Academic Department of Urology, CHRU Lille, Lille Nord de France University, Lille, France.
World J Urol. 2013 Feb;31(1):83-91. doi: 10.1007/s00345-012-0964-4. Epub 2012 Oct 11.
Recent publications have assessed the prognostic significance of hydronephrosis in the outcome of upper tract urothelial carcinoma (UUT-UC). Our study sought to determine the prognostic impact of hydronephrosis on UUT-UC survival and its relationship to the clinicopathological features.
A retrospective, multi-institutional French study was conducted on 401 patients who underwent radical nephroureterectomy for non-metastatic UUT-UC. Hydronephrotic status was determined using preoperative imaging reports. Univariate and multivariate analyses were conducted to identify factors associated with survival.
Preoperative hydronephrosis was present in 74 patients. Median follow-up was 26 months. Hydronephrosis was associated only with ureteral localisation (p < 0.001). No difference was observed in 5-year cancer-specific survival (CSS) between the hydronephrosis group (80.1 %) and the no hydronephrosis group (83.6 %) (p > 0.05). Only age (p = 0.02) and pT stage (p = 0.01) were independent predictors of CSS. Hydronephrosis was not a significant predictor of CSS in the univariate and multivariate analyses (p = 0.87 and p = 0.66). No significant difference was observed for 5-year metastasis-free survival (MFS) between the hydronephrosis group (69.8 % ± 6.6 %) and the no hydronephrosis group (80.5 % ± 3 %) (p = 0.052). Hydronephrosis was not a significant predictor of MFS in the univariate and multivariate analyses (p = 0.16 and p = 0.36). Multifocality (p = 0.02), pT stage (p < 0.001) and positive surgical margins (p = 0.02) were independent predictors of MFS. For the pelvic tumours subgroup, hydronephrosis was an independent predictor of MFS (p = 0.01) but not CSS (p = 0.86).
Preoperative hydronephrosis was not associated with survival. However, among tumours presenting with hydronephrosis, pelvicalyceal tumours appear to have a worse prognosis than ureteral tumours.
最近的出版物评估了上尿路尿路上皮癌（UUT-UC）结局中积水的预后意义。我们的研究旨在确定积水对上尿路尿路上皮癌生存的预后影响及其与临床病理特征的关系。
对 401 例接受根治性肾输尿管切除术治疗非转移性 UUT-UC 的患者进行了回顾性、多机构的法国研究。使用术前影像学报告确定积水状态。进行单因素和多因素分析以确定与生存相关的因素。
术前积水 74 例。中位随访时间为 26 个月。积水仅与输尿管定位有关（p<0.001）。积水组（80.1%）和无积水组（83.6%）5 年癌症特异性生存率（CSS）无差异（p>0.05）。只有年龄（p=0.02）和 pT 分期（p=0.01）是 CSS 的独立预测因素。单因素和多因素分析中，积水不是 CSS 的显著预测因素（p=0.87 和 p=0.66）。积水组（69.8%±6.6%）和无积水组（80.5%±3%）5 年无转移生存率（MFS）无差异（p=0.052）。单因素和多因素分析中，积水不是 MFS 的显著预测因素（p=0.16 和 p=0.36）。多灶性（p=0.02）、pT 分期（p<0.001）和阳性切缘（p=0.02）是 MFS 的独立预测因素。对于骨盆肿瘤亚组，积水是 MFS 的独立预测因素（p=0.01），但不是 CSS（p=0.86）。
术前积水与生存无关。然而，在存在积水的肿瘤中，肾盂肿瘤的预后似乎比输尿管肿瘤差。
