Qin Chuan, Liang En-Li, Du Zhi-Yong, Qiu Xiao-Yu, Tang Gang, Chen Fei-Ran, Zhang Bo, Tian Da-Wei, Hu Hai-Long, Wu Chang-Li
Department of Urology Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University College of Management and Economics, Tianjin University, Tianjin, China.
Medicine (Baltimore). 2017 May;96(21):e6945. doi: 10.1097/MD.0000000000006945.
To evaluate the impact of urothelial carcinoma with divergent differentiation (UCDD) on the prognosis of patients for primary upper urinary tract urothelial carcinoma (UTUC) with pN0/x status treated with radical nephroureterectomy (RNU) and to evaluate the prognostic value of UCDD in different tumor locations (renal pelvis and ureter).Data from a total of 346 patients with UTUC who received RNU between January 2012 and March 2016 in the institution were retrospectively analyzed. Clinicopathological features and prognostic factors age, sex, complaint, height, weight, blood pressure, tumor grade, stage, smoking status, history of adjuvant chemotherapy, tumor location, history of bladder cancer, tumor necrosis, degree of hydronephrosis, tumor size, tumor focality, and preoperative anemia were compared between patients with pure UTUC and patients with UCDD. The endpoints were cancer-specific survival (CSS), overall survival (OS), and intraluminal recurrence-free survival (IRFS).Overall, divergent differentiation was present in 50 patients (14.5%). UCDD was related to different tumor location (P = .01), smoking (P = .04), higher body mass index (P = .02), and advanced tumor grade (P = .01). By Kaplan-Meier analysis, UCDD was found to be significantly correlated with worse IRFS, CSS, and OS (all P < .01). Multivariate analysis demonstrated that UCDD was an independent predictor of IRFS (P < .01), CSS (P = .01), and OS (P = .01). However, 40 patients died for various reasons and the 5-year OS rates were 91.9% in UCDD- group and 68.0% in UCDD+ group, respectively. In patients with ureteral tumors, UCDD was the significant predictor for IRFS, CSS, and OS. However, the prognostic value of UCDD was not observed in pyelocaliceal tumors.The presence of divergent differentiation is associated with inferior survival. UCDD may identify patients at high risks for poor prognosis especially in patients with ureteral tumors. As a result, more attention and follow-up should be given to patients with ureteric urothelial carcinoma.
评估伴异向分化的尿路上皮癌（UCDD）对接受根治性肾输尿管切除术（RNU）治疗的原发性上尿路尿路上皮癌（UTUC）且病理分期为pN0/x患者预后的影响，并评估UCDD在不同肿瘤部位（肾盂和输尿管）的预后价值。回顾性分析了2012年1月至2016年3月间在该机构接受RNU治疗的346例UTUC患者的数据。比较了单纯UTUC患者和UCDD患者的临床病理特征及预后因素，包括年龄、性别、主诉、身高、体重、血压、肿瘤分级、分期、吸烟状况、辅助化疗史、肿瘤部位、膀胱癌病史、肿瘤坏死、肾积水程度、肿瘤大小、肿瘤灶性及术前贫血情况。观察终点为癌症特异性生存（CSS）、总生存（OS）和腔内无复发生存（IRFS）。总体而言，50例患者（14.5%）存在异向分化。UCDD与不同肿瘤部位（P = 0.01）、吸烟（P = 0.04）、较高的体重指数（P = 0.02）及高级别肿瘤分级（P = 0.01）相关。通过Kaplan-Meier分析发现，UCDD与较差的IRFS、CSS和OS显著相关（均P < 0.01）。多因素分析表明，UCDD是IRFS（P < 0.01）、CSS（P = 0.01）和OS（P = 0.01）的独立预测因素。然而，40例患者因各种原因死亡，UCDD阴性组和UCDD阳性组的5年OS率分别为91.9%和68.0%。在输尿管肿瘤患者中，UCDD是IRFS、CSS和OS的显著预测因素。然而，在肾盂输尿管肿瘤中未观察到UCDD的预后价值。异向分化的存在与较差的生存率相关。UCDD可能识别出预后不良的高危患者，尤其是输尿管肿瘤患者。因此，对于输尿管尿路上皮癌患者应给予更多关注和随访。
