Izquierdo L, Truán D, Alvarez-Vijande R, Alcaraz A
Servicio de Urología, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
Actas Urol Esp. 2010 Mar;34(3):232-7.
Upper urinary tract urothelial carcinoma (UUTUC) represents 5% of all urothelial tumors and has uncertain prognostic. Exist few series which describes clinical-pathological parameters of tumor progression. The aim of this study is to evaluate clinical and pathological parameters and determine their value as prognostic factors of tumor progression and cancer-specific survival.
Retrospective analysis of 114 cases of radical nephroureterectomy or partial ureterectomy collected between 1991-2004. Variables analyzed were age, sex, pathological tumor stage, histological tumor grade, CIS, tumor localization, multiplicity, bladder cancer history, pathological nodes and adjuvant chemotherapy. Spearman test was used for correlations. The probabilities of progression free survival and cancer-specific survival were calculated using Kaplan-Meier curves. In the multivariate analysis forward stepwise Cox regression was performed.
Pathological stage was: 15 pTa, 25 pT1, 26 pT2, 32 pT3 and 16 pT4. There were 10 G1 (9%), 52 G2 (45.5%) and 52 G3 (45.5%). Fifteen patients presented pathological nodes at the moment of diagnosis. Fourteen percent of 114 patients received adjuvant treatment (Platin-based regimen). Mean follow-up: 74.8 months; 30.7% of the patients developed tumor progression. Death from the disease: 24.6%. Five-years overall and cancer-specific survival: 59.3% and 72.9%, respectively. Five-year progression-free survival: 68%. Mean time of tumor progression: 12.2 months and 23.3 months for cancer-specific death. In the multivariate analysis the independent predictive variables of death and tumor progression were histological grade and pathological stage.
We demonstrated that histological grade and pathological stage constitute independent prognostic factors of tumor progression and cancer-specific survival in UUTUC.
上尿路尿路上皮癌（UUTUC）占所有尿路上皮肿瘤的5%，其预后尚不确定。描述肿瘤进展临床病理参数的系列研究较少。本研究的目的是评估临床和病理参数，并确定它们作为肿瘤进展和癌症特异性生存预后因素的价值。
回顾性分析1991年至2004年间收集的114例行根治性肾输尿管切除术或部分输尿管切除术的病例。分析的变量包括年龄、性别、病理肿瘤分期、组织学肿瘤分级、原位癌（CIS）、肿瘤定位、多发性、膀胱癌病史、病理淋巴结及辅助化疗。采用Spearman检验进行相关性分析。使用Kaplan-Meier曲线计算无进展生存期和癌症特异性生存期的概率。在多变量分析中进行向前逐步Cox回归。
病理分期为：15例pTa，25例pT1，26例pT2，32例pT3和16例pT4。有10例G1（9%），52例G2（45.5%）和52例G3（45.5%）。15例患者在诊断时出现病理淋巴结转移。114例患者中有14%接受了辅助治疗（铂类方案）。平均随访时间：74.8个月；30.7%的患者出现肿瘤进展。死于该疾病的比例为24.6%。五年总生存率和癌症特异性生存率分别为59.3%和72.9%。五年无进展生存率为68%。肿瘤进展的平均时间：癌症特异性死亡为12.2个月和23.3个月。在多变量分析中，死亡和肿瘤进展的独立预测变量是组织学分级和病理分期。
我们证明组织学分级和病理分期是UUTUC中肿瘤进展和癌症特异性生存的独立预后因素。
