Simone Giuseppe, Papalia Rocco, Loreto Andrea, Leonardo Costantino, Sentinelli Steno, Gallucci Michele
Department of Urology, Regina Elena National Cancer Institute, Rome, Italy.
BJU Int. 2009 Apr;103(8):1052-7. doi: 10.1111/j.1464-410X.2008.08134.x. Epub 2008 Oct 17.
To identify significant prognostic indicators of upper urinary tract (UUT) urothelial carcinoma (UC) and to assess a risk stratification of patients.
We retrospectively analysed data from 162 patients with non-metastatic UC primarily occurring in UUT treated with open nephroureterectomy. Variables assessed included age, gender, pT, tumour grade, tumour necrosis extension, pN, tumour location, multifocal location, tumour diameter, and subsequent development of a bladder tumour. Tumour necrosis was measured using commercial software (Eureka interface system, version 4.0.22, HESP technology, Menarini Diagnostics, Italy) and was classified as none, focal (<10% of tumour area) or extensive, >or=10% of tumour area). The prognostic significance of each variable on metastasis-free survival (MFS) and disease-free survival (DFS) was tested in univariable analysis with the log-rank test. Variables with significance levels of P < 0.05 according to the univariable analyses were entered into a multivariable forward-stepwise Cox regression model.
At a mean follow-up of 66 months, 20 cancer-related deaths (12.3%) were censored. In multivariable analysis, tumour diameter, pT stage and tumour necrosis were independent predictors of MFS and DFS. All events occurred in patients with extensive tumour necrosis and a tumour diameter of >or=3 cm. The median survival of patients with advanced-stage tumours, extensive necrosis and a tumour diameter of >or=3 cm were significantly impaired by increasing pT stage(P < 0.001).
Tumour necrosis and tumour diameter are compelling prognostic factors that deserve further study in a prospective setting to determine if their use in combination with more traditional variables, such as pT stage, might better determine prognosis and guide the follow-up and treatment of patients.
确定上尿路（UUT）尿路上皮癌（UC）的重要预后指标，并评估患者的风险分层。
我们回顾性分析了162例主要发生在上尿路的非转移性UC患者的数据，这些患者接受了开放性肾输尿管切除术。评估的变量包括年龄、性别、pT、肿瘤分级、肿瘤坏死范围、pN、肿瘤位置、多灶性位置、肿瘤直径以及随后膀胱肿瘤的发生情况。使用商业软件（Eureka界面系统，版本4.0.22，HESP技术，意大利美纳里尼诊断公司）测量肿瘤坏死情况，并将其分类为无、局灶性（<肿瘤面积的10%）或广泛性（≥肿瘤面积的10%）。在单变量分析中，使用对数秩检验测试每个变量对无转移生存期（MFS）和无病生存期（DFS）的预后意义。根据单变量分析，显著性水平P<0.05的变量被纳入多变量向前逐步Cox回归模型。
平均随访66个月，20例（12.3%）与癌症相关的死亡被审查。在多变量分析中，肿瘤直径、pT分期和肿瘤坏死是MFS和DFS的独立预测因素。所有事件均发生在肿瘤坏死广泛且肿瘤直径≥3 cm的患者中。晚期肿瘤、广泛坏死且肿瘤直径≥3 cm患者的中位生存期因pT分期增加而显著受损（P<0.001）。
肿瘤坏死和肿瘤直径是令人信服的预后因素，值得在前瞻性研究中进一步探讨，以确定将它们与更传统的变量（如pT分期）结合使用是否能更好地确定预后并指导患者的随访和治疗。
