Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Urology, Kyorin University School of Medicine, Tokyo, Japan.
Jpn J Clin Oncol. 2022 Jan 3;52(1):65-72. doi: 10.1093/jjco/hyab143.
The ureterovesical junction is the boundary between the urinary bladder and upper urinary tract. Because treatment strategies for bladder cancer and upper tract urothelial carcinoma are entirely different, urothelial carcinoma involving the ureterovesical junction requires special attention. Nevertheless, studies focusing on the disease are lacking.
We reviewed consecutive patients with urothelial carcinoma treated via either transurethral resection of bladder tumor (n = 2791) or radical nephroureterectomy (n = 292) between 2000 and 2020 and identified those with bladder cancer involving the ureteral orifice (n = 64) and those with upper tract urothelial carcinoma involving the intramural ureter (≤2 cm) (n = 41). After excluding overlapping cases (n = 24), 80 patients with urothelial carcinoma involving the ureterovesical junction were analyzed.
The initial symptoms or reasons for diagnosing urothelial carcinoma involving the ureterovesical junction were hematuria (n = 30), hydronephrosis (n = 21), follow-up examinations for prior urothelial carcinoma (n = 13), screening examinations (n = 7), frequent urination (n = 6) and unknown causes (n = 3). During a median follow-up period of 42 months, 18 patients died of urothelial carcinoma. The definitive surgical treatments for urothelial carcinoma involving the ureterovesical junction were transurethral resection of bladder tumor alone (n = 26), radical nephroureterectomy (n = 41) and radical cystectomy (n = 13), with different treatments having different cancer-specific survivals. Multivariate analyses identified T stage (≥T2) as an independent predictor of shorter cancer-specific survival.
Given the positional property of urothelial carcinoma involving the ureterovesical junction, the profiles of patients with the disease were highly heterogeneous. Further optimization of treatment strategies for urothelial carcinoma involving the ureterovesical junction is urgently warranted for better clinical outcomes.
输尿管膀胱连接部是膀胱和上尿路的交界处。由于膀胱癌和上尿路尿路上皮癌的治疗策略完全不同，因此需要特别关注累及输尿管膀胱连接部的尿路上皮癌。然而，目前针对该疾病的研究还很缺乏。
我们回顾了 2000 年至 2020 年间通过经尿道膀胱肿瘤切除术（n=2791 例）或根治性肾输尿管切除术（n=292 例）治疗的连续患者，并确定了累及输尿管口的膀胱癌患者（n=64 例）和累及壁内输尿管的上尿路尿路上皮癌患者（≤2 cm）（n=41 例）。排除重叠病例（n=24 例）后，分析了 80 例累及输尿管膀胱连接部的尿路上皮癌患者。
累及输尿管膀胱连接部的尿路上皮癌患者的初始症状或诊断原因包括血尿（n=30）、肾积水（n=21）、既往尿路上皮癌的随访检查（n=13）、筛查检查（n=7）、尿频（n=6）和原因不明（n=3）。在中位随访 42 个月期间，18 例患者死于尿路上皮癌。累及输尿管膀胱连接部的尿路上皮癌的确定性手术治疗包括单纯经尿道膀胱肿瘤切除术（n=26）、根治性肾输尿管切除术（n=41）和根治性膀胱切除术（n=13），不同的治疗方法具有不同的癌症特异性生存率。多变量分析确定 T 分期（≥T2）是癌症特异性生存率较短的独立预测因素。
鉴于累及输尿管膀胱连接部的尿路上皮癌的位置特性，该疾病患者的特征高度异质。为了获得更好的临床结果，迫切需要进一步优化累及输尿管膀胱连接部的尿路上皮癌的治疗策略。
