Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
World J Urol. 2011 Aug;29(4):487-94. doi: 10.1007/s00345-011-0645-8. Epub 2011 Jan 20.
The purpose of this study is to assess the association of concomitant carcinoma in situ (CIS) with disease recurrence and cancer-related death in a multi-institutional series of patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).
We collected retrospectively the data of 772 patients treated with RNU and ipsilateral bladder cuff excision at 9 international institutions in Asia, Europe, and Northern America from 1987 to 2008. Surgical specimens were processed according to standard pathologic procedures at each institution. Univariable and multivariable Cox regression models addressed time to recurrence and cancer-specific mortality.
Concomitant CIS was present in 88 patients (11.4%); it was associated with more advanced pathologic stage, higher tumor grade, and presence of lymphovascular invasion (all P-values < 0.05). The five-year recurrence-free (RFS) and cancer-specific survival (CSS) estimates were 74.4 and 76.3%, respectively, in the absence of CIS compared with 56.4 and 59.9%, respectively, in the presence of CIS (P-values < 0.0001 for RFS and 0.002 for CSS, respectively). On multivariable Cox regression analyses, concomitant CIS was an independent predictor of both RFS (hazard ratio (HR): 1.9; P = 0.007) and CSS (HR: 1.7, P = 0.048). Similar findings were reconfirmed in subgroups analyses limited to T2, organ confined, and N0/Nx UTUC, or patients who did not receive adjuvant chemotherapy.
Presence of concomitant CIS is an independent predictor of both RFS and CSS in patients treated with RNU for UTUC. This information may be useful in risk stratification of UTUC patients for follow-up and additional therapy.
本研究旨在评估多机构系列接受根治性肾输尿管切除术（RNU）治疗的上尿路上皮癌（UTUC）患者中同时存在原位癌（CIS）与疾病复发和癌症相关死亡的相关性。
我们回顾性收集了 1987 年至 2008 年期间，来自亚洲、欧洲和北美的 9 个国际机构的 772 例接受 RNU 和同侧膀胱袖状切除术治疗的患者数据。每个机构均按照标准病理程序处理手术标本。单变量和多变量 Cox 回归模型解决了复发时间和癌症特异性死亡率的问题。
88 例（11.4%）患者同时存在 CIS；它与更晚期的病理分期、更高的肿瘤分级和存在脉管侵犯相关（所有 P 值均<0.05）。在不存在 CIS 的情况下，五年无复发生存率（RFS）和癌症特异性生存率（CSS）估计值分别为 74.4%和 76.3%，而在存在 CIS 的情况下，分别为 56.4%和 59.9%（RFS 分别为 P 值<0.0001，CSS 为 P 值=0.002）。多变量 Cox 回归分析显示，同时存在 CIS 是 RFS（危险比（HR）：1.9；P=0.007）和 CSS（HR：1.7，P=0.048）的独立预测因素。在仅限于 T2、器官受限和 N0/Nx UTUC 或未接受辅助化疗的患者的亚组分析中，也证实了类似的发现。
同时存在 CIS 是接受 RNU 治疗 UTUC 患者的 RFS 和 CSS 的独立预测因素。这些信息可能有助于对 UTUC 患者进行风险分层，以进行随访和额外治疗。
