GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France.
BJU Int. 2019 Apr;123(4):618-623. doi: 10.1111/bju.14647. Epub 2019 Jan 6.
To assess the location of intravesical recurrence (IVR) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), to determine the main predictive factors for IVR in the bladder-cuff area (BCA), and to assess the effect of BCA recurrence (BCAR) on prognosis.
This was a multicentre, retrospective study using the French collaborative database on UTUC, which includes data for all patients treated in 24 referral uro-oncology centres across the country. All patients who underwent RNU with bladder-cuff excision and who developed IVR between 1995 and 2010 were selected. Patients were divided into two groups: Group A: BCAR; and Group B: recurrence elsewhere in the bladder. The Kaplan-Meier method was used to estimate the probability of BCAR-free survival. Groups were compared using the log-rank test. Independent risk factors for BCAR were identified using a Cox proportional hazard regression model, with univariate and multivariate analyses.
Overall, 163 patients were included in the final analysis: Group A, 87 patients (53.4%) and Group B, 76 (46.6%). The clinicopathological characteristics were similar in the groups. The median (interquartile range [IQR]) follow-up was 36 (31.7-40.39) months. The median (IQR) time to IVR was 10.0 (8.6-13.39) months [Group A: 11.0 (8.8-13.2) months vs Group B: 10.0 (8.5-11.5) months; P = 0.35]. The probability of BCAR at 1, 2, and 3 years was 45.5% (95% confidence interval [CI] 40.1-50.9), 17.9% (95% CI 13.7-22.1), and 10.8% (95% CI 7.4-14.2) respectively, whereas the probability of recurrence elsewhere in the bladder was 42.1% (95% CI 36.4-47.8), 14.7% (95% CI 10.6-18.8), and 4.4% (95% CI 1.9-6.9), respectively (P = 0.35). Pathological tumour stage (≥pT3) was significantly related to the risk of BCAR (P = 0.03).
There were more BCARs after RNU in advanced UTUC. However, no preferred site for recurrence was detected.
评估上尿路尿路上皮癌（UTUC）根治性肾输尿管切除术（RNU）后膀胱内复发（IVR）的位置，确定膀胱袖口区域（BCA）内 IVR 的主要预测因素，并评估 BCAR 对预后的影响。
这是一项多中心、回顾性研究，使用了法国 UTUC 合作数据库，该数据库包含了全国 24 家转诊泌尿科中心治疗的所有患者的数据。选择了 1995 年至 2010 年间接受 RNU 加膀胱袖口切除术且在膀胱内发生 IVR 的所有患者。患者分为两组：A 组：BCAR；B 组：膀胱其他部位复发。采用 Kaplan-Meier 法估计无 BCAR 生存概率。使用对数秩检验比较组间差异。使用单因素和多因素分析确定 BCAR 的独立危险因素。
共纳入 163 例患者进行最终分析：A 组 87 例（53.4%），B 组 76 例（46.6%）。两组的临床病理特征相似。中位（四分位距 [IQR]）随访时间为 36 个月（31.7-40.39）。IVR 的中位（IQR）时间为 10.0 个月（8.6-13.39）[A 组：11.0 个月（8.8-13.2）vs B 组：10.0 个月（8.5-11.5）；P=0.35]。1、2、3 年时 BCAR 的概率分别为 45.5%（95%可信区间 [CI] 40.1-50.9）、17.9%（95% CI 13.7-22.1）和 10.8%（95% CI 7.4-14.2），而膀胱其他部位复发的概率分别为 42.1%（95% CI 36.4-47.8）、14.7%（95% CI 10.6-18.8）和 4.4%（95% CI 1.9-6.9）（P=0.35）。病理肿瘤分期（≥pT3）与 BCAR 风险显著相关（P=0.03）。
在高级别 UTUC 中，RNU 后更易发生 BCAR。然而，并未发现复发的首选部位。
