Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Department of Urology, International University of Health and Welfare, Narita, Chiba, Japan.
Int J Urol. 2021 Jan;28(1):54-60. doi: 10.1111/iju.14393. Epub 2020 Nov 9.
To identify the prognosis of patients with non-urothelial carcinoma of the upper urinary tract and compare it with that of patients with urothelial carcinoma.
We used hospital-based cancer registry data in Japan to extract histologically confirmed non-urothelial carcinoma and urothelial carcinoma cases of the upper urinary tract diagnosed in 2008-2009. We estimated the 5-year overall survival by a Kaplan-Meier analysis. The Cox proportional hazards regression analysis was used to evaluate prognostic factors.
A total of 2567 upper urinary tract cancer patients with confirmed histological subtypes were identified. The most common histology of non-urothelial carcinoma was squamous cell carcinoma (n = 88, 3.4%) followed by adenocarcinoma (n = 33, 1.3%) and small cell carcinoma (n = 10, 0.4%). The proportion of advanced stage in the squamous cell carcinoma patients was significantly higher than that in the urothelial carcinoma patients (P = 0.003). In stage IV, the proportion of patients who received a combination of surgery + chemotherapy in the urothelial carcinoma group was higher than that in the non-urothelial carcinoma group (34% vs 16%, respectively). The 5-year overall survival rates of the non-urothelial carcinoma patients at stages I-III and stage IV were significantly worse than those of the urothelial carcinoma patients (P = 0.003, P < 0.001, respectively). In multivariate analyses, age ≥73 years, advanced stage (stage IV), tumor location (ureter) and the presence of non-urothelial carcinoma histology were independent poor prognosis factors.
The prognosis of non-urothelial carcinoma patients is worse than that of urothelial carcinoma patients, especially for non-urothelial carcinoma patients at stage IV. More effective systemic therapies are required to improve these patients' oncological outcomes.
明确非尿路上皮性上尿路癌患者的预后，并与尿路上皮性上尿路癌患者的预后进行比较。
我们利用日本基于医院的癌症登记数据，提取了 2008-2009 年间诊断的经组织学证实的非尿路上皮性和尿路上皮性上尿路癌病例。我们通过 Kaplan-Meier 分析来估计 5 年总生存率。使用 Cox 比例风险回归分析来评估预后因素。
共确定了 2567 例有明确组织学亚型的上尿路癌患者。非尿路上皮性癌中最常见的组织学类型是鳞状细胞癌（n=88，3.4%），其次是腺癌（n=33，1.3%）和小细胞癌（n=10，0.4%）。鳞状细胞癌患者的晚期比例显著高于尿路上皮癌患者（P=0.003）。在 IV 期，尿路上皮癌组接受手术+化疗联合治疗的患者比例高于非尿路上皮癌组（分别为 34%和 16%）。非尿路上皮性癌患者在 I-III 期和 IV 期的 5 年总生存率明显差于尿路上皮癌患者（P=0.003，P<0.001）。多变量分析显示，年龄≥73 岁、晚期（IV 期）、肿瘤位置（输尿管）和非尿路上皮性癌组织学存在是独立的预后不良因素。
非尿路上皮性癌患者的预后较尿路上皮性癌患者差，尤其是 IV 期非尿路上皮性癌患者。需要更有效的全身治疗来改善这些患者的肿瘤学结局。
