and used univariate and multivariate analyses with logistic regression modelling to determine prognostic variables for bladder recurrences.
In all, 51 (49.5%) patients developed bladder tumours after treatment for UUT-TCC, at a mean interval of 13.2 months. Patient age (P = 0.01), UUT tumour size (P = 0.03), UUT tumour multifocality (P = 0.05), a history of bladder tumours (P = 0.03), and the number of previous bladder tumours (P = 0.05) predicted the development of bladder recurrences on univariate analysis. On multivariate analysis, only a previous history of bladder tumours (odds ratio 2.6, P = 0.05) remained significant. Over 90% of the recurrent bladder tumours were superficial, with two-thirds of these being low to moderate grade. Six patients had muscle-invasive disease, and five had a cystectomy.
Bladder tumours occurred in half the patients after treatment for UUT-TCC; > 60% of these subsequent bladder tumours were superficial, low- to moderate-grade lesions. Neither the pathology of the UUT tumours nor the method of treatment for the UUT disease was associated with recurrent bladder tumours. Only a history of bladder cancer predicted the development of subsequent bladder tumours.
评估上尿路移行细胞癌（TCC）患者，以确定继发膀胱肿瘤的发生率、病理分布及危险因素。
1993年至2003年间，我院对103例上尿路移行细胞癌患者进行了治疗。我们回顾了这些患者的人口统计学、临床、手术及病理数据，中位随访时间为38.7个月，并采用单因素和多因素分析及逻辑回归模型来确定膀胱复发的预后变量。
总计51例（49.5%）患者在接受上尿路移行细胞癌治疗后发生了膀胱肿瘤，平均间隔时间为13.2个月。单因素分析显示，患者年龄（P = 0.01）、上尿路肿瘤大小（P = 0.03）、上尿路肿瘤多灶性（P = 0.05）、膀胱肿瘤病史（P = 0.03）及既往膀胱肿瘤数量（P = 0.05）可预测膀胱复发的发生。多因素分析显示，只有既往膀胱肿瘤病史（优势比2.6，P = 0.05）仍具有显著性。超过90%的复发性膀胱肿瘤为浅表性，其中三分之二为低至中度分级。6例患者出现肌层浸润性疾病，5例行膀胱切除术。
上尿路移行细胞癌治疗后，半数患者发生膀胱肿瘤；这些继发膀胱肿瘤中，> 60%为浅表性、低至中度分级病变。上尿路肿瘤的病理及上尿路疾病的治疗方法均与复发性膀胱肿瘤无关。只有膀胱癌病史可预测继发膀胱肿瘤的发生。
