Yamashita Ryo, Watanabe Reiko, Ito Ichiro, Shinsaka Hideo, Nakamura Masafumi, Matsuzaki Masato, Niwakawa Masashi
Division of Urology, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi, Suntougun, Shizuoka, 411-8777, Japan.
Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan.
Int Urol Nephrol. 2017 Mar;49(3):425-430. doi: 10.1007/s11255-017-1510-5. Epub 2017 Jan 11.
To determine major risk factors for bladder cancer (BC) recurrence after nephroureterectomy (Nux) by focusing on the pathologic appearances of tumors in upper urinary tract urothelial carcinomas (UUTUCs).
We performed 147 Nux procedures between November 2002 and September 2015. Forty-eight patients were excluded because of a history of BC (28 patients), previous or concurrent radical cystectomy (9 patients), neoadjuvant chemotherapy (5 patients), and other reasons (6 patients). We classified UUTUCs into three types: renal pelvic, short-length ureteral, and long-length ureteral cancer; the cutoff for categorizing short- versus long-length ureteral cancer was the median tumor length. Univariate and multivariate analyses with Cox regression methods were performed to calculate hazard ratios (HRs) for BC recurrence using nine clinical covariates, including our new pathologic classification.
The median follow-up period for the survivors was 60 months (range 1-157 months). Of 99 patients, 36 (36%) had BC recurrence; of these 36 patients, 30 (85%) experienced recurrence within 2 years and 17 (47%) had invasive BC (≥pT1). Statistical analyses demonstrated that pathologic tumor type was the major significant risk factor for BC recurrence. Long-length (>5 cm) ureteral cancer had the highest risk of BC recurrence compared to other tumor types (multivariate HR 2.1; 95% confidence interval 1.03-4.2).
Our simple classification system based on the tumor's pathologic appearance is useful for predicting BC recurrence. Patients with long-length ureteral cancer have a high risk of BC recurrence.
通过关注上尿路尿路上皮癌（UUTUC）肿瘤的病理表现，确定肾输尿管切除术（Nux）后膀胱癌（BC）复发的主要危险因素。
我们在2002年11月至2015年9月期间进行了147例Nux手术。48例患者因BC病史（28例）、既往或同期根治性膀胱切除术（9例）、新辅助化疗（5例）及其他原因（6例）被排除。我们将UUTUC分为三种类型：肾盂癌、短段输尿管癌和长段输尿管癌；区分短段与长段输尿管癌的临界值为肿瘤长度的中位数。采用Cox回归方法进行单因素和多因素分析，使用包括我们新的病理分类在内的9个临床协变量计算BC复发的风险比（HRs）。
幸存者的中位随访期为60个月（范围1 - 157个月）。99例患者中，36例（36%）发生BC复发；在这36例患者中，30例（85%）在2年内复发，17例（47%）为浸润性BC（≥pT1）。统计分析表明，病理肿瘤类型是BC复发的主要显著危险因素。与其他肿瘤类型相比，长段（>5 cm）输尿管癌BC复发风险最高（多因素HR 2.1；95%置信区间1.03 - 4.2）。
我们基于肿瘤病理表现的简单分类系统有助于预测BC复发。长段输尿管癌患者BC复发风险高。
