Clinic of Urology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia.
Urol Oncol. 2013 Nov;31(8):1615-20. doi: 10.1016/j.urolonc.2012.03.004. Epub 2012 Apr 21.
To evaluate the prognostic factors for survival and disease recurrence in patients treated surgically for upper tract urothelial carcinoma (UTUC), focusing especially on the impact of history of non-muscle-invasive bladder cancer.
A single-center series of 221 consecutive patients who were treated surgically for UTUC between January 1999 and December 2010 was evaluated. Patients who had a history of bladder tumor at a higher stage than the upper tract disease, preoperative chemotherapy, or previous contralateral UTUC were excluded. None of the patients included in this study had distant metastasis at diagnosis of UTUC. In total, 183 patients (mean age 66 years, range 36-88) were then available for evaluation. Tumor multifocality was defined as the synchronous presence of 2 or more pathologically confirmed tumors in any upper urinary tract location (renal pelvis or ureter). All patients were treated with either open radical nephroureterectomy (RNU) or open conservative surgery. Recurrence-free probabilities and cancer-specific survival were estimated using the Kaplan-Meier method and Cox regression analyses.
Fifty-one patients (28%) had previous carcinoma not invading bladder muscle. Previous history of non-muscle-invasive bladder cancer was significantly associated with tumor multifocality (P < 0.001), concomitant bladder cancer (P < 0.001), higher tumor stage (P = 0.020), and lymphovascular invasion (P = 0.026). Using univariate analyses, history of non-muscle-invasive bladder cancer was significantly associated with an increased risk of both any recurrence (HR = 2.17; P = 0.003) and bladder-only recurrence (HR = 3.17; P = 0.001). Previous carcinoma not invading bladder muscle (HR = 2.58; P = 0.042) was an independent predictor of bladder-only recurrence. Overall 5-year disease recurrence-free (any recurrence and bladder-only recurrence) survival rates were 66.7% and 77%, respectively. Previous history of non-muscle-invasive bladder cancer was not associated with cancer-specific survival. Our results are subject to the inherent biases associated with high-volume tertiary care centers.
Patients with previous history of non-muscle-invasive bladder cancer had a higher risk of having multifocal and UTUC with higher tumor stages (pT3 or greater). History of bladder tumor was an independent predictor of bladder cancer recurrence but had no effect on non-bladder recurrence, and cancer-specific survival in patients who underwent surgical treatment of UTUC.
评估接受上尿路尿路上皮癌（UTUC）手术治疗患者的生存和疾病复发的预后因素，特别关注非肌肉浸润性膀胱癌病史的影响。
评估了 1999 年 1 月至 2010 年 12 月期间在一个中心接受 UTUC 手术治疗的 221 例连续患者。排除了在上尿路疾病中具有比上尿路疾病更高阶段的膀胱癌病史、术前化疗或先前对侧 UTUC 的患者。本研究中包括的患者在诊断 UTUC 时均无远处转移。总共，183 例患者（平均年龄 66 岁，范围 36-88 岁）可进行评估。肿瘤多灶性定义为同时存在 2 个或更多个经病理证实的任何上尿路位置（肾盂或输尿管）中的肿瘤。所有患者均接受开放性根治性肾输尿管切除术（RNU）或开放性保守手术治疗。使用 Kaplan-Meier 方法和 Cox 回归分析估计无复发生存率和癌症特异性生存率。
51 例（28％）患者有非肌层浸润性膀胱癌病史。非肌层浸润性膀胱癌病史与肿瘤多灶性（P <0.001）、同时性膀胱癌（P <0.001）、更高的肿瘤分期（P = 0.020）和血管淋巴管侵犯（P = 0.026）显著相关。单因素分析显示，非肌层浸润性膀胱癌病史与任何复发（HR = 2.17；P = 0.003）和膀胱单独复发（HR = 3.17；P = 0.001）的风险增加显著相关。非肌层浸润性膀胱癌病史（HR = 2.58；P = 0.042）是膀胱单独复发的独立预测因素。总体 5 年疾病无复发生存率（任何复发和膀胱单独复发）分别为 66.7％和 77％。非肌层浸润性膀胱癌病史与癌症特异性生存率无关。我们的结果受到大容量三级护理中心固有的偏见的影响。
有非肌层浸润性膀胱癌病史的患者具有更高的多灶性和具有更高肿瘤分期（pT3 或更高）的 UTUC 风险。膀胱癌病史是膀胱肿瘤复发的独立预测因素，但对非膀胱复发和接受 UTUC 手术治疗患者的癌症特异性生存率无影响。
