Wu Jie, Xu Pei-Hang, Luo Wen-Jie, Dai Bo, Shen Yi-Jun, Ye Ding-Wei, Wang Yu-Chen, Zhu Yi-Ping
Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Front Surg. 2021 Feb 22;8:590448. doi: 10.3389/fsurg.2021.590448. eCollection 2021.
Of patients with upper urinary tract urothelial carcinoma (UTUC), 22-47% developed bladder recurrence after radical nephroureterectomy. Furthermore, the effect of surgery for UTUC-bladder cancer (BC) has not been well validated. The aim of this study was to assess the impact of standard primary BC surgical strategy on survival of patients diagnosed with UTUC-BC. A total of 676 UTUC-BC patients and 197,753 primary BC patients diagnosed from 2004 to 2016, were identified based on the SEER database. The Kaplan-Meier method and the Fine and Gray competing risks analysis were performed to assess overall survival (OS) and cancer-specific mortality (CSM). Multivariate Cox regression model and competing risks regression model were used to identify independent risk factors. Propensity score matching (PSM) was also performed to adjust potential confounding factors. The baseline characteristics and survival outcomes of the two BC patient cohorts are quite different. For UTUC-BC patients, no significant difference in OS (NMIBC: = 0.88; MIBC: = 0.98) or cumulative incidence of CSM (NMIBC: = 0.12; MIBC: = 0.96) were noted for various surgical procedures. Local tumor treatment and partial cystectomy for UTUC-NMIBC patients produced lower 1-year (6.1%) and 3-year CSM (16.2%). Radical cystectomy for UTUC-MIBC patients produced lower 1-year (11.8%) but higher 3-year CSM (62.7%). After PSM for covariates, UTUC-BC patients still had a worse prognosis after surgery compared with primary BC patients. Based on regression models, older age, advanced T stage, N positive disease, M positive disease, and shorter interval between UTUC and BC were identified as independent risk factors for UTUC-BC patients. Standard primary BC surgical strategy did not provide significant survival benefit for UTUC-BC patients. Compared with primary BC patients, UTUC-BC patients had a worse prognosis after surgery, suggesting that current primary BC surgical guidelines are not entirely appropriate for UTUC-BC patients. Our findings underscore the continued importance and need for better prognosis and improved guidelines for management of UTUC-BC patients.
在上尿路尿路上皮癌（UTUC）患者中，22% - 47%的患者在根治性肾输尿管切除术后出现膀胱复发。此外，UTUC合并膀胱癌（BC）的手术效果尚未得到充分验证。本研究的目的是评估标准原发性膀胱癌手术策略对诊断为UTUC - BC患者生存的影响。基于监测、流行病学和最终结果（SEER）数据库，确定了2004年至2016年期间诊断的676例UTUC - BC患者和197,753例原发性膀胱癌患者。采用Kaplan - Meier方法和Fine - Gray竞争风险分析来评估总生存期（OS）和癌症特异性死亡率（CSM）。使用多变量Cox回归模型和竞争风险回归模型来确定独立危险因素。还进行了倾向评分匹配（PSM）以调整潜在的混杂因素。两个膀胱癌患者队列的基线特征和生存结果差异很大。对于UTUC - BC患者，不同手术方式的OS（非肌层浸润性膀胱癌：= 0.88；肌层浸润性膀胱癌：= 0.98）或CSM累积发生率（非肌层浸润性膀胱癌：= 0.12；肌层浸润性膀胱癌：= 0.96）均无显著差异。UTUC - 非肌层浸润性膀胱癌患者的局部肿瘤治疗和部分膀胱切除术的1年CSM（6.1%）和3年CSM（16.2%）较低。UTUC - 肌层浸润性膀胱癌患者的根治性膀胱切除术的1年CSM（11.8%）较低，但3年CSM（62.7%）较高。在对协变量进行PSM后，与原发性膀胱癌患者相比，UTUC - BC患者术后预后仍然较差。基于回归模型，年龄较大、T分期较晚、N阳性疾病、M阳性疾病以及UTUC与BC之间的间隔时间较短被确定为UTUC - BC患者的独立危险因素。标准原发性膀胱癌手术策略未为UTUC - BC患者提供显著的生存益处。与原发性膀胱癌患者相比，UTUC - BC患者术后预后较差，这表明当前原发性膀胱癌手术指南并不完全适用于UTUC - BC患者。我们的研究结果强调了对UTUC - BC患者进行更好的预后评估和改进管理指南的持续重要性和必要性。
