Huang Chun-Chieh, Su Yu-Li, Luo Hao-Lun, Chen Yen-Ta, Sio Terence T, Hsu Hsuan-Chih, Lai Chia-Hsuan
Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Front Oncol. 2019 Mar 21;9:157. doi: 10.3389/fonc.2019.00157. eCollection 2019.
Our hospital is a tertiary medical center located in southern Taiwan, which is an endemic area for upper tract urothelial carcinoma (UTUC) cases. Using a large registry-based surgical database, we examined our cohort of patients with UTUC, and evaluated the treatment outcome and gender-specific differences in this population. A total of 506 patients with localized UTUC undergoing nephroureterectomy from 2004 to 2013 were enrolled. The patient, tumor, and treatment-related characteristics were prospectively recorded by the registry. Overall (OS) and cancer-specific (CSS) survival outcomes were evaluated as well. Gender differences as related to clinical and pathological factors were examined by chi-square testing. Univariate and multivariate Cox regression analyses were applied. There were more female patients (57.9%) in this population. The median follow-up was 6.9 years for living patients. The actuarial 5-year OS and CSS rates were 69.4 and 84.9%, respectively. Being female, aged <70 years, and early T-stage were statistically significantly associated with better OS and CSS by multivariate analyses. The 5-year CSS rates for females vs. males were 89.6 and 78.5%, respectively ( < 0.005). A subgroup analysis suggested that better survival outcomes for females only existed in the stage 0a/0is/I (non-muscle-invasive), but not in the advanced stage. In an endemic area, females were more likely diagnosed with UTUC, but had significantly improved OS and CSS compared to their male counterparts, which were mostly driven by the non-muscle-invasive cases. Future research should focus on better understanding the epidemiologic risk-factor profile and pathophysiologic differences based on gender.
我们的医院是位于台湾南部的一家三级医疗中心，该地区是上尿路尿路上皮癌（UTUC）病例的流行地区。我们使用一个基于大型登记处的外科手术数据库，对我们的UTUC患者队列进行了研究，并评估了该人群的治疗结果和性别差异。纳入了2004年至2013年期间共506例接受肾输尿管切除术的局限性UTUC患者。登记处前瞻性记录了患者、肿瘤及与治疗相关的特征。还评估了总生存期（OS）和癌症特异性生存期（CSS）。通过卡方检验研究了与临床和病理因素相关的性别差异。应用单因素和多因素Cox回归分析。该人群中女性患者较多（57.9%）。存活患者的中位随访时间为6.9年。5年精算OS率和CSS率分别为69.4%和84.9%。多因素分析显示，女性、年龄<70岁和早期T分期与更好的OS和CSS在统计学上显著相关。女性和男性的5年CSS率分别为89.6%和78.5%（<0.005）。亚组分析表明，女性更好的生存结果仅存在于0a/0is/I期（非肌层浸润性），而在晚期则不存在。在一个流行地区，女性更易被诊断为UTUC，但与男性相比，其OS和CSS有显著改善，这主要由非肌层浸润性病例驱动。未来的研究应集中于更好地了解基于性别的流行病学危险因素概况和病理生理差异。
