Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
BJU Int. 2010 Apr;105(8):1102-6. doi: 10.1111/j.1464-410X.2009.08836.x. Epub 2009 Sep 2.
To determine the pathological features and clinical course of intravesical recurrence after nephroureterectomy (NU) for upper urinary tract (UUT) cancer.
Among 325 patients undergoing NU with bladder cuff excision for UUT cancer, in this retrospective multi-institutional study we evaluated 113 who developed bladder tumour after NU. Excluding patients with (i) perioperative systemic chemotherapy or radiotherapy for UUT cancer; (ii) a history of previous or synchronous bladder cancer at the time of NU; (iii) distant metastasis at the time of NU; (iv) a follow-up of <1 year after the initial bladder cancer recurrence; or (v) missing data, 74 patients were included in this study. We compared the pathology between UUT cancer and the first bladder cancer recurrence, using Fisher's exact test. Further intravesical recurrence and bladder cancer progression was analysed using the Kaplan-Meier method, with the log-rank test used to assess significance. A Cox proportional hazard model was used for multivariate analysis.
The grade of the first bladder cancer recurrence strongly correlated with that of the UUT tumour (P < 0.001) and the carcinoma in situ (CIS) lesion with the first bladder cancer recurrence correlated with high grade (grade 3) UUT tumour (P < 0.001). In all, 56 of the assessable 70 patients further developed intravesical recurrence at a median interval of 7 months after the first bladder cancer recurrence. There were no clinicopathological factors that predicted the second recurrence. Progression occurred in 14 patients, at a median interval of 25 months. A CIS lesion with the first bladder cancer recurrence was a risk factor for progression on multivariate analysis.
A large proportion of the patients who developed bladder tumour after NU had further intravesical recurrence, which indicated its refractory nature. Especially when a CIS lesion is detected in the initial intravesical recurrence, a careful follow-up is mandatory to detect bladder cancer progression.
确定上尿路尿路上皮癌行肾输尿管切除术（NU）后膀胱内复发的病理特征和临床病程。
在 325 例行 NU 加膀胱袖套切除的上尿路尿路上皮癌患者中，本回顾性多中心研究纳入了 113 例 NU 后发生膀胱癌的患者。排除以下患者：（i）UUT 癌围手术期全身化疗或放疗；（ii）NU 时存在既往或同时性膀胱癌病史；（iii）NU 时发生远处转移；（iv）初始膀胱癌复发后随访<1 年；或（v）缺失数据。最终纳入 74 例患者进行研究。采用 Fisher 确切概率法比较 UUT 癌与首次膀胱癌复发的病理特征。采用 Kaplan-Meier 法分析进一步的膀胱内复发和膀胱癌进展情况，采用对数秩检验评估其差异的显著性。采用 Cox 比例风险模型进行多因素分析。
首次膀胱癌复发的分级与 UUT 肿瘤强烈相关（P<0.001），且首次膀胱癌复发时存在原位癌（CIS）与高级别（G3）UUT 肿瘤相关（P<0.001）。在可评估的 70 例患者中，共有 56 例在首次膀胱癌复发后中位时间 7 个月时再次发生膀胱内复发。没有临床病理因素可预测第二次复发。14 例患者发生进展，中位时间为 25 个月。首次膀胱癌复发时存在 CIS 是多因素分析中进展的危险因素。
NU 后发生膀胱癌的患者中有很大一部分发生了进一步的膀胱内复发，表明其具有难治性。特别是在初始膀胱内复发时检测到 CIS 病变时，必须进行仔细的随访以检测膀胱癌的进展。
