Goldberg Hanan, Cheung Douglas C, Chandrasekar Thenappan, Klaassen Zachary, Wallis Christopher J D, Kulkarni Girish S, Sayyid Rashid, Evans Andrew, Masoomian Mehdi, Bapat Bharati, van der Kwast Theodorus, Hamilton Robert J, Zlotta Alexandre, Fleshner Neil
Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network and the University of Toronto, Toronto, ON, Canada.
Pathology Department, Princess Margaret Cancer Center, University Health Network and the University of Toronto, Toronto, ON, Canada.
Can Urol Assoc J. 2019 Sep;13(9):E292-E299. doi: 10.5489/cuaj.5595.
Upper tract urothelial carcinoma (UTUC) accounts for <5% of all urothelial cancers. We aimed to ascertain the clinical differences between UTUC tumours presenting de novo (DnUTUC) and those presenting secondary (SUTUC) following a bladder cancer diagnosis.
Our institutional database was queried for all UTUC patients who were surgically treated with radical nephroureterectomy or ureterectomy between 2003 and 2017. Bladder recurrence and cancer-specific mortality were compared. To reduce the possible bias due to confounding variables obtained from a simple comparison of outcomes, DnUTUC patients were matched (for age, gender, tumour location, type of surgery, grade, TNM staging, presence of carcinoma in situ, and lymphovascular invasion) with propensity score to SUTUC patients. Bladder recurrence and cancer-specific mortality were assessed with Cox proportional hazards model.
A total of 117 UTUC patients were identified: 80 with DnUTUC (68.4%) and 37 with SUTUC (31.6%). A greater proportion of males with SUTUC was demonstrated (89.2% vs. 68.8; p=0.02). In both groups, 67.5% of patients had high-grade disease, but SUTUC demonstrated a higher carcinoma in situ rate (43.2% vs. 25%; p=0.047). Univariate analysis demonstrated that the five-year bladder recurrence rate was trending to be higher in SUTUC (65.3% vs. 20.5%; p=0.099). In the Cox model, however, it was associated with increased bladder recurrence (hazard ratio [HR] 3.69; 95% confidence interval [CI] 1.68-8.09; p=0.001). Although univariate analysis demonstrated that SUTUC patients were more likely to die of their disease (30.6% vs. 9%; p=0.009), the multivariable Cox model did not demonstrate this association. The limitations of this study include its retrospective, single-centre design and relatively small cohort of patients.
In this hypothesis-generating study, some evidence suggests that further research is needed to delineate differences between SUTUC and DnUTUC.
上尿路尿路上皮癌（UTUC）占所有尿路上皮癌的比例不到5%。我们旨在确定初发性UTUC肿瘤（DnUTUC）与膀胱癌诊断后继发性UTUC肿瘤（SUTUC）之间的临床差异。
查询我院机构数据库中2003年至2017年间接受根治性肾输尿管切除术或输尿管切除术的所有UTUC患者。比较膀胱复发率和癌症特异性死亡率。为了减少因简单比较结果中混杂变量可能导致的偏差，采用倾向评分法将DnUTUC患者与SUTUC患者进行匹配（按年龄、性别、肿瘤位置、手术类型、分级、TNM分期、原位癌的存在情况和淋巴管浸润情况）。采用Cox比例风险模型评估膀胱复发率和癌症特异性死亡率。
共确定117例UTUC患者：80例为DnUTUC（68.4%），37例为SUTUC（31.6%）。结果显示SUTUC男性患者比例更高（89.2%对68.8%；p = 0.02）。两组中67.5%的患者患有高级别疾病，但SUTUC的原位癌发生率更高（43.2%对25%；p = 0.047）。单因素分析表明，SUTUC的五年膀胱复发率有升高趋势（65.3%对20.5%；p = 0.099）。然而，在Cox模型中，它与膀胱复发增加相关（风险比[HR] 3.69；95%置信区间[CI] 1.68 - 8.09；p = 0.001）。虽然单因素分析表明SUTUC患者死于疾病的可能性更大（30.6%对9%；p = 0.009），但多变量Cox模型未显示这种关联。本研究的局限性包括其回顾性、单中心设计以及相对较小的患者队列。
在这项产生假设的研究中，一些证据表明需要进一步研究以明确SUTUC和DnUTUC之间的差异。
