Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota55905, USA.
Cancer. 2010 Jul 15;116(14):3399-407. doi: 10.1002/cncr.25202.
A scoring algorithm of site-specific disease recurrence after cystectomy for urothelial carcinoma was designed.
Identified were 1388 patients who underwent radical cystectomy for nonmetastatic urothelial carcinoma between 1980 and 1998. Clinical, surgical, and pathologic features were evaluated for associations with 4 locations of site-specific disease recurrence: upper urinary tract, abdomen/pelvis, thoracic region, and bone. Recurrence-free survival rates were estimated using the Kaplan-Meier method. Cox proportional hazards models were fit to test associations with disease recurrence.
A total of 493 (35.5%) patients experienced at least 1 recurrence. There were 67, 388, 143, and 145 patients with recurrences to the upper tract, abdomen/pelvis, thoracic region, and bone at a median of 3.1 years, 1.1 years, 1.3 years, and 1.0 years, respectively. Pathologic T4 stage (hazard ratio [HR], 2.84; P=.006), positive ureteral margins (HR, 5.71; P<.001), and multifocality (HR, 2.07; P=.009) were found to be independent predictors of upper tract recurrence. Pathologic T3 (HR, 2.30; P<.001) and T4 stage (HR, 3.55; P<.001), lymph node invasion (HR, 1.97; P<.001), extent of lymphadenectomy (pNx [HR, 1.66; P=.002] and <10 lymph nodes [HR, 1.52; P<.001]), multifocality (HR, 1.80; P<.001), and prostatic involvement (HR, 1.45; P=.019) were found to be independent predictors of abdominal/pelvic recurrence. Features independently associated with thoracic recurrence included pathologic T3 (HR, 2.61; P<.001) and T4 (HR, 3.39; P<.001), lymph node invasion (HR, 2.64; P<.001), extent of lymphadenectomy (pNx [HR, 1.89; P=.019] and <10 lymph nodes [HR, 1.58; P<.030]), and multifocality (HR, 1.79; P<.001). Pathologic T3 (HR, 3.45; P<.001) and T4 stage (HR, 3.87; P<.001), lymph node invasion (HR, 1.79; P=.006), occupational exposure to radiation (HR, 2.97; P=.003), and a positive urethral margin (HR, 2.28; P=.039) were found to be independent predictors of osseous recurrence. Macroscopic hematuria (HR, 0.52; P=.009) and obesity (HR, 0.59; P=.027) were found to be protective and negatively associated with upper tract and osseous recurrence, respectively. Scoring algorithms to predict the likelihood of disease recurrence to these sites were developed using regression coefficients from the multivariable models.
Scoring algorithms based on independent predictors of site-specific recurrence were presented. These models may be used to tailor postoperative surveillance to the individual patient based upon clinicopathologic features at the time of cystectomy.
设计了一种用于预测膀胱癌根治性膀胱切除术后特定部位复发的评分算法。
回顾性分析了 1980 年至 1998 年间接受根治性膀胱切除术的 1388 例非转移性尿路上皮癌患者。评估了临床、手术和病理特征与 4 个特定部位复发的关系：上尿路、腹部/骨盆、胸部和骨骼。使用 Kaplan-Meier 方法估计无复发生存率。使用 Cox 比例风险模型检验与疾病复发的相关性。
共有 493（35.5%）例患者至少经历了 1 次复发。上尿路、腹部/骨盆、胸部和骨骼的中位复发时间分别为 3.1 年、1.1 年、1.3 年和 1.0 年，分别有 67、388、143 和 145 例患者出现复发。病理 T4 期（风险比[HR]，2.84；P=0.006）、输尿管切缘阳性（HR，5.71；P<.001）和多灶性（HR，2.07；P=0.009）被发现是上尿路复发的独立预测因素。病理 T3（HR，2.30；P<.001）和 T4 期（HR，3.55；P<.001）、淋巴结侵犯（HR，1.97；P<.001）、淋巴结清扫范围（pNx[HR，1.66；P=0.002]和<10 个淋巴结[HR，1.52；P<.001]）、多灶性（HR，1.80；P<.001）和前列腺受累（HR，1.45；P=.019）被发现是腹部/骨盆复发的独立预测因素。与胸部复发相关的特征包括病理 T3（HR，2.61；P<.001）和 T4（HR，3.39；P<.001）、淋巴结侵犯（HR，2.64；P<.001）、淋巴结清扫范围（pNx[HR，1.89；P=.019]和<10 个淋巴结[HR，1.58；P<.030]）和多灶性（HR，1.79；P<.001）。病理 T3（HR，3.45；P<.001）和 T4 期（HR，3.87；P<.001）、淋巴结侵犯（HR，1.79；P=.006）、职业性辐射暴露（HR，2.97；P=.003）和尿道切缘阳性（HR，2.28；P=.039）被发现是骨骼复发的独立预测因素。肉眼血尿（HR，0.52；P=.009）和肥胖（HR，0.59；P=.027）被发现是对上尿路和骨骼复发有保护作用的因素，分别与上尿路和骨骼复发呈负相关。使用多变量模型中的回归系数开发了用于预测这些部位疾病复发可能性的评分算法。
提出了基于特定部位复发的独立预测因素的评分算法。这些模型可以根据膀胱切除术后的临床病理特征，为个体患者量身定制术后监测方案。
