在根治性肾输尿管切除术时，肿瘤大小可预测上尿路上皮癌的肌层浸润和非器官受限疾病。
Tumor Size Predicts Muscle-invasive and Non-organ-confined Disease in Upper Tract Urothelial Carcinoma at Radical Nephroureterectomy.
机构信息
Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Canada.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Canada; Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.
出版信息
Eur Urol Focus. 2022 Mar;8(2):498-505. doi: 10.1016/j.euf.2021.03.003. Epub 2021 Mar 15.
BACKGROUND
Pathological stage and grade of renal pelvis urothelial carcinoma (RPUC) are difficult to estimate before radical nephroureterectomy (RNU).
OBJECTIVE
To examine tumor size as an independent predictor of muscle-invasive and/or non-organ-confined rates of RPUC at RNU.
DESIGN, SETTING, AND PARTICIPANTS: Within the Surveillance, Epidemiology and End Results (SEER) database (2004-2016), we identified nonmetastatic RPUC at RNU.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
First, we examined stage and grade distributions. Second, two separate univariable and subsequent multivariable logistic regression models (LRMs) were fitted to test the association between tumor size and the rate of (1) muscle-invasive or higher (pT2-4N0-2) and (2) non-organ-confined (pT3-4N0-2) RPUC at RNU.
RESULTS AND LIMITATIONS
Of 4657 patients, 3052 (65.5%) had pT2-4N0-2 and 2382 (51.2%) pT3-4N0-2 RPUC at RNU. The median tumor size was 3.7 cm (interquartile range 2.5-5.0). The high-grade RPUC rate ranged from 71.1% to 87.2% (p < 0.001) among SEER registries. Conversely, no differences were recorded for stage (p > 0.05) or tumor size (p = 0.1) across all registries. Rates of pT2-4N0-2 and pT3-4N0-2 RPUC increased with tumor size. Specifically, for tumor size intervals from 0.1-1.0 cm to 9.1-10.0 cm, the pT2-4N0-2 rate ranged from 45% to 83% and the pT3-4N0-2 rate ranged from 23% to 75%, respectively (both p < 0.001). In multivariable LRMs, tumor size (in 1-cm units) was an independent predictor of pT2-4N0-2 (odds ratio [OR] 1.25; p < 0.001) and pT3-4N0-2 (OR 1.30; p < 0.001) disease at RNU.
CONCLUSIONS
Tumor size is a key predictor of muscle-invasive or non-organ-confined RPUC. Greater tumor size directly and virtually linearly predicts a higher rate of invasive or non-organ-confined RPUC at RNU.
PATIENT SUMMARY
For patients with cancer in urinary tract cells lining the kidney, larger tumor size predicts worse stage of the disease at surgery.
背景
在根治性肾输尿管切除术（RNU）前，肾盂尿路上皮癌（RPUC）的病理分期和分级较难估计。
目的
探讨肿瘤大小作为 RNU 时肌层浸润和/或非器官受限 RPUC 率的独立预测因子。
设计、地点和参与者：在监测、流行病学和最终结果（SEER）数据库（2004-2016 年）中，我们鉴定了 RNU 时非转移性 RPUC。
结局测量和统计学分析
首先，我们检查了分期和分级分布。其次，我们分别使用两个单变量和随后的多变量逻辑回归模型（LRMs）来检验肿瘤大小与（1）肌层浸润或更高（pT2-4N0-2）和（2）非器官受限（pT3-4N0-2）RPUC 率之间的关联。
结果和局限性
在 4657 名患者中，3052 名（65.5%）患者在 RNU 时患有 pT2-4N0-2，2382 名（51.2%）患者患有 pT3-4N0-2 RPUC。肿瘤大小中位数为 3.7cm（四分位距 2.5-5.0）。高分级 RPUC 率在 SEER 登记处之间为 71.1%-87.2%（p<0.001）。相反，所有登记处的肿瘤大小（p=0.1）或肿瘤大小（p=0.1）均无差异。pT2-4N0-2 和 pT3-4N0-2 RPUC 率随肿瘤大小增加而增加。具体而言，在肿瘤大小间隔为 0.1-1.0cm 至 9.1-10.0cm 时，pT2-4N0-2 率范围为 45%-83%，pT3-4N0-2 率范围为 23%-75%（均 p<0.001）。在多变量 LRM 中，肿瘤大小（以 1cm 为单位）是 pT2-4N0-2（优势比[OR]1.25；p<0.001）和 pT3-4N0-2（OR 1.30；p<0.001）疾病的独立预测因子。
结论
肿瘤大小是肌层浸润或非器官受限 RPUC 的关键预测因子。更大的肿瘤大小直接且几乎呈线性地预测 RNU 时侵袭性或非器官受限 RPUC 的发生率更高。
患者总结
对于患有肾脏尿路细胞癌的患者，肿瘤越大，手术时疾病的分期越差。
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