Mehta R, Gillan A S, Ming Z Y, Rai B P, Byrne D, Nabi G
Academic Section of Urology, Division of Imaging and Technology, Medical Research Institute, Medical School, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, Scotland, UK,
World J Urol. 2015 Jan;33(1):41-9. doi: 10.1007/s00345-014-1262-0. Epub 2014 Mar 12.
Little is known about the effects of socio-economic deprivation on the oncological outcomes of surgically treated upper tract transitional cell carcinoma.
From January 1998 to December 2012, 161 patients underwent nephroureterectomy for upper urinary tract cancer at our tertiary medical centre. We included 124 patients where complete data were available for further analysis. This study also analysed the impact of the reported risk factors such as grade, stage, multifocality in addition to socio-economic deprivation on the long-term oncological outcomes after nephroureterectomy.
One hundred and twenty-four (77 %) patients with complete data for socio-economic status were analysed in this study. The median age of the cohort was 73 years (interquartile range 45-86). There were 20, 18, 17, 40 and 29 patients in different socio-economic categories ranging from 1 to 5, respectively. The median duration of follow-up was 68 months (9-174). A statistically higher grade (p value 0.005) and higher stage (p value 0.0005) disease was seen in patients from less deprived categories on both univariate and multivariate analyses. The cancer-specific mortality and follow-up recurrences, however, did not significantly differ between the different socio-economic categories on multivariate analysis (p value 0.13; 0.6) and on univariate and multivariate analyses. A higher number of patients with multifocal disease and concomitant carcinoma in situ (CIS) had disease recurrences which were statistically significant (p values 0.026 and 0.014, respectively) on multivariate analysis.
A lower recurrence-free survival was observed in patients with multifocal disease and those with concomitant CIS following nephroureterectomy for clinically localized disease. Long-term follow-up did not show any significant differences in cancer-specific survival between different deprivation categories.
关于社会经济剥夺对手术治疗的上尿路移行细胞癌肿瘤学结局的影响，目前所知甚少。
1998年1月至2012年12月，161例患者在我们的三级医疗中心接受了上尿路癌根治性肾输尿管切除术。我们纳入了124例可获得完整数据以供进一步分析的患者。本研究还分析了除社会经济剥夺外，已报道的危险因素如分级、分期、多灶性对肾输尿管切除术后长期肿瘤学结局的影响。
本研究分析了124例（77%）具有社会经济状况完整数据的患者。该队列的中位年龄为73岁（四分位间距45 - 86岁）。社会经济类别从1到5的患者分别有20例、18例、17例、40例和29例。中位随访时间为68个月（9 - 174个月）。单因素和多因素分析均显示，来自贫困程度较低类别的患者疾病分级（p值0.005）和分期（p值0.0005）更高。然而，多因素分析中不同社会经济类别之间的癌症特异性死亡率和随访复发率无显著差异（p值分别为0.13和0.6），单因素和多因素分析结果相同。多灶性疾病和原位癌（CIS）患者的疾病复发率更高，多因素分析显示差异有统计学意义（p值分别为0.026和0.014）。
对于临床局限性疾病行肾输尿管切除术后，多灶性疾病患者和伴有CIS的患者无复发生存率较低。长期随访未显示不同贫困类别之间癌症特异性生存率有任何显著差异。
