Yeh Hsin-Chih, Jan Hau-Chern, Wu Wen-Jeng, Li Ching-Chia, Li Wei-Ming, Ke Hung-Lung, Huang Shu-Pin, Liu Chia-Chu, Lee Yung-Chin, Yang Sheau-Fang, Liang Peir-In, Huang Chun-Nung
Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
PLoS One. 2015 Oct 15;10(10):e0139624. doi: 10.1371/journal.pone.0139624. eCollection 2015.
To investigate the impact of preoperative hydronephrosis and flank pain on prognosis of patients with upper tract urothelial carcinoma.
In total, 472 patients with upper tract urothelial carcinoma managed by radical nephroureterectomy were included from Kaohsiung Medical University Hospital Healthcare System. Clinicopathological data were collected retrospectively for analysis. The significance of hydronephrosis, especially when combined with flank pain, and other relevant factors on overall and cancer-specific survival were evaluated.
Of the 472 patients, 292 (62%) had preoperative hydronephrosis and 121 (26%) presented with flank pain. Preoperative hydronephrosis was significantly associated with age, hematuria, flank pain, tumor location, and pathological tumor stage. Concurrent presence of hydronephrosis and flank pain was a significant predictor of non-organ-confined disease (multivariate-adjusted hazard ratio = 2.10, P = 0.025). Kaplan-Meier analysis showed significantly poorer overall and cancer-specific survival in patients with preoperative hydronephrosis (P = 0.005 and P = 0.026, respectively) and in patients with flank pain (P < 0.001 and P = 0.001, respectively) than those without. However, only simultaneous hydronephrosis and flank pain independently predicted adverse outcome (hazard ratio = 1.98, P = 0.016 for overall survival and hazard ratio = 1.87, P = 0.036 for and cancer-specific survival, respectively) in multivariate Cox proportional hazards models. In addition, concurrent presence of hydronephrosis and flank pain was also significantly predictive of worse survival in patient with high grade or muscle-invasive disease. Notably, there was no difference in survival between patients with hydronephrosis but devoid of flank pain and those without hydronephrosis.
Concurrent preoperative presence of hydronephrosis and flank pain predicted non-organ-confined status of upper tract urothelial carcinoma. When accompanied with flank pain, hydronephrosis represented an independent predictor for worse outcome in patients with upper tract urothelial carcinoma.
探讨术前肾积水和胁腹痛对上尿路尿路上皮癌患者预后的影响。
从高雄医学大学附属医院医疗系统纳入472例行根治性肾输尿管切除术的上尿路尿路上皮癌患者。回顾性收集临床病理数据进行分析。评估肾积水尤其是合并胁腹痛及其他相关因素对总生存和癌症特异性生存的意义。
472例患者中，292例（62%）有术前肾积水，121例（26%）有胁腹痛。术前肾积水与年龄、血尿、胁腹痛、肿瘤位置及病理肿瘤分期显著相关。肾积水和胁腹痛同时存在是非器官局限性疾病的显著预测因素（多变量调整风险比=2.10，P=0.025）。Kaplan-Meier分析显示，术前有肾积水的患者（分别为P=0.005和P=0.026）和有胁腹痛的患者（分别为P<0.001和P=0.001）的总生存和癌症特异性生存明显比无肾积水和胁腹痛的患者差。然而，在多变量Cox比例风险模型中，只有同时存在肾积水和胁腹痛独立预测不良结局（总生存风险比=1.98，P=0.016；癌症特异性生存风险比=1.87，P=0.036）。此外，肾积水和胁腹痛同时存在对高级别或肌层浸润性疾病患者的生存预后也有显著的不良预测作用。值得注意的是，有肾积水但无胁腹痛的患者与无肾积水的患者生存率无差异。
术前同时存在肾积水和胁腹痛预示上尿路尿路上皮癌的非器官局限性状态。当伴有胁腹痛时，肾积水是上尿路尿路上皮癌患者预后不良的独立预测因素。
