Veccia Alessandro, Antonelli Alessandro, Martini Alberto, Falagario Ugo, Carrieri Giuseppe, Grob Mayer B, Guruli Georgi, Simeone Claudio, Wiklund Peter, Porpiglia Francesco, Autorino Riccardo
Division of Urology, Department of Surgery, VCU Health System, Richmond, Virginia, USA.
Urology Unit, ASST Spedali Civili Hospital, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy.
Int J Urol. 2020 Nov;27(11):966-972. doi: 10.1111/iju.14336. Epub 2020 Aug 9.
To evaluate the prognostic value of tumor location in patients with upper tract urothelial carcinoma.
Within the Surveillance, Epidemiology and End Results Incidence Database, 6619 upper tract urothelial carcinoma cases were identified, including 3719 confined to the renal pelvis and 2971 to the ureter. Predictors of surgical technique (kidney sparing surgery versus radical nephroureterectomy), as well as 2- and 5-year cancer-specific survival and overall survival were evaluated.
Median follow-up time was 29 months (interquartile range 0-126 months) for both groups. Multivariate logistic analysis showed tumor dimension as the only factor associated with radical nephroureterectomy (odds ratio 1.02; P < 0.001). Ureteral 2- and 5-year overall survival were lower (log-rank P = 0.001) compared with renal pelvis. When stratifying tumor location according to dimensions, a ureteral carcinoma >3 cm was associated with the worst 2- and 5-year cancer-specific mortality (Pepe-Mori P < 0.001), and overall survival (log-rank P < 0.001). The 2- and 5-year cancer-specific mortality (Pepe-Mori P < 0.001) and overall survival were the worst for ureteral ≥T3 tumors (log-rank P < 0.001). The 2- and 5-year cancer-specific mortality (Pepe-Mori P < 0.001) and overall survival (log-rank P < 0.001) were the worst for ureteral grade III-IV cancers. Ureteral tumor location (subdistribution hazard ratio 1.18, P < 0.001), tumor dimension ≥3 (subdistribution hazard ratio 1.25, P < 0.001), T staging (T2-4 all P < 0.001), grading (grade III subdistribution hazard ratio 2.20, P = 0.001; grade IV subdistribution hazard ratio 2.39, P < 0.001) were found to be associated with higher cancer mortality.
Ureteral tumor location in upper tract urothelial carcinoma seems to be associated with worse oncological outcomes, especially in the case of advanced disease. Although the type of surgical treatment does not seem to impact survival, surgeons should use caution in adopting a kidney-sparing surgery for patients with ureteral upper tract urothelial carcinoma.
评估肿瘤位置对上尿路尿路上皮癌患者的预后价值。
在监测、流行病学和最终结果发病率数据库中，识别出6619例上尿路尿路上皮癌病例，其中3719例局限于肾盂，2971例局限于输尿管。评估手术技术（保留肾手术与根治性肾输尿管切除术）的预测因素，以及2年和5年的癌症特异性生存率和总生存率。
两组的中位随访时间均为29个月（四分位间距0 - 126个月）。多因素逻辑分析显示肿瘤大小是与根治性肾输尿管切除术相关的唯一因素（比值比1.02；P < 0.001）。与肾盂相比，输尿管的2年和5年总生存率较低（对数秩检验P = 0.001）。根据肿瘤大小对肿瘤位置进行分层时，输尿管癌>3 cm与最差的2年和5年癌症特异性死亡率（佩佩 - 森里检验P < 0.001）及总生存率（对数秩检验P < 0.001）相关。输尿管≥T3期肿瘤的2年和5年癌症特异性死亡率（佩佩 - 森里检验P < 0.001）及总生存率最差（对数秩检验P < 0.001）。输尿管III - IV级癌症的2年和5年癌症特异性死亡率（佩佩 - 森里检验P < 0.001）及总生存率最差（对数秩检验P < 0.001）。发现输尿管肿瘤位置（亚分布风险比1.18，P < 0.001）、肿瘤大小≥3 cm（亚分布风险比1.25，P < 0.001）、T分期（T2 - 4所有P < 0.001）、分级（III级亚分布风险比2.20，P = 0.001；IV级亚分布风险比2.39，P < 0.001）与较高的癌症死亡率相关。
上尿路尿路上皮癌中输尿管肿瘤位置似乎与更差的肿瘤学结局相关，尤其是在晚期疾病的情况下。虽然手术治疗方式似乎不影响生存率，但外科医生在为输尿管上尿路尿路上皮癌患者采用保留肾手术时应谨慎。
