Department of Urology, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan; Department of Urology, Hiroshima Prefectural Hospital, Hiroshima, Japan.
Department of Urology, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.
Urol Oncol. 2022 Dec;40(12):539.e9-539.e16. doi: 10.1016/j.urolonc.2022.08.010. Epub 2022 Oct 13.
Patients with histological variants (HV) of bladder cancer have more advanced disease and poorer survival rates than those with pure urothelial carcinoma (UC). Moreover, lymphovascular invasion (LVI) is an important biomarker after RNU in systematic reviews and meta-analyses. Thus, here we investigated the clinical and prognostic impact of HV and LVI in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU).
Data from 223 UTUC patients treated with RNU without neoadjuvant chemotherapy were retrospectively evaluated. We analyzed differences in clinicopathological features and survival rates between patients with pure UC and those with HV. Conditional survival (CS) analysis was performed to obtain prognostic information over time.
A total of 32 patients (14.3%) had HV, with the most common variant being squamous differentiation, followed by glandular differentiation. UTUC with HV was significantly associated with advanced pathological T stage (pT ≥ 3), higher tumor grade (G3), and LVI, compared to pure UC (all P < 0.01). Progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS), were all significantly worse in the HV group compared to the pure UC group (all, P < 0.001). In multivariable analysis, HV and LVI were independent predictors of CSS and OS. We classified the patients into three groups using these two predictors: low-risk (neither HV nor LVI), intermediate-risk (either HV or LVI), and high-risk (both HV and LVI). Significant differences in PFS, CSS, and OS rates were found among the 3 groups. In CS analysis, the conditional PFS, CSS, and OS rates at 1, 2, 3, 4, and 5 years improved with increased duration of event-free survival. CS analysis revealed that most progression events occurred within 2 years after RNU, and patients with risk factors had worse PFS at all time points.
A risk model using HV and LVI can stratify PFS, CSS, and OS of patients treated with RNU. In addition, CS analysis revealed that HV and LVI were poor prognostic factors over time after RNU.
与纯尿路上皮癌（UC）相比，具有组织学变异型（HV）的膀胱癌患者疾病更晚期，生存率更低。此外，在系统评价和荟萃分析中，淋巴血管侵犯（LVI）是 RNU 后的一个重要生物标志物。因此，我们在此研究了接受根治性肾输尿管切除术（RNU）治疗的上尿路上皮癌（UTUC）患者中 HV 和 LVI 的临床和预后影响。
回顾性评估了 223 例接受 RNU 治疗且未接受新辅助化疗的 UTUC 患者的数据。我们分析了纯 UC 患者和 HV 患者之间的临床病理特征和生存率差异。进行条件生存（CS）分析以获得随时间变化的预后信息。
共有 32 例（14.3%）患者存在 HV，最常见的变异型为鳞状分化，其次为腺分化。与纯 UC 相比，具有 HV 的 UTUC 与更晚期的病理 T 分期（pT≥3）、更高的肿瘤分级（G3）和 LVI 显著相关（均 P<0.01）。与纯 UC 组相比，HV 组的无进展生存期（PFS）、癌症特异性生存期（CSS）和总生存期（OS）均显著更差（均 P<0.001）。多变量分析显示，HV 和 LVI 是 CSS 和 OS 的独立预测因素。我们使用这两个预测因素将患者分为三组：低风险（既无 HV 也无 LVI）、中风险（有 HV 或 LVI）和高风险（均有 HV 和 LVI）。三组间的 PFS、CSS 和 OS 率存在显著差异。在 CS 分析中，随着无事件生存时间的延长，条件 PFS、CSS 和 OS 率均提高。CS 分析显示，大多数进展事件发生在 RNU 后 2 年内，并且具有危险因素的患者在所有时间点的 PFS 更差。
使用 HV 和 LVI 的风险模型可分层 RNU 治疗患者的 PFS、CSS 和 OS。此外，CS 分析显示，RNU 后随着时间的推移，HV 和 LVI 是预后不良的因素。
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