Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY 10065, USA.
Eur Urol. 2012 Oct;62(4):677-84. doi: 10.1016/j.eururo.2012.02.018. Epub 2012 Feb 15.
Dissimilarities in management and outcomes exist between upper tract urothelial carcinoma (UTUC) and urothelial carcinoma of the bladder (UCB).
The aim of this study was to analyze the stage-specific impact of upper or lower urinary tract tumor location on oncologic outcomes.
DESIGN, SETTING, AND PARTICIPANTS: Data were collected from 4335 patients with UCB treated with radical cystectomy (RC) and bilateral pelvic lymphadenectomy (PLND), 877 patients with ureteral UTUC, and 1615 with pelvicalyceal UTUC treated with radical nephroureterectomy (RNU). No patient received preoperative chemotherapy or radiation therapy.
Patients were treated with RC and bilateral PLND or RNU.
Outcomes were assessed according to primary tumor location.
Compared to UTUC patients, UCB patients had more advanced tumor stage and higher grade, and they were more likely to harbor lymphovascular invasion (LVI) and lymph node metastasis (p<0.001). In non-muscle-invasive tumor stages, UCB patients were more likely to experience disease recurrence and mortality compared to renal pelvicalyceal tumor patients (p<0.002) but not ureteral tumors (p>0.05). In pT2 and pT3 tumors, there was no difference in outcomes between the three tumor locations. In pT4 tumors, patients with ureteral and pelvicalyceal tumors were more likely to experience disease recurrence and mortality compared to UCB patients (p<0.004). These stage-specific findings were unchanged after adjustment for the effects of age, gender, tumor grade, LVI, lymph node status, and adjuvant chemotherapy. This study is limited by its retrospective and multicenter nature.
Stage-specific differences in outcomes exist between UCB and UTUC. The differentially worse outcomes by stage between UCB and UTUC patients underline the differences between both cancer entities and the need for individualized stage-specific management for each patient.
上尿路尿路上皮癌（UTUC）和膀胱尿路上皮癌（UCB）的治疗和预后存在差异。
本研究旨在分析上尿路或下尿路肿瘤位置对肿瘤学结果的分期特异性影响。
设计、地点和参与者：数据来自 4335 例接受根治性膀胱切除术（RC）和双侧盆腔淋巴结清扫术（PLND）治疗的 UCB 患者、877 例输尿管 UTUC 患者和 1615 例接受根治性肾输尿管切除术（RNU）治疗的肾盂输尿管 UTUC 患者。所有患者均未接受术前化疗或放疗。
患者接受 RC 和双侧 PLND 或 RNU 治疗。
根据原发肿瘤位置评估结局。
与 UTUC 患者相比，UCB 患者肿瘤分期更晚、分级更高，且更易发生脉管侵犯（LVI）和淋巴结转移（p<0.001）。在非肌层浸润性肿瘤分期中，与肾盂输尿管肿瘤患者相比（p<0.002），UCB 患者更易出现疾病复发和死亡，但与输尿管肿瘤患者相比（p>0.05）无差异。在 pT2 和 pT3 肿瘤中，三种肿瘤位置之间的结局无差异。在 pT4 肿瘤中，与 UCB 患者相比，输尿管和肾盂输尿管肿瘤患者更易出现疾病复发和死亡（p<0.004）。这些分期特异性发现在调整年龄、性别、肿瘤分级、LVI、淋巴结状态和辅助化疗的影响后仍然存在。本研究受其回顾性和多中心性质的限制。
UCB 和 UTUC 的预后存在分期特异性差异。UCB 和 UTUC 患者在分期上的预后差异突出了这两种癌症实体之间的差异，以及为每位患者提供个体化分期特异性管理的必要性。
