Tan Lia-Beng, Chang Lin-Li, Cheng Kuang-I, Huang Chun-Hsiung, Kwan Aij-Lie
Department of Urology, St. Joesh's Hospital, Yunlinsien, Taiwan.
BJU Int. 2009 Feb;103(3):312-6. doi: 10.1111/j.1464-410X.2008.07985.x. Epub 2008 Sep 8.
To compare the predictive value for 5-year survival of demographic characteristics, pathological grade and stage between upper tract urothelial carcinoma (UTUC) of the renal pelvis (RPUC) and ureter (UUC) in a Taiwanese population.
In this study (1986-98) we analysed 141 patients with UTUC, including 71 with RPUC and 70 with UUC (median age 59 years; median follow-up 54 months, SD 2.5). Prognostic indicators were examined by univariate and multivariate logistic regression analyses.
A significant percentage of patients had tumour on the right side and a high proportion of those with UUC were women. Gross haematuria and hypertension were the most common symptoms of RPUC. The sensitivity of intravenous pyelography in diagnosing RPUC and UUC was 49% (34/69) and 36% (25/70), respectively. However, in patients assessed by retrograde pyelography the diagnostic sensitivity was 85% (60/71) for RPUC and 89% (55/62) for UUC. The incidence of tumour recurrence after nephroureterectomy with bladder cuff excision was significantly higher in those with UUC (13%) than RPUC (3.6%). Distant metastasis was detected in 37 of 141 (26%) patients, the most common sites being bone (46%), lung (22%), liver (14%) and colon (8%). Univariate logistic regression analysis showed significant differences in the prognosis for high-grade and high-stage tumours. The prognosis was particularly poor in patients aged >60 years. According to the multivariate logistic regression analysis, tumour stage and grade were the best outcome predictors for RPUC, but stage and age were the best outcome predictors for UUC.
UUC is more common in women and has a more aggressive clinical outcome than RPUC after nephroureterectomy with bladder cuff incision. Tumour stage and grade are the best predictors of survival in patients with RPUC. Also, in patients with UUC the prognosis is poor in older patients and those with advanced stages of cancer.
比较台湾人群中肾盂上尿路尿路上皮癌(RPUC)和输尿管上尿路尿路上皮癌(UUC)的人口统计学特征、病理分级和分期对5年生存率的预测价值。
在本研究(1986 - 1998年)中,我们分析了141例上尿路尿路上皮癌患者,其中71例为肾盂上尿路尿路上皮癌,70例为输尿管上尿路尿路上皮癌(中位年龄59岁;中位随访时间54个月,标准差2.5)。通过单因素和多因素逻辑回归分析来检验预后指标。
相当比例的患者肿瘤位于右侧,输尿管上尿路尿路上皮癌患者中女性比例较高。肉眼血尿和高血压是肾盂上尿路尿路上皮癌最常见的症状。静脉肾盂造影诊断肾盂上尿路尿路上皮癌和输尿管上尿路尿路上皮癌的敏感性分别为49%(34/69)和36%(25/70)。然而,在逆行肾盂造影评估的患者中,肾盂上尿路尿路上皮癌的诊断敏感性为85%(60/71),输尿管上尿路尿路上皮癌为89%(55/62)。行肾输尿管切除术加膀胱袖口切除术的患者中,输尿管上尿路尿路上皮癌的肿瘤复发率(13%)显著高于肾盂上尿路尿路上皮癌(3.6%)。141例患者中有37例(26%)发生远处转移,最常见部位为骨(46%)、肺(22%)、肝(14%)和结肠(8%)。单因素逻辑回归分析显示,高级别和高分期肿瘤的预后存在显著差异。年龄>60岁的患者预后尤其差。根据多因素逻辑回归分析,肿瘤分期和分级是肾盂上尿路尿路上皮癌最佳的预后预测指标,但分期和年龄是输尿管上尿路尿路上皮癌最佳的预后预测指标。
输尿管上尿路尿路上皮癌在女性中更为常见,且在肾输尿管切除术加膀胱袖口切除术术后的临床结局比肾盂上尿路尿路上皮癌更具侵袭性。肿瘤分期和分级是肾盂上尿路尿路上皮癌患者生存的最佳预测指标。此外,输尿管上尿路尿路上皮癌患者中,老年患者和癌症晚期患者预后较差。