Academic Department of Urology, CHU Lille, Univ Lille Nord de France, F-59000 Lille, France.
Eur Urol. 2011 Dec;60(6):1258-65. doi: 10.1016/j.eururo.2011.05.049. Epub 2011 Jun 7.
It is not known whether the primary tumour location of upper urinary tract urothelial carcinoma (UUT-UC) is associated with prognosis.
To evaluate the impact of initial primary tumour location on survival in patients who had undergone radical nephroureterectomy (RNU).
DESIGN, SETTING, AND PARTICIPANTS: Using a multi-institutional, retrospective database, we identified 609 patients with UUT-UC who had undergone RNU between 1995 and 2010. Tumour location was categorised as renal pelvis, ureter, or multifocal.
All patients had undergone RNU.
Tumour location was tested as a prognostic factor for survival through univariate and multivariable Cox regression analysis.
Tumour location was renal pelvis in 317 cases (52%), ureter in 185 cases (30%), and multifocal in 107 cases (18%). Compared to renal pelvic and ureteral tumours, multifocal tumours were more likely to be associated with advanced stages (pT3/pT4; 39%, 30%, and 54%, respectively; p<0.001) and high-grade disease (53%, 56%, and 76%, respectively; p<0.001). On multivariable analysis, tumour location was an independent prognostic factor for cancer-specific death, disease recurrence, and metastasis (p<0.05). The 5-yr cancer-specific death-free survival probability was 86.8% for renal pelvic tumours, 68.9% for ureteral tumours, and 56.8% for multifocal tumours (p<0.001). The retrospective design of this study was its main limitation.
Ureteral and multifocal tumours had a worse prognosis than renal pelvic tumours. These findings are not in line with recently published data and should be investigated in a prospective assessment to obtain a definitive statement regarding this matter.
上尿路上皮癌（UUT-UC）的原发肿瘤位置是否与预后相关尚不清楚。
评估根治性肾输尿管切除术（RNU）后患者的初始原发肿瘤位置对生存的影响。
设计、设置和参与者：使用多机构回顾性数据库，我们确定了 1995 年至 2010 年间接受 RNU 的 609 例 UUT-UC 患者。肿瘤位置分为肾盂、输尿管或多灶性。
所有患者均接受 RNU。
通过单变量和多变量 Cox 回归分析，将肿瘤位置作为生存的预后因素进行检验。
肿瘤位置为肾盂 317 例（52%），输尿管 185 例（30%），多灶性 107 例（18%）。与肾盂和输尿管肿瘤相比，多灶性肿瘤更有可能与晚期（pT3/pT4；分别为 39%、30%和 54%；p<0.001）和高级别疾病（分别为 53%、56%和 76%；p<0.001）相关。多变量分析显示，肿瘤位置是癌症特异性死亡、疾病复发和转移的独立预后因素（p<0.05）。肾盂肿瘤的 5 年癌症特异性无死亡生存概率为 86.8%，输尿管肿瘤为 68.9%，多灶性肿瘤为 56.8%（p<0.001）。本研究的主要局限性是回顾性设计。
输尿管和多灶性肿瘤的预后比肾盂肿瘤差。这些发现与最近发表的数据不一致，应在前瞻性评估中进行研究，以对这一问题作出明确的陈述。
