Chen Chuan-Shu, Li Jian-Ri, Wang Shian-Shiang, Yang Cheng-Kuang, Cheng Chen-Li, Yang Chi-Rei, Ou Yen-Chuan, Ho Hao-Chung, Lin Chia-Yen, Hung Sheng-Chun, Chen Cheng-Che, Wang Shu-Chi, Chiu Kun-Yuan, Yang Shun-Fa
Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan.
Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan.
Diagnostics (Basel). 2020 Apr 3;10(4):201. doi: 10.3390/diagnostics10040201.
The purpose of this study was to identify the significant risk factors of urinary bladder recurrence (UBR) after nephroureterectomy (NUx) in patients with upper tract urothelial carcinoma (UTUC). A total of 550 patients diagnosed with UTUC between January 2001 and December 2015 were included in this retrospective study. The median age of our patients was 68 (range 24-93) and the median follow-up time after NUx was 40.3 months (range 8-191). The most important censored point of this study was the first episode of UBR. Of the 550 patients, UBR occurred in 164 patients (29.8%). One hundred and forty-two (86.6%) patients with UBR were identified within two years after NUx for UTUC, with the median time interval between NUx and UBR being 8.4 months (range 3-59.8). Through univariate analysis, the positive surgical margin ( = 0.049) and tumor multifocality ( = 0.024) were both significant prognostic factors for UBR-free survival after NUx in patients with UTUC. However, only tumor multifocality ( = 0.037) remained a significant prognostic factor by multivariate analysis. In conclusion, tumor multifocality is a significant risk factor of UBR after nephroureterectomy in patients with upper tract urothelial carcinoma.
本研究的目的是确定上尿路尿路上皮癌（UTUC）患者行肾输尿管切除术（NUx）后膀胱复发（UBR）的显著风险因素。本回顾性研究纳入了2001年1月至2015年12月期间共550例诊断为UTUC的患者。我们患者的中位年龄为68岁（范围24 - 93岁），NUx后的中位随访时间为40.3个月（范围8 - 191个月）。本研究最重要的删失点是首次发生UBR。在这550例患者中，164例（29.8%）发生了UBR。142例（86.6%）发生UBR的患者在UTUC行NUx后两年内被确诊，NUx与UBR之间的中位时间间隔为8.4个月（范围3 - 59.8个月）。通过单因素分析，手术切缘阳性（P = 0.049）和肿瘤多灶性（P = 0.024）均是UTUC患者行NUx后无UBR生存的显著预后因素。然而，多因素分析显示只有肿瘤多灶性（P = 0.037）仍然是一个显著的预后因素。总之，肿瘤多灶性是上尿路尿路上皮癌患者行肾输尿管切除术后发生UBR的一个显著风险因素。
