Chen Tzu Shuang, Chen Yen Ta, Wang Hung Jen, Chiang Po Hui, Yang Wen Chou, Lee Wei Ching, Chuang Yao Chi, Cheng Yuan Tso, Kang Chih Hsiung, Lee Wei Chia, Chen Chien Hsu, Shen Yuan Chi, Liu Yi Yang, Liu Hui Ying, Chang Yin Lun, Su Yu Li, Huang Chun Chieh, Luo Hao Lun
Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Jhong Siao Urological Hospital, Kaohsiung, Taiwan.
Front Oncol. 2022 Mar 15;12:850874. doi: 10.3389/fonc.2022.850874. eCollection 2022.
We aimed to evaluate the impact of tumor location on cancer outcomes in patients with pT3N0M0 upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU) with bladder cuff excision.
We retrospectively reviewed 302 patients with pT3N0M0 UTUC who underwent RNU with bladder cuff excision at our institution between 2005 and 2019, including 191 renal pelvis tumors and 111 ureteral tumors. Clinicopathologic characteristics were compared between renal pelvis and ureter urothelial carcinomas. Multivariate Cox proportional hazard regression was used to assess the association between outcomes and clinical factors. Outcomes of interest included intravesical recurrence-free survival (IVRFS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and cancer-specific survival (CSS), which were measured using the Kaplan-Meier curve with a log-rank test.
A total of 302 patients underwent RNU with bladder cuff excision. During the median follow-up of 42.7 months, 70 (23.2%), 95 (31.5%), and 99 (32.8%) patients experienced intravesical recurrence, local recurrence, and distant metastasis, respectively. Seventy (23.2%) patients died from UTUC. Multivariate Cox regression analysis showed that tumor location was an independent predictor of local recurrence (HR = 2.05, p = 0.001), with borderline independent significance in intravesical recurrence (HR = 1.54, p = 0.074) and distant metastasis (HR = 1.45, p = 0.08). Kaplan-Meier analysis showed that ureter tumors had a worse 5-year local recurrence (log-rank p < 0.001) and borderline worse 5-year intravesical recurrence (log-rank p = 0.055) and 5-year distant metastasis (log-rank p = 0.073).
Ureter tumors seem to be associated with worse oncological outcomes, especially with local recurrence in UTUC. Further large and long-term studies are warranted for investigating biological differences based on tumor location.
我们旨在评估肿瘤位置对接受根治性肾输尿管切除术（RNU）并切除膀胱袖口的pT3N0M0上尿路尿路上皮癌（UTUC）患者癌症预后的影响。
我们回顾性分析了2005年至2019年间在我院接受RNU并切除膀胱袖口的302例pT3N0M0 UTUC患者，其中包括191例肾盂肿瘤和111例输尿管肿瘤。比较肾盂和输尿管尿路上皮癌的临床病理特征。采用多变量Cox比例风险回归分析评估预后与临床因素之间的关联。感兴趣的预后指标包括膀胱内无复发生存期（IVRFS）、局部无复发生存期（LRFS）、远处无转移生存期（DMFS）和癌症特异性生存期（CSS），使用Kaplan-Meier曲线和对数秩检验进行测量。
共有302例患者接受了RNU并切除膀胱袖口。在中位随访42.7个月期间，分别有70例（23.2%）、95例（31.5%）和99例（32.8%）患者出现膀胱内复发、局部复发和远处转移。70例（23.）患者死于UTUC。多变量Cox回归分析显示，肿瘤位置是局部复发的独立预测因素（HR = 2.05，p = 0.001），在膀胱内复发（HR = 1.54，p = 0.074）和远处转移（HR = 1.45，p = 0.08）方面具有临界独立意义。Kaplan-Meier分析显示，输尿管肿瘤的5年局部复发情况较差（对数秩p < 0.001），5年膀胱内复发情况临界较差（对数秩p = 0.055），5年远处转移情况临界较差（对数秩p = 0.073）。
输尿管肿瘤似乎与更差的肿瘤学预后相关，尤其是UTUC中的局部复发。有必要进行进一步的大型长期研究，以探讨基于肿瘤位置的生物学差异。
