Moussa S, Yafi F A, El-Hakim A, Fahmy N, Aprikian A, Tanguay S, Anidjar M, Kassouf W
Division of Urology, McGill University Health Center, Montreal, QC H3G 1A4, Canada.
Urol Int. 2010;84(1):50-5. doi: 10.1159/000273466. Epub 2010 Feb 17.
It remains controversial whether we can apply similar principles in the management of upper urinary tract urothelial carcinoma (UUT-UC) based on the behavior of bladder urothelial carcinoma (B-UC). We sought to assess whether UUT-UC and B-UC have similar biology and performed a stage-by-stage comparative analysis of outcome between the 2 groups.
A retrospective review was performed on patients who underwent nephroureterectomy for UUT-UC and radical cystectomy for B-UC from 1991 to 2006. Standard variables were collected and recurrence-free and overall survival (OS) rates were calculated.
280 patients with a median age of 69 years were included (99 UUT-UC treated via nephroureterectomy and 181 B-UC treated via radical cystectomy). Median follow-up was 29 months. None received neoadjuvant chemotherapy. Patients with UUT-UC presented less commonly with invasive disease compared to those with B-UC (44 vs. 77% were >pT2). Overall, 5-year OS for the B-UC group was significantly lower than for the UUT-UC group (60.8 vs. 74.5%, p = 0.02). However, when patients were stratified by stage (>pT2), patients with B-UC had similar OS compared to those with UUT-UC (54.6 vs. 60.8%, p = 0.74).
Invasive UUT-UC appears to have similar tumor biology compared to B-UC. Whether we can safely extrapolate on the benefit of neoadjuvant and adjuvant strategies to patients with UUT-UC requires further investigation.
基于膀胱尿路上皮癌（B-UC）的行为，在处理上尿路尿路上皮癌（UUT-UC）时能否应用相似原则仍存在争议。我们试图评估UUT-UC和B-UC是否具有相似的生物学特性，并对两组患者的结局进行逐阶段比较分析。
对1991年至2006年期间因UUT-UC接受肾输尿管切除术和因B-UC接受根治性膀胱切除术的患者进行回顾性研究。收集标准变量并计算无复发生存率和总生存率（OS）。
纳入280例患者，中位年龄69岁（99例UUT-UC患者接受肾输尿管切除术，181例B-UC患者接受根治性膀胱切除术）。中位随访时间为29个月。所有患者均未接受新辅助化疗。与B-UC患者相比，UUT-UC患者出现浸润性疾病的情况较少（>pT2者分别为44%和77%）。总体而言，B-UC组的5年OS显著低于UUT-UC组（60.8%对74.5%，p = 0.02）。然而，当按分期（>pT2）对患者进行分层时，B-UC患者与UUT-UC患者的OS相似（54.6%对60.8%，p = 0.74）。
浸润性UUT-UC似乎与B-UC具有相似的肿瘤生物学特性。对于UUT-UC患者能否安全地推断新辅助和辅助治疗策略的益处，还需要进一步研究。
