Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
Ann Surg Oncol. 2012 Dec;19(13):4337-44. doi: 10.1245/s10434-012-2499-8. Epub 2012 Jul 18.
To describe the natural history and identify predictors of cancer-specific survival in patients who experience disease recurrence after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).
Of 2,494 UTUC patients treated with RNU without neoadjuvant chemotherapy, 597 patients experienced disease recurrence. A total of 148 patients (25 %) received adjuvant chemotherapy before disease recurrence. Multivariable Cox regression model addressed time to cancer-specific mortality after disease recurrence.
The median time from RNU to disease recurrence was 12 months (interquartile range 5-22). A total of 491 (82 %) of 597 patients died from UTUC, and 8 patients (1.3 %) died from other causes. The median time from disease recurrence to death of UTUC was 10 months. Actuarial cancer-specific survival estimate at 12 months after disease recurrence was 35 %. On multivariable analysis that adjusted for the effects of standard clinicopathologic characteristics, higher tumor stages [hazard ratio (HR) pT3 vs. pT0-T1: 1.66, p = 0.001; HR pT4 vs. pT0-T1: 1.90, p = 0.002], absence of lymph node dissection (HR 1.28, p = 0.041), ureteral tumor location (HR 1.44, p < 0.0005) and a shorter interval from surgery to disease recurrence (p < 0.0005) were significantly associated with cancer-specific mortality. The adjusted 6-, 12- and 24-month postrecurrence cancer-specific mortality was 73, 60 and 57 %, respectively.
Approximately 80 % of patients who experience disease recurrence after RNU die within 2 years after recurrence. Patients with non-organ-confined stage, absence of lymph node dissection, ureteral tumor location and/or shorter time to disease recurrence died of their tumor more quickly than their counterparts. These factors should be considered in patient counseling and risk stratification for salvage treatment decision making.
描述经历根治性肾输尿管切除术（RNU）治疗上尿路上皮癌（UTUC）后复发患者的自然病史，并确定其癌症特异性生存的预测因素。
在 2494 例接受 RNU 治疗且未接受新辅助化疗的 UTUC 患者中，有 597 例患者出现疾病复发。共有 148 例（25%）患者在疾病复发前接受了辅助化疗。多变量 Cox 回归模型分析了疾病复发后癌症特异性死亡的时间。
从 RNU 到疾病复发的中位时间为 12 个月（四分位间距 5-22）。597 例患者中共有 491 例（82%）死于 UTUC，8 例（1.3%）死于其他原因。从疾病复发到 UTUC 死亡的中位时间为 10 个月。疾病复发后 12 个月的癌症特异性生存估计值为 35%。在多变量分析中，调整了标准临床病理特征的影响后，较高的肿瘤分期[pT3 与 pT0-T1 的危险比（HR）为 1.66，p=0.001；pT4 与 pT0-T1 的 HR 为 1.90，p=0.002]、无淋巴结清扫术（HR 为 1.28，p=0.041）、输尿管肿瘤位置（HR 为 1.44，p<0.0005）和手术至疾病复发的时间间隔较短（p<0.0005）与癌症特异性死亡率显著相关。调整后的疾病复发后 6、12 和 24 个月的癌症特异性死亡率分别为 73%、60%和 57%。
大约 80%经历 RNU 治疗后复发的患者在复发后 2 年内死亡。非器官受限期、无淋巴结清扫术、输尿管肿瘤位置和/或较短的疾病复发时间的患者比其他患者更快地死于肿瘤。在为挽救性治疗决策进行患者咨询和风险分层时，应考虑这些因素。
