Kuroda Kenji, Asakuma Junichi, Horiguchi Akio, Kawaguchi Makoto, Shinchi Masayuki, Masunaga Ayako, Tasaki Shinsuke, Sato Akinori, Ito Keiichi
Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
Mol Clin Oncol. 2019 May;10(5):547-554. doi: 10.3892/mco.2019.1829. Epub 2019 Mar 20.
Chronic kidney disease (CKD) is a common condition among elderly patients and has been reported to be a biomarker for the presence of malignant disease. In addition, unfavorable outcomes for patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy can be due to independent clinical factors. Therefore, the present study analyzed the clinicopathological data of patients with UTUC, who underwent radical nephroureterectomy at our institution, to clarify whether preoperative CKD and other factors are independent predictors of the shorter disease-specific and/or recurrence-free survival time of these patients. A retrospective review of 187 patients who underwent radical nephroureterectomy was conducted, and patients were followed for at least 3 months postoperatively. The clinicopathological factors that are thought to have potentially significant roles in the progression and metastasis of malignant tumors and for disease-specific and recurrence-free survival were evaluated. Positive surgical margins and an estimation of the glomerular filtration rate (eGFR) of <60 were independent factors for the shorter disease-specific survival time in multivariate analysis with Cox's proportional hazards model [hazard ratio (HR), 2.401: 95% confidence interval (CI), 1.044-5.255; and HR, 2.371: 95% CI, 1.024-5.898, respectively]. Another multivariate analysis also revealed that positive surgical margins (HR, 4.477; 95% CI, 2.042-9.469), and preoperative eGFR <60 (HR, 2.362; 95% CI, 1.067-5.592) were independent factors for the worse recurrence-free survival rate in all patients. Patients with UTUC who had eGFR <60 as well as positive surgical margins had significantly shorter time to disease-specific mortality and extraurothelial recurrence. The present study demonstrated that patients with UTUC undergoing radical nephroureterectomy who have CKD as well as positive surgical margins should be carefully followed up postoperatively.
慢性肾脏病（CKD）在老年患者中较为常见，据报道它是恶性疾病存在的一种生物标志物。此外，接受根治性肾输尿管切除术的上尿路尿路上皮癌（UTUC）患者预后不良可能归因于独立的临床因素。因此，本研究分析了在我们机构接受根治性肾输尿管切除术的UTUC患者的临床病理数据，以阐明术前CKD及其他因素是否是这些患者疾病特异性生存时间和/或无复发生存时间较短的独立预测因素。对187例行根治性肾输尿管切除术的患者进行了回顾性研究，术后对患者进行了至少3个月的随访。评估了被认为在恶性肿瘤进展和转移以及疾病特异性生存和无复发生存中可能具有重要作用的临床病理因素。在使用Cox比例风险模型的多因素分析中，手术切缘阳性和估计肾小球滤过率（eGFR）<60是疾病特异性生存时间较短的独立因素[风险比（HR），2.401：95%置信区间（CI），1.044 - 5.255；以及HR，2.371：95%CI，1.024 - 5.898]。另一项多因素分析还显示，手术切缘阳性（HR，4.477；95%CI，2.042 - 9.469）和术前eGFR<60（HR，2.362；95%CI，1.067 - 5.592）是所有患者无复发生存率较差的独立因素。eGFR<60且手术切缘阳性的UTUC患者疾病特异性死亡和输尿管外复发的时间明显更短。本研究表明，接受根治性肾输尿管切除术且患有CKD以及手术切缘阳性的UTUC患者术后应密切随访。
