Moritake Jun, Miki Jun, Tsuzuki Shunsuke, Hata Kenichi, Shimomura Tatsuya, Kimura Takahiro, Furuta Akira, Furuta Nozomu, Egawa Shin
Department of Urology, The Jikei University Hospital.
Department of Urology, The Jikei University Kashiwa Hospital.
Nihon Hinyokika Gakkai Zasshi. 2016;107(2):79-86. doi: 10.5980/jpnjurol.107.79.
(Objectives) We retrospectively investigated the prognostic factors and the role of adjuvant chemotherapy against upper tract urothelial carcinoma (UTUC) after surgery. (Materials and methods) 343 patients of UTUC who underwent radical nephroureterectomy at Jikei University Hospital and affiliated institutions between January 2004 and February 2012 were retrospectively analyzed. A chi-squared test was used for categorical variables. Survival probabilities after surgery were estimated using the Kaplan-Meier method. Multivariate Cox regression models addressed overall survival and cancer-specific survival after surgery. (Results) The 5-year overall and cancer-specific survival rates were 64.6% and 74.6%, respectively. On multivariate analysis, higher age, male, higher pT-stage and lymphovascular invasion (LVI) were associated with worse overall survival and higher pT-stage and LVI were associated with worse cancer-specific survival. 44 patients (G3 and ≥pT3) who received cisplatin-based adjuvant chemotherapy had improved overall survival (P=0.044). (Conclusions) Higher pT-stage, LVI were important prognostic variables associated with oncologic outcomes. Cisplatin-based adjuvant chemotherapy offered a significant benefit to overall survival in high risk UTUC (G3 and ≥pT3), but more investigations are needed to confirm its utility.
（目的）我们回顾性研究了上尿路尿路上皮癌（UTUC）术后的预后因素及辅助化疗的作用。（材料与方法）回顾性分析了2004年1月至2012年2月在东京慈惠会医科大学医院及其附属医院接受根治性肾输尿管切除术的343例UTUC患者。分类变量采用卡方检验。采用Kaplan-Meier法估计术后生存概率。多因素Cox回归模型分析术后总生存和癌症特异性生存情况。（结果）5年总生存率和癌症特异性生存率分别为64.6%和74.6%。多因素分析显示，高龄、男性、较高的pT分期和淋巴管浸润（LVI）与较差的总生存相关，较高的pT分期和LVI与较差的癌症特异性生存相关。44例接受以顺铂为基础的辅助化疗的患者（G3且pT3及以上）总生存有所改善（P=0.044）。（结论）较高的pT分期、LVI是与肿瘤学结局相关的重要预后变量。以顺铂为基础的辅助化疗对高危UTUC（G3且pT3及以上）的总生存有显著益处，但需要更多研究来证实其效用。
