Fang Dong, Zhang Lei, Li Xuesong, Yu Wei, Singla Nirmish, Zhao Guangzhi, Xiong Gengyan, Song Yi, He Qun, He Zhisong, Zhou Liqun
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China.
Ann Surg Oncol. 2015 Aug;22(8):2789-98. doi: 10.1245/s10434-014-4302-5. Epub 2015 Jan 7.
To explore the characteristics, predictive risk factors, and prognostic effect of concomitant non-muscle-invasive bladder cancer (NMIBC) in patients with upper tract urothelial carcinoma (UTUC).
We evaluated 727 consecutive UTUC patients treated with radical resection between 2000 and 2012 in a high-volume center of China. Preoperative cystoscopy was performed in all patients. Patients with previous or concomitant total cystectomy were excluded.
Overall, 73 patients (10.0 %) had NMIBC. Concomitant NMIBC was associated with previous bladder cancer (p = 0.003), tumor located in ureter (p = 0.008), multifocality (p < 0.001), and preoperative renal insufficiency (p = 0.023). The presence of concomitant NMIBC was predictive for lower tumor stage (p = 0.019), papillary architecture (p = 0.023), and organ-confined disease (pT < 3 and N-, p = 0.006). The median follow-up duration was 57 months. The presence of concomitant NMIBC was a risk factor for bladder recurrence (p < 0.001), and particularly in patients with non-muscle-invasive UTUCs, it affects cancer-specific survival (odds ratio 1.614, p = 0.030) and contralateral recurrence (odds ratio, 1.907, p = 0.016). Most concomitant NMIBC were found at the lateral wall or bladder neck, while most intravesical recurrences occurred near the site of surgery or posterior wall.
The most common site for concomitant NMIBC was lateral wall and bladder neck, and previous bladder cancer, tumor located in ureter, tumor multifocality, and preoperative renal insufficiency were risk factors for concomitant NMIBC. The presence of concomitant NMIBC is predictive for relative better pathologic outcomes but higher rate of bladder recurrence, while the effect on postoperative survival was limited with patients early-stage UTUCs. The potential mechanisms need further investigation.
探讨上尿路尿路上皮癌（UTUC）患者合并非肌层浸润性膀胱癌（NMIBC）的特征、预测风险因素及预后影响。
我们评估了2000年至2012年在中国一家大型中心接受根治性切除术的727例连续UTUC患者。所有患者均进行了术前膀胱镜检查。排除既往有或合并全膀胱切除术的患者。
总体而言，73例患者（10.0%）合并NMIBC。合并NMIBC与既往膀胱癌（p = 0.003）、肿瘤位于输尿管（p = 0.008）、多灶性（p < 0.001）及术前肾功能不全（p = 0.023）相关。合并NMIBC的存在可预测较低的肿瘤分期（p = 0.019）、乳头状结构（p = 0.023）及器官局限性疾病（pT < 3且N-，p = 0.006）。中位随访时间为57个月。合并NMIBC的存在是膀胱复发的危险因素（p < 0.001），特别是在非肌层浸润性UTUC患者中，它影响癌症特异性生存（比值比1.614，p = 0.030）和对侧复发（比值比1.907，p = 0.016）。大多数合并的NMIBC位于侧壁或膀胱颈，而大多数膀胱内复发发生在手术部位附近或后壁。
合并NMIBC最常见的部位是侧壁和膀胱颈，既往膀胱癌、肿瘤位于输尿管、肿瘤多灶性及术前肾功能不全是合并NMIBC的危险因素。合并NMIBC的存在可预测相对较好的病理结果，但膀胱复发率较高，而对早期UTUC患者术后生存的影响有限。潜在机制需要进一步研究。
