Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
Department of Urology, Stockholm South General Hospital, Stockholm, Sweden.
World J Urol. 2019 Nov;37(11):2335-2342. doi: 10.1007/s00345-019-02760-4. Epub 2019 Apr 23.
The aim of this prospective study was to identify the tumour characteristics that are associated with invasiveness and those that are relevant for disease-specific survival (DSS) in upper tract urothelial carcinoma, UTUC.
From a prospective consecutive cohort of patients with suspicion of UTUC, those who were diagnosed with UTUC using URS prior to rNU between 2005 and 2012 were included. Tumour characteristics were analysed for prediction of invasiveness and association with DSS. Stages were categorised as superficial (pTa-1 and CIS only) or invasive (≥ pT2). Tumours were graded according to WHO 1999 classification. DSS was analysed regarding possible association with stage, grade, size, multifocality, location, ploidy and rate of proliferation. Associations were tested using Fisher's exact test, Pearson Chi-square or Cox's regression. Kaplan-Meier survival curves were constructed.
Forty-five consecutive patients were included, and 43 of them were included in the final analyses because their rNU specimens were available for reassessment. The only tumour characteristics that were significantly associated with stage were tumour grade (P < 0.001), DNA ploidy (P = 0.045) and rate of proliferation (P = 0.004). No association with stage was noted for size, multifocality or location. Grade, stage and rate of proliferation were associated with DSS.
Grade, DNA ploidy and S-phase fraction were the only tumour characteristics associated with stage in our study. However, DNA ploidy was not associated with DSS. The prognostic factors that we identified were tumour grade, stage, and S-phase fraction.
本前瞻性研究旨在确定与上尿路上皮癌（UTUC）侵袭性相关的肿瘤特征和与疾病特异性生存（DSS）相关的肿瘤特征。
从 2005 年至 2012 年间，通过输尿管镜检查怀疑患有 UTUC 的连续前瞻性队列中，纳入了接受经尿道输尿管镜肾实质切开术（rNU）前诊断为 UTUC 的患者。分析肿瘤特征以预测侵袭性和与 DSS 的关联。分期分为表浅（仅 pTa-1 和 CIS）或浸润性（≥pT2）。肿瘤分级根据世界卫生组织 1999 年分类进行。分析 DSS 与分期、分级、大小、多灶性、位置、倍性和增殖率的可能相关性。使用 Fisher 确切检验、Pearson 卡方检验或 Cox 回归检验进行关联测试。构建 Kaplan-Meier 生存曲线。
纳入了 45 例连续患者，其中 43 例最终纳入分析，因为他们的 rNU 标本可用于重新评估。与分期显著相关的唯一肿瘤特征是肿瘤分级（P<0.001）、DNA 倍性（P=0.045）和增殖率（P=0.004）。肿瘤大小、多灶性或位置与分期无关联。分级、分期和增殖率与 DSS 相关。
在我们的研究中，只有分级、DNA 倍性和 S 期分数与分期相关。然而，DNA 倍性与 DSS 无关。我们确定的预后因素是肿瘤分级、分期和 S 期分数。
