Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Pingtung Hospital, Department of Health, Executive Yuan, Pingtung, Taiwan.
Urol Oncol. 2013 Nov;31(8):1670-5. doi: 10.1016/j.urolonc.2012.05.004. Epub 2012 Jun 9.
To investigate the association of tumor location on oncological outcomes in patients treated with radical nephroureterectomy (RNU) for primary ureteral urothelial carcinoma (UC).
From January 1990 to December 2007, 127 patients with primary solitary ureteral UC who underwent RNU at our institution were included. The patients were divided into 3 groups based on tumor location-proximal, middle, or distal ureter. Patients' medical records were reviewed retrospectively. The clinicopathologic data and oncologic outcomes were compared among the groups.
Of the 127 patients, 40 (31.5%) had tumors in the proximal ureter, 40 (31.5%) in the middle ureter, and 47 (37.0%) in the distal ureter. Patients with distal ureteral UC were more likely to undergo open procedures to manage the bladder cuff (P = 0.005). Other clinical and histopathologic variables were not different among the 3 groups. Comparing the proximal, middle, or distal ureteral UC, bladder recurrence developed in, respectively, 25.0%, 25.0%, and 21.3% cases (P = 0.892); local retroperitoneal recurrence in 2.5%, 12.5%, and 4.3% (P = 0.141); contralateral recurrence in 0%, 0%, and 4.3%(P = 0.177); and distant metastasis in 17.5%, 10.0%, and 4.3% (P = 0.147). Recurrence-free and cancer-specific survival among the 3 groups were not different (P = 0.781 and 0.192, respectively).
Tumor location cannot be used to predict oncologic outcomes in patients treated with RNU for primary ureteral UC. Therefore, clinical decisions or follow-up protocol should not differ among patients with primary proximal, middle, or distal ureteral UC.
探讨根治性肾输尿管切除术（RNU）治疗原发性输尿管尿路上皮癌（UC）患者肿瘤位置与肿瘤学结局的相关性。
回顾性分析 1990 年 1 月至 2007 年 12 月在我院接受 RNU 的 127 例原发性单发输尿管 UC 患者的临床资料。根据肿瘤位置（近端、中段或远端输尿管）将患者分为 3 组。分析比较各组患者的临床病理资料及肿瘤学结局。
127 例患者中，40 例（31.5%）肿瘤位于输尿管近端，40 例（31.5%）位于输尿管中段，47 例（37.0%）位于输尿管远端。远端输尿管 UC 患者更倾向于接受开放手术处理膀胱袖口（P=0.005）。3 组患者的其他临床和组织病理学变量无差异。近端、中段或远端输尿管 UC 患者的膀胱复发率分别为 25.0%、25.0%和 21.3%（P=0.892）；局部腹膜后复发率分别为 2.5%、12.5%和 4.3%（P=0.141）；对侧复发率分别为 0%、0%和 4.3%（P=0.177）；远处转移率分别为 17.5%、10.0%和 4.3%（P=0.147）。3 组患者的无复发生存率和癌症特异性生存率无差异（P=0.781 和 0.192）。
肿瘤位置不能用于预测接受 RNU 治疗的原发性输尿管 UC 患者的肿瘤学结局。因此，对于原发性输尿管近端、中段或远端 UC 患者，临床决策或随访方案不应有所不同。
