Park Jinsung, Ha Seong Heon, Min Gyeng Eun, Song Cheryn, Hong Bumsik, Hong Jun Hyuk, Kim Choung-Soo, Ahn Hanjong
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
J Urol. 2009 Sep;182(3):894-9. doi: 10.1016/j.juro.2009.05.040. Epub 2009 Jul 17.
We investigated whether tumor location has independent prognostic significance in upper tract transitional cell carcinoma cases and which factor determines it.
We reviewed data on 122 renal pelvis and 102 ureteral tumor cases, including the recurrence pattern. Tumor location and other clinicopathological variables were evaluated regarding cancer specific and recurrence-free survival. Stage pT3 tumors were stratified into those invading renal parenchyma or peripelvic/periureteral fat.
Overall 5-year cancer specific survival and recurrence-free survival rates were 77.0% and 71.6%, respectively, at a mean followup of 60.7 months. Of the clinicopathological parameters T stage was the most significant prognosticator of the survival rate, while nodal involvement, high grade and ureteral tumor location were also significant for lower survival rates. Stratification analysis for matching pathological stage revealed that, while survival rates were similar in the renal pelvis and ureteral tumor groups at stage pT2 or less, renal pelvic tumors were associated with significantly higher survival rates than ureteral tumors for stage pT3. Specifically renal pelvic tumors invading the renal parenchyma were associated with a lower local failure rate, and higher cancer specific and recurrence-free survival rates than tumors invading peripelvic or periureteral fat, ie 77.5% vs 49.7% 5-year cancer specific survival and 75.6% vs 32.0% 5-year recurrence-free survival (p = 0.014 and 0.003, respectively).
Tumor location is an independent prognostic factor for pT3 upper tract transitional cell carcinoma. The overall better prognosis of renal pelvic tumors was mainly attributable to pT3 tumor outcomes, specifically lesions invading the renal parenchyma. These findings may be due to the protective role of thick renal parenchyma against local tumor spread.
我们研究了肿瘤位置在上尿路移行细胞癌病例中是否具有独立的预后意义以及决定其预后的因素。
我们回顾了122例肾盂肿瘤和102例输尿管肿瘤病例的数据，包括复发模式。评估肿瘤位置及其他临床病理变量对癌症特异性生存率和无复发生存率的影响。pT3期肿瘤被分为侵犯肾实质或肾周/输尿管周围脂肪的肿瘤。
平均随访60.7个月时，总体5年癌症特异性生存率和无复发生存率分别为77.0%和71.6%。在临床病理参数中，T分期是生存率最显著的预后指标，而淋巴结受累、高级别和输尿管肿瘤位置对较低的生存率也有显著影响。对匹配病理分期的分层分析显示，在pT2期及以下时，肾盂肿瘤组和输尿管肿瘤组的生存率相似，但在pT3期，肾盂肿瘤的生存率显著高于输尿管肿瘤。具体而言，侵犯肾实质的肾盂肿瘤与局部失败率较低、癌症特异性生存率和无复发生存率较高相关，即5年癌症特异性生存率分别为77.5%和49.7%，5年无复发生存率分别为75.6%和32.0%（p分别为0.014和0.003）。
肿瘤位置是pT3期上尿路移行细胞癌的独立预后因素。肾盂肿瘤总体较好的预后主要归因于pT3期肿瘤的结果，特别是侵犯肾实质的病变。这些发现可能是由于厚肾实质对局部肿瘤扩散的保护作用。
