New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA.
Eur Urol. 2010 Jun;57(6):1072-9. doi: 10.1016/j.eururo.2009.07.002. Epub 2009 Jul 15.
There is a lack of consensus regarding the prognostic significance of ureteral versus renal pelvic upper tract urothelial carcinoma (UTUC).
To investigate the association of tumor location on outcomes for UTUC in an international cohort of patients managed by radical nephroureterectomy (RNU).
DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of institutional databases from 10 institutions worldwide identified patients with UTUC.
The 1249 patients in the study underwent RNU with ipsilateral bladder cuff resection between 1987 and 2007.
Data accrued included age, gender, race, surgical approach (open vs laparoscopic), tumor pathology (stage, grade, lymph node status), tumor location, use of perioperative chemotherapy, prior endoscopic therapy, urothelial carcinoma recurrence, and mortality from urothelial carcinoma. Tumor location was divided into two groups (renal pelvis and ureter) based on the location of the dominant tumor.
The 5-yr recurrence-free and cancer-specific survival estimates for this cohort were 75% and 78%, respectively. On multivariate analysis, only pathologic tumor (pT) classification (p<0.001), grade (p<0.02), and lymph node status (p<0.001) were associated with disease recurrence and cancer-specific survival. When adjusting for these variables, there was no difference in the probability of disease recurrence (hazard ratio [HR]: 1.22; p=0.133) or cancer death (HR: 1.23; p=0.25) between ureteral and renal pelvic tumors. Adding tumor location to a base prognostic model for disease recurrence and cancer death that included pT stage, tumor grade, and lymph node status only improved the predictive accuracy of this model by 0.1%. This study is limited by biases associated with its retrospective design.
There is no difference in outcomes between patients with renal pelvic tumors and with ureteral tumors following nephroureterectomy. These data support the current TNM staging system, whereby renal pelvic and ureteral carcinomas are classified as one integral group of tumors.
关于输尿管和肾盂上尿路尿路上皮癌（UTUC）的预后意义，目前尚未达成共识。
通过根治性肾输尿管切除术（RNU）治疗的国际患者队列，研究肿瘤位置与 UTUC 结局之间的关联。
设计、设置和参与者：对来自全球 10 个机构的机构数据库进行回顾性分析，确定了 UTUC 患者。
该研究中的 1249 例患者在 1987 年至 2007 年间接受了 RNU 治疗，同时切除了同侧膀胱袖口。
收集的数据包括年龄、性别、种族、手术方式（开放与腹腔镜）、肿瘤病理（分期、分级、淋巴结状态）、肿瘤位置、围手术期化疗的使用、先前的内镜治疗、尿路上皮癌复发和尿路上皮癌死亡。根据主要肿瘤的位置，将肿瘤位置分为两组（肾盂和输尿管）。
该队列的 5 年无复发生存和癌症特异性生存率估计分别为 75%和 78%。多变量分析显示，只有病理肿瘤（pT）分类（p<0.001）、分级（p<0.02）和淋巴结状态（p<0.001）与疾病复发和癌症特异性生存相关。在调整这些变量后，输尿管和肾盂肿瘤之间疾病复发的概率（危险比[HR]：1.22；p=0.133）或癌症死亡的概率（HR：1.23；p=0.25）无差异。将肿瘤位置添加到包括 pT 分期、肿瘤分级和淋巴结状态的疾病复发和癌症死亡的基本预后模型中，仅使该模型的预测准确性提高了 0.1%。本研究受到其回顾性设计相关的偏倚限制。
肾输尿管切除术后肾盂肿瘤患者与输尿管肿瘤患者的结局无差异。这些数据支持当前的 TNM 分期系统，根据该系统，肾盂和输尿管癌被归类为一个整体的肿瘤组。
