Altok Muammer, Sahin Ali F, Gokce Mehmet I, Ekin Gokhan R, Divrik Rauf Taner
Department of Urology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA.
Department of Urology, Sivas Numune Hospital, Sivas, Turkey.
Int Braz J Urol. 2017 Nov-Dec;43(6):1052-1059. doi: 10.1590/S1677-5538.IBJU.2017.0218.
Bladder cancer (BC) may involve the ureteral orifice, and the resection of the orifice has oncological and functional consequences such as development of upper tract urothelial carcinoma (UTUC), vesicoureteral reflux or ureteral stenosis. The aim of this study was to investigate the oncological and functional outcomes of the ureteral orifice resection in BC patients and determine the predictive factors for UTUC development.
A total of 1359 patients diagnosed with BC, between 1992 and 2012, were reviewed retrospectively. Patients were grouped with respect to orifice resection and compared for development of UTUC, survival and functional outcomes. Kaplan-Meier method was used to compare survival outcomes. Logistic regression analysis was performed to determine predictors of UTUC development.
Ureteral orifice involvement was detected in 138 (10.2%) patients. The rate of synchronous (10.1% vs. 0.7%, p=0.0001) and metachronous (5.3% vs. 0.9%, p=0.0001) UTUC development was found to be higher in patients with ureteral orifice involvement. Orifice involvement and tumor stage were found to be associated with development of UTUC in the regression analysis. Overall (p=0.963) and cancer specific survival rates (p=0.629) were found to be similar. Hydronephrosis was also significantly higher in patients with orifice involved BC, due to the orifice obstruction caused by the tumor (33.3% vs. 13.9%, p<0.05).
BC with ureteral orifice involvement has significantly increased the risk of having synchronous or metachronous UTUC. However, orifice involvement was not found to be associated with survival outcomes. Development of stricture due to resection is a very rare complication.
膀胱癌（BC）可能累及输尿管口，输尿管口切除会产生肿瘤学及功能方面的后果，如发生上尿路尿路上皮癌（UTUC）、膀胱输尿管反流或输尿管狭窄。本研究旨在探讨BC患者输尿管口切除的肿瘤学及功能结局，并确定UTUC发生的预测因素。
回顾性分析1992年至2012年间共1359例诊断为BC的患者。根据输尿管口切除情况对患者进行分组，并比较UTUC的发生、生存及功能结局。采用Kaplan-Meier法比较生存结局。进行逻辑回归分析以确定UTUC发生的预测因素。
138例（10.2%）患者检测到输尿管口受累。发现输尿管口受累患者中同步性（10.1%对0.7%，p = 0.0001）和异时性（5.3%对0.9%，p = 0.0001）UTUC的发生率更高。回归分析发现输尿管口受累和肿瘤分期与UTUC的发生有关。总体生存率（p = 0.963）和癌症特异性生存率（p = 0.629）相似。由于肿瘤导致的输尿管口梗阻，输尿管口受累的BC患者肾积水也明显更高（33.3%对13.9%，p<0.05）。
累及输尿管口的BC显著增加了发生同步或异时性UTUC的风险。然而，未发现输尿管口受累与生存结局相关。切除导致的狭窄是一种非常罕见的并发症。
