Division of Urology, Department of Surgery, University of Colorado, Aurora, Colorado.
American College of Surgeons, Commission on Cancer, Chicago, Illinois.
Cancer. 2018 Jun 15;124(12):2507-2514. doi: 10.1002/cncr.31372. Epub 2018 Apr 6.
The current study was conducted to assess the impact of lymphovascular invasion on the survival of patients with urothelial carcinoma of the renal pelvis.
Patients with urothelial carcinoma of the renal pelvis who underwent radical nephroureterectomy from 2010 through 2015 were identified in the National Cancer Data Base. Patients were characterized according to demographic and clinical factors, including pathologic tumor stage and lymphovascular invasion. Associations with overall survival were assessed through proportional hazards regression analysis.
A total of 4177 patients were identified; 1576 had lymphovascular invasion. Patients with T3 disease and lymphovascular invasion had 5-year survival that was significantly worse than that of patients with T3 disease without lymphovascular invasion (34.7% vs 52.6; P < .001 by the log-rank test), and approached that of patients with T4 disease without lymphovascular invasion (34.7% vs 26.5%; P = .002). On multivariate analysis controlling for age, comorbidities, grade, lymph node status, surgical margin status, race, sex, and chemotherapy administration, patients with T3 disease and lymphovascular invasion also were found to have significantly worse survival compared with patients with T3 disease without lymphovascular invasion (hazard ratio, 1.7; 95% confidence interval, 1.4-1.91).
Lymphovascular invasion status is a key prognostic marker that can stratify the risk of patients with pT3 upper tract urothelial carcinoma further. Patients with this pathologic feature should be carefully considered for clinical trials exploring existing and novel therapies. Cancer 2018;124:2507-14. © 2018 American Cancer Society.
本研究旨在评估淋巴血管侵犯对肾盂尿路上皮癌患者生存的影响。
从国家癌症数据库中确定了 2010 年至 2015 年间接受根治性肾输尿管切除术的肾盂尿路上皮癌患者。根据人口统计学和临床因素对患者进行特征描述，包括病理肿瘤分期和淋巴血管侵犯。通过比例风险回归分析评估与总生存的相关性。
共确定了 4177 例患者，其中 1576 例有淋巴血管侵犯。T3 疾病伴淋巴血管侵犯患者的 5 年生存率明显低于 T3 疾病无淋巴血管侵犯患者（34.7%对 52.6%；对数秩检验 P<0.001），接近 T4 疾病无淋巴血管侵犯患者（34.7%对 26.5%；P=0.002）。多变量分析控制年龄、合并症、分级、淋巴结状态、手术切缘状态、种族、性别和化疗管理后，T3 疾病伴淋巴血管侵犯患者的生存也明显差于 T3 疾病无淋巴血管侵犯患者（风险比，1.7；95%置信区间，1.4-1.91）。
淋巴血管侵犯状态是一个关键的预后标志物，可以进一步分层 pT3 上尿路上皮癌患者的风险。具有该病理特征的患者应仔细考虑参加探索现有和新疗法的临床试验。癌症 2018；124:2507-14。©2018 美国癌症协会。
