Ding Tao, Zheng Zhuojun, Xu Renfang, Zhou Cuixing
Department of Urology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
Department of Hematology, Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
Oncotarget. 2017 Jul 27;8(39):65983-65996. doi: 10.18632/oncotarget.19623. eCollection 2017 Sep 12.
This study investigated the prognostic factors and outcomes of a large observational cohort of patients with primary transitional cell carcinoma of the ureter, which was obtained from the Surveillance, Epidemiology, and End Results database.
We used the Surveillance, Epidemiology, and End Results program to identify 1910 patients who had available clinical and follow-up information and were diagnosed for primary transitional cell carcinoma of the ureter between 2004 and 2013. Descriptive statistics were used to explore the epidemiology, treatment practices, and tumor characteristics of the patients. Univariate and multivariable Cox regression models were used to analyze the patient data.
The median overall survival (OS) was 46 months, and the 5-year OS rate was 41.8%. The median CSS was 78 months, and the 5-year CSS rate was 54.3%. Multivariate analysis identified tumor grade, tumor size, AJCC stage, M stage, cancer-directed surgical procedure and radiation as independent factors of primary transitional cell carcinoma of the ureter. For early stage patients, the surgical procedure was associated with fairly longer survival and additional radiation may cause more harm than benefit. Meanwhile, for advanced stage patients, the impact of surgery on OS and CSS greatly decreased. Radiation exerted a very limited impact on clinical outcomes. Patients with bad tumor differentiation or a large tumor size were more likely to have advanced stage disease.
Durable cancer control can be expected in patients treated with surgery for early stage UTUC. The presence of advanced stage disease exerts a profound detrimental effect on the survival of patients.
本研究调查了从监测、流行病学和最终结果数据库中获取的一大组原发性输尿管移行细胞癌患者的预后因素及结局。
我们使用监测、流行病学和最终结果计划，确定了1910例有可用临床和随访信息且在2004年至2013年间被诊断为原发性输尿管移行细胞癌的患者。采用描述性统计方法探讨患者的流行病学、治疗方法及肿瘤特征。使用单变量和多变量Cox回归模型分析患者数据。
中位总生存期（OS）为46个月，5年OS率为41.8%。中位癌症特异性生存期（CSS）为78个月，5年CSS率为54.3%。多变量分析确定肿瘤分级、肿瘤大小、美国癌症联合委员会（AJCC）分期、M分期、癌症导向手术及放疗是原发性输尿管移行细胞癌的独立因素。对于早期患者，手术与较长生存期相关，额外放疗可能弊大于利。同时，对于晚期患者，手术对OS和CSS的影响大幅降低。放疗对临床结局的影响非常有限。肿瘤分化差或肿瘤体积大的患者更易出现晚期疾病。
早期上尿路尿路上皮癌（UTUC）患者接受手术治疗有望实现持久的癌症控制。晚期疾病的存在对患者生存有深远的不利影响。
