既往膀胱癌对接受根治性肾输尿管切除术患者复发的影响

The Role of Prior Bladder Cancer on Recurrence in Patients Treated with Radical Nephroureterectomy.

作者信息

Martini Alberto, Lonati Chiara, Montorsi Francesco, Briganti Alberto, Colombo Renzo, Necchi Andrea, Simeone Claudio, Zamboni Stefania, Afferi Luca, Mattei Agostino, Carando Roberto, Ploussard Guillaume, Soria Francesco, Marra Giancarlo, Rouprêt Morgan, Xylinas Evanguelos, Pradere Benjamin, Abufaraj Mohammad, D'Andrea David, Shariat Shahrokh F, Moschini Marco

机构信息

Department of Urology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy.

Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Urology, Spedali Civili of Brescia, Brescia, Italy.

出版信息

Clin Genitourin Cancer. 2022 Jun;20(3):e190-e198. doi: 10.1016/j.clgc.2021.12.006. Epub 2021 Dec 11.

DOI:10.1016/j.clgc.2021.12.006

PMID:35105509

Abstract

INTRODUCTION

The prognostic role of prior history of bladder cancer (BCa) among patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) is poorly addressed. We aimed to investigate the role of prior BCa on any recurrence, distant metastases, and bladder recurrence following RNU among low-grade (LG) and high-grade (HG) UTUC patients.

PATIENTS AND METHODS

We retrospectively analyzed 1,580 UTUC patients treated with RNU at 8 tertiary referral centers between 1992 and 2016. Any recurrence was defined as recurrence in the urinary tract, in the resection bed, or distant metastases (defined as disease outside the urinary tract and regional lymph nodes). Time to recurrence was computed from RNU. Multivariable Cox models were generated to predict risk of any recurrence, distant metastases, and bladder recurrence according to prior BCa history, coded as no prior BCa, non-muscle-invasive (NMIBC), and muscle-invasive BCa (MIBC).

RESULTS

Median follow-up for survivors was 4 years. Overall, 71%, 25%, and 4% of patients had no prior BCa, NMIBC and MIBC. 5-year any recurrence-free survival was 61%, 41%, and 19% in LG (P < .001) and 42%, 34%, and 30% in HG patients (P = .1) with no prior BCa, NMIBC, and MIBC. On multivariable models, LG patients with NMIBC and MIBC showed a significantly higher risk of any recurrence compared to no prior BCa (both p≤0.005); previous NMIBC was associated with any recurrence among HG patients (P = 0.04). 5-year distant metastases-free survival was 92%, 90%, and 87% in LG (P > .05) and 68%, 75%, and 45% in HG patients (P = .01) with no prior BCa, NMIBC, and MIBC. Previous NMIBC increased the risk of bladder recurrence among LG (P < .001) and HG (P = .003) patients.

CONCLUSIONS

UTUC patients with prior history of BCa exhibit a higher risk of any recurrence after RNU. Our study provides important information which could address patient's counseling and decision-making process.

摘要

引言

对于接受根治性肾输尿管切除术（RNU）治疗上尿路尿路上皮癌（UTUC）的患者，既往膀胱癌（BCa）病史的预后作用尚未得到充分研究。我们旨在探讨既往BCa病史对低级别（LG）和高级别（HG）UTUC患者RNU术后任何复发、远处转移及膀胱复发的影响。

患者与方法

我们回顾性分析了1992年至2016年间在8家三级转诊中心接受RNU治疗的1580例UTUC患者。任何复发定义为尿路、手术切缘或远处转移（定义为尿路及区域淋巴结以外的疾病）。复发时间从RNU术后开始计算。根据既往BCa病史（分为无既往BCa、非肌层浸润性（NMIBC）和肌层浸润性BCa（MIBC））生成多变量Cox模型，以预测任何复发、远处转移及膀胱复发的风险。

结果

幸存者的中位随访时间为4年。总体而言，71%、25%和4%的患者无既往BCa、NMIBC和MIBC。LG患者中，无既往BCa、NMIBC和MIBC的5年无任何复发生存率分别为61%、41%和19%（P <.001）；HG患者中分别为42%、34%和30%（P =.1）。在多变量模型中，LG患者中NMIBC和MIBC患者的任何复发风险显著高于无既往BCa患者（均p≤0.005）；既往NMIBC与HG患者的任何复发相关（P = 0.04）。LG患者中无既往BCa、NMIBC和MIBC的5年无远处转移生存率分别为92%、90%和87%（P >.05）；HG患者中分别为68%、75%和45%（P =.01）。既往NMIBC增加了LG（P <.001）和HG（P =.003）患者的膀胱复发风险。