Department of Radiation Oncology, Peking University First Hospital, Peking University, Beijing, China.
Department of Urology, Peking University First Hospital, Peking University, Beijing, China.
World J Surg Oncol. 2020 May 30;18(1):114. doi: 10.1186/s12957-020-01877-w.
This study aims to identify predictive local recurrence risk factors and site-specific local recurrence pattern of upper tract urothelial carcinoma (UTUC) with different primary tumor locations.
Three hundred and eighty-nine UTUC patients with radical nephroureterectomy were included in this study. Univariate and multivariate Cox proportional hazards regressions were performed to measure the risk of local recurrence. We also mapped the position of local recurrence sites stratified by primary tumor locations.
A total of 73 patients (18.7%) developed local recurrence within a median follow-up of 41 months (range, 3-80 months). For patients with local recurrence, the median interval of local recurrence was 9 months. Ureter tumor, multifocality, T stage, G grade, lymph node metastasis (LNM), lymph node dissection (LND), and lymph vascular invasion (LVI) were all significantly associated with increased local recurrence by univariable analyses (P < 0.05). Only multifocality, T3-4, G3, and LNM remained independent predictors of increased local recurrence by multivariable analyses. Adjuvant radiotherapy could reduce the local recurrence (HR = 0.177; 95% CI 0.064-0.493, P = 0.001). Patients with local recurrence had poorer cancer-specific survival (4-year cancer-specific survival rate 36 ± 7.5% vs 88.4 ± 2.2%, P = 0.000). We evaluated local recurrence pattern stratified by tumor locations. Para-aortic lymph node region was the most common recurrence area for all the patients. Left-sided UTUC had more than 70% recurrent lymph nodes in the left para-aortic region (LPA). For right-sided UTUC patients, recurrent para-aortic lymph nodes distributed in the LPA (33.3%), aortocaval (AC) (41.5%), and right paracaval (RPC) (25.2%) regions. Recurrence in the internal and external iliac regions was only found in the distal ureter group (P < 0.05). Renal pelvic fossa recurrence was only found in renal pelvic tumor (22.2%, P = 0.007). The ureter tumor bed recurrence rate was higher for ureter patients (P = 0.001).
Multifocality, T3-4, G3, and LNM are predictors of higher local recurrence rate of UTUC. Adjuvant radiotherapy can reduce local recurrence rate. Local recurrence patterns are different according to primary tumor locations.
本研究旨在确定具有不同原发肿瘤部位的上尿路尿路上皮癌（UTUC）的局部复发风险因素和特定部位的局部复发模式。
本研究纳入了 389 例接受根治性肾输尿管切除术的 UTUC 患者。采用单变量和多变量 Cox 比例风险回归来测量局部复发的风险。我们还根据原发肿瘤部位分层，绘制了局部复发部位的位置图。
共有 73 例患者（18.7%）在中位随访 41 个月（范围 3-80 个月）内发生局部复发。对于局部复发的患者，局部复发的中位间隔时间为 9 个月。输尿管肿瘤、多灶性、T 分期、G 分级、淋巴结转移（LNM）、淋巴结清扫（LND）和淋巴血管侵犯（LVI）在单变量分析中均与局部复发风险增加显著相关（P < 0.05）。仅多灶性、T3-4、G3 和 LNM 在多变量分析中仍然是局部复发风险增加的独立预测因素。辅助放疗可降低局部复发风险（HR = 0.177；95%CI 0.064-0.493，P = 0.001）。局部复发的患者癌症特异性生存率更差（4 年癌症特异性生存率为 36 ± 7.5%比 88.4 ± 2.2%，P = 0.000）。我们根据肿瘤部位评估了局部复发模式。主动脉旁淋巴结区域是所有患者最常见的复发区域。左侧 UTUC 左侧主动脉旁区域（LPA）的复发淋巴结超过 70%。对于右侧 UTUC 患者，复发的主动脉旁淋巴结分布在 LPA（33.3%）、腹主动脉旁（AC）（41.5%）和右肾旁（RPC）（25.2%）区域。髂内和髂外区域的复发仅见于远端输尿管组（P < 0.05）。肾盂复发仅见于肾盂肿瘤（22.2%，P = 0.007）。输尿管肿瘤患者的输尿管肿瘤床复发率更高（P = 0.001）。
多灶性、T3-4、G3 和 LNM 是 UTUC 局部复发率较高的预测因素。辅助放疗可降低局部复发率。根据原发肿瘤部位，局部复发模式不同。
