Mouracade Pascal, Velten Michel, Gigante Marc, Alenda Olivier, Ploussard Guillaume, Obadia Frederic, Timsit Marc Olivier, Mejean Arnaud
Department of Urology, Université Paris Descartes, France.
Can J Urol. 2012 Feb;19(1):6105-10.
This study aims to assess the influence of different prognostic factors on survival of upper tract urothelial carcinoma (UTUC) managed by nephroureterectomy and to investigate whether these factors have an independent prognostic significance.
A retrospective review of institutional databases from two teaching hospitals identified 269 consecutive patients with UTUC managed with nephroureterctomy between 1985 and 2005. Mean follow up was 80.6 months (median 70.3 months). Follow up was completed until January 2009. Tumor location and other clinicopathological variables were analyzed regarding survival. Data accrued included age, gender, tumor characteristics (pT stage, grade, lymph node status), tumor location, use of chemotherapy and period of diagnosis. Tumor location was divided into two groups (renal pelvis and ureter) based on the location of the tumor.
Five year and 10 year overall survival estimates for this cohort were 71.3% and 40.0% respectively. According to tumor location, survival was 73.6% and 47.0% for the renal pelvis versus 67.8% and 32.3% for the ureter, respectively (log rank test: p = 0.027). In multivariate analysis, among the clinicopathological variables, T stage was the most significant prognostic factor (p < 0.001). Nodal involvement (p = 0,005), high grade (p < 0.001), first period of diagnosis (p < 0.001) and ureteral tumor location (p = 0.003) were significantly associated with lower survival rates. Prognosis of UTUC improved over time: survival was significantly better during the last period of diagnosis (2001-2005) (p < 0.002).
Tumor location and diagnostic period should be considered as an independent prognostic factor for upper tract transitional cell carcinoma.
本研究旨在评估不同预后因素对上尿路尿路上皮癌（UTUC）行肾输尿管切除术患者生存情况的影响，并探究这些因素是否具有独立的预后意义。
对两家教学医院机构数据库进行回顾性分析，确定了1985年至2005年间连续269例行肾输尿管切除术的UTUC患者。平均随访时间为80.6个月（中位数70.3个月）。随访至2009年1月结束。分析肿瘤位置及其他临床病理变量对生存情况的影响。收集的数据包括年龄、性别、肿瘤特征（pT分期、分级、淋巴结状态）、肿瘤位置、化疗使用情况及诊断时期。根据肿瘤位置将其分为两组（肾盂和输尿管）。
该队列的5年和10年总生存率估计分别为71.3%和40.0%。根据肿瘤位置，肾盂患者的生存率分别为73.6%和47.0%，输尿管患者的生存率分别为67.8%和32.3%（对数秩检验：p = 0.027）。多因素分析中，在临床病理变量中，T分期是最显著的预后因素（p < 0.001）。淋巴结受累（p = 0.005）、高级别（p < 0.001）、首个诊断时期（p < 0.001）及输尿管肿瘤位置（p = 0.003）与较低生存率显著相关。UTUC的预后随时间改善：在最后诊断时期（2001 - 2005年）生存率显著更高（p < 0.002）。
肿瘤位置和诊断时期应被视为上尿路移行细胞癌的独立预后因素。
