Shibing Yan, Liangren Liu, Qiang Wei, Hong Liao, Turun Song, Junhao Lei, Lu Yang, Zhengyong Yuan, Yonghao Jiang, Guangqing Fu, Yunxiang Li, Dehong Cao
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Department of Urology, Dujiangyan Medical Center/Affiliated Hospital of Chengdu University, Dujiangyan City, Sichuan Province, China.
BJU Int. 2016 Dec;118(6):902-910. doi: 10.1111/bju.13463. Epub 2016 Mar 27.
To evaluate the prognostic impact of tumour size on survival outcomes in upper urinary tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU).
Data on 795 patients treated with RNU for UTUC from seven centres were retrospectively analysed with focus on tumour size. Clinicopathological features and relevant prognostic factors were compared between patients with tumours ≤3.0 cm and those with tumours >3.0 cm in size. The primary endpoints were cancer-specific survival (CSS), disease recurrence-free survival (RFS) and overall survival (OS).
At a median follow-up of 32 months, 313 (39.4%) patients died from UTUC, 321 (40.4%) developed cancer recurrence, and 359 (45.1%) died from all causes. Tumour size >3.0 cm was associated with unfavourable clinicopathlogical features. Kaplan-Meier analysis showed that tumour size was significantly correlated with worse CSS, RFS and OS (all P < 0.001). Multivariate analysis showed that tumour size was an independent predictor of CSS (hazard ratio [HR] 2.296; P < 0.001), RFS (HR 2.193; P < 0.001) and OS (HR 2.417; P < 0.001).
Tumour size >3.0 cm was a significant predictor of CSS, RFS and OS after RNU for patients with UTUC. Further studies are warranted before tumour size is included in risk prediction tools.
评估肿瘤大小对上尿路尿路上皮癌（UTUC）患者行根治性肾输尿管切除术（RNU）后生存结局的预后影响。
回顾性分析来自七个中心的795例行RNU治疗UTUC的患者数据，重点关注肿瘤大小。比较肿瘤大小≤3.0 cm和>3.0 cm的患者的临床病理特征及相关预后因素。主要终点为癌症特异性生存（CSS）、无疾病复发生存（RFS）和总生存（OS）。
中位随访32个月时，313例（39.4%）患者死于UTUC，321例（40.4%）发生癌症复发，359例（45.1%）死于各种原因。肿瘤大小>3.0 cm与不良临床病理特征相关。Kaplan-Meier分析显示，肿瘤大小与较差的CSS、RFS和OS显著相关（均P<0.001）。多因素分析显示，肿瘤大小是CSS（风险比[HR]2.296；P<0.001）、RFS（HR 2.193；P<0.001）和OS（HR 2.417；P<0.001）的独立预测因素。
对于UTUC患者，肿瘤大小>3.0 cm是RNU术后CSS、RFS和OS的重要预测因素。在将肿瘤大小纳入风险预测工具之前，有必要进行进一步研究。
