Park Jinsung, Park Sejun, Song Cheryn, Hong Jun Hyuk, Kim Choung-Soo, Ahn Hanjong
Department of Urology, Eulji University Hospital, Daejeon, Korea.
World J Urol. 2014 Feb;32(1):157-63. doi: 10.1007/s00345-013-1073-8. Epub 2013 Apr 9.
To elucidate the reasons for conflicting results regarding the prognostic significance of tumor location in upper tract urothelial carcinoma (UTUC), we analyzed the stage-specific impact of tumor location on oncological outcomes following radical nephroureterectomy (RNU).
Data from 392 patients who underwent RNU with curative intent between 1991 and 2010 were reviewed. Prognostic impact of tumor location and various clinicopathological factors for recurrence-free survival (RFS) and cancer-specific survival (CSS) was evaluated using Kaplan-Meier and Cox regression analyses at each pathological stage. Tumor location was classified as renal pelvis or ureter, and pT3 tumors were further stratified as invading the renal parenchyma or peripelvic or periureteral fat.
In stage-specific analysis, tumor location did not have prognostic significance in patients with ≤pT2 tumors, whereas RFS and CSS rates were significantly lower in patients with pT3 ureteral tumors than renal pelvic tumors. Subgroup analysis showed that RFS and CSS rates were significantly higher for pT3 tumors invading the renal parenchyma than the peripelvic or periureteral fat. On multivariate analysis in pT3 tumors adjusting other clinicopathological parameters, tumor location remained significant predictors for both RFS and CSS. Compared with tumors invading renal parenchyma, tumors invading peripelvic fat or periureteral fat were associated with about 3.5 times higher risk for cancer-specific mortality (p < 0.05).
Location-dependent survival difference exists only in patients with pT3 UTUC. Conflicting institutional results regarding tumor location in UTUC may be due to difference in the proportions of parenchymal versus peripelvic fat invasion in pT3 pelvic tumors.
为阐明上尿路尿路上皮癌（UTUC）中肿瘤位置的预后意义存在相互矛盾结果的原因，我们分析了肿瘤位置对根治性肾输尿管切除术（RNU）后肿瘤学结局的分期特异性影响。
回顾了1991年至2010年间392例行根治性意图RNU患者的数据。使用Kaplan-Meier和Cox回归分析评估各病理分期下肿瘤位置及各种临床病理因素对无复发生存期（RFS）和癌症特异性生存期（CSS）的预后影响。肿瘤位置分为肾盂或输尿管，pT3肿瘤进一步分层为侵犯肾实质或肾盂周围或输尿管周围脂肪。
在分期特异性分析中，肿瘤位置对≤pT2期肿瘤患者无预后意义，而pT3期输尿管肿瘤患者的RFS和CSS率显著低于肾盂肿瘤患者。亚组分析显示，pT3期侵犯肾实质的肿瘤的RFS和CSS率显著高于侵犯肾盂周围或输尿管周围脂肪的肿瘤。在pT3期肿瘤的多变量分析中，调整其他临床病理参数后，肿瘤位置仍是RFS和CSS的重要预测因素。与侵犯肾实质的肿瘤相比，侵犯肾盂周围脂肪或输尿管周围脂肪的肿瘤癌症特异性死亡风险高约3.5倍（p<0.05）。
仅在pT3期UTUC患者中存在位置依赖性生存差异。UTUC中关于肿瘤位置的机构结果相互矛盾可能是由于pT3期肾盂肿瘤中实质侵犯与肾盂周围脂肪侵犯比例的差异。
