Yeh Hsin-Chih, Chang Chao-Hsiang, Fang Jen-Kai, Chen I-Hsuan Alan, Lin Jen-Tai, Hong Jian-Hua, Huang Chao-Yuan, Wang Shian-Shiang, Chen Chuan-Shu, Lo Chi-Wen, Yu Chih-Chin, Tseng Jen-Shu, Lin Wun-Rong, Jou Yeong-Chin, Cheong Ian-Seng, Jiang Yuan-Hong, Tsai Chung-You, Hsueh Thomas Y, Chen Yung-Tai, Huang Hsu-Che, Tsai Yao-Chou, Lin Wei-Yu, Wu Chia-Chang, Lin Po-Hung, Lin Te-Wei, Wu Wen-Jeng
Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Front Oncol. 2022 Jun 2;12:872849. doi: 10.3389/fonc.2022.872849. eCollection 2022.
We aimed to evaluate the impact of preoperative local symptoms on prognosis after radical nephroureterectomy in patients with upper tract urothelial carcinoma (UTUC).
This retrospective study consisted of 2,662 UTUC patients treated at 15 institutions in Taiwan from 1988 to 2019. Clinicopathological data were retrospectively collected for analysis by the Taiwan UTUC Collaboration Group. The Kaplan-Meier method was used to calculate overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS). The prognostic value of preoperative local symptoms in OS, CSS, DFS, and BRFS was investigated using Cox proportional hazards models.
The median follow-up was 36.6 months. Among 2,662 patients, 2,130 (80.0%) presented with hematuria and 398 (15.0%) had symptomatic hydronephrosis at diagnosis. Hematuria was associated with less symptomatic hydronephrosis (0.001), more dialysis status ( = 0.027), renal pelvic tumors (0.001), and early pathological tumor stage ( = 0.001). Symptomatic hydronephrosis was associated with female patients (0.001), less dialysis status ( = 0.001), less bladder cancer history (0.001), ureteral tumors (0.001), open surgery ( = 0.006), advanced pathological tumor stage (0.001), and postoperative chemotherapy ( = 0.029). Kaplan-Meier analysis showed that patients with hematuria or without symptomatic hydronephrosis had significantly higher rates of OS, CSS, and DFS (all 0.001). Multivariate analysis confirmed that presence of hematuria was independently associated with better OS (HR 0.789, 95% CI 0.661-0.942) and CSS (HR 0.772, 95% CI 0.607-0.980), while symptomatic hydronephrosis was a significant prognostic factor for poorer OS (HR 1.387, 95% CI 1.142-1.683), CSS (HR 1.587, 95% CI 1.229-2.050), and DFS (HR 1.378, 95% CI 1.122-1.693).
Preoperative local symptoms were significantly associated with oncological outcomes, whereas symptomatic hydronephrosis and hematuria had opposite prognostic effects. Preoperative symptoms may provide additional information on risk stratification and perioperative treatment selection for patients with UTUC.
我们旨在评估术前局部症状对上尿路尿路上皮癌（UTUC）患者根治性肾输尿管切除术后预后的影响。
这项回顾性研究纳入了1988年至2019年在台湾15家机构接受治疗的2662例UTUC患者。台湾UTUC协作组回顾性收集临床病理数据进行分析。采用Kaplan-Meier法计算总生存期（OS）、癌症特异性生存期（CSS）、无病生存期（DFS）和无膀胱复发生存期（BRFS）。使用Cox比例风险模型研究术前局部症状在OS、CSS、DFS和BRFS中的预后价值。
中位随访时间为36.6个月。在2662例患者中，2130例（80.0%）在诊断时出现血尿，398例（15.0%）有症状性肾积水。血尿与较少的症状性肾积水（P<0.001）、更多的透析状态（P = 0.027）、肾盂肿瘤（P<0.001）和早期病理肿瘤分期（P<0.001）相关。症状性肾积水与女性患者（P<0.001）、较少的透析状态（P = 0.001）、较少的膀胱癌病史（P<0.001）、输尿管肿瘤（P<0.001）、开放手术（P = 0.006）、晚期病理肿瘤分期（P<0.001）和术后化疗（P = 0.029）相关。Kaplan-Meier分析显示，有血尿或无症状性肾积水的患者的OS、CSS和DFS率显著更高（均P<0.001）。多变量分析证实，血尿的存在与更好的OS（HR 0.789，95%CI 0.661 - 0.942）和CSS（HR 0.772，95%CI 0.607 - 0.980）独立相关，而症状性肾积水是OS（HR 1.387，95%CI 1.142 - 1.683）、CSS（HR 1.587，95%CI 1.229 - 2.050）和DFS（HR 1.378，95%CI 1.122 - 1.693）较差的显著预后因素。
术前局部症状与肿瘤学结局显著相关，而症状性肾积水和血尿具有相反的预后影响。术前症状可为UTUC患者的风险分层和围手术期治疗选择提供额外信息。
