Yamada Yukio, Nakagawa Tohru, Miyakawa Jimpei, Kawai Taketo, Taguchi Satoru, Tabata Mariko, Kaneko Tomoyuki, Ishikawa Akira, Miyazaki Hideyo, Kondo Yasushi, Matsumoto Akihiko, Naito Akihiro, Hikatsu Masahiro, Fujii Yoichi, Akiyama Yoshiyuki, Yamada Yuta, Sato Yusuke, Nomiya Akira, Yamada Daisuke, Murata Taro, Suzuki Motofumi, Enomoto Yutaka, Nishimatsu Hiroaki, Takeuchi Takumi, Tanaka Yoshinori, Kume Haruki
Department of Urology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-Ku, Tokyo, 173-8605, Japan.
Department of Urology, Musashino Red Cross Hospital, Musashino, Tokyo, Japan.
World J Urol. 2023 Mar;41(3):767-776. doi: 10.1007/s00345-023-04300-7. Epub 2023 Feb 4.
The prognosis of patients with pT3 upper tract urothelial carcinoma (UTUC) varies. The current study aimed to further classify patients with pT3 UTUC into different survival outcome groups based on tumor location and site of invasion.
This retrospective study included 323 patients with pT3 UTUC who underwent nephroureterectomy at 11 hospitals in Japan. Histological and clinical data were obtained via a chart review. Univariate and multivariate Cox proportional hazards analyses showed the effect of different variables on recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS).
The median age of the patients was 72 years. Patients with pT3 UTUCs were divided into two groups: those with renal parenchymal invasion only (pT3a, n = 95) and those with peripelvic or periureteral fat invasion (pT3b, n = 228). pT3b UTUC was significantly associated with hydronephrosis, low preoperative estimated glomerular filtration rate (eGFR), histological nodal metastasis, nuclear grade 3, lymphovascular invasion (LVI), carcinoma in situ, and positive surgical margin. Based on the univariate analyses, patients with pT3b UTUC had a significantly lower 5-year RFS (42.4% vs. 70.1%, p < 0.0001), 5-year CSS (54.3% vs. 80.0%, p = 0.0002), and 5-year OS (47.8% vs. 76.8%, p < 0.0001) than those with pT3a UTUC. According to the multivariate analyses, nodal metastasis, LVI, adjuvant chemotherapy, preoperative eGFR, nuclear grade (RFS only), surgical margin (RFS only), and Charlson comorbidity index (OS only), but not pT3b stage, were associated with survival.
Compared with pT3a UTUC, pT3b UTUC was significantly associated with worse histological features, consequently resulting in unsatisfactory survival outcomes.
pT3期上尿路尿路上皮癌（UTUC）患者的预后各不相同。本研究旨在根据肿瘤位置和侵犯部位，将pT3期UTUC患者进一步分为不同的生存结局组。
这项回顾性研究纳入了日本11家医院323例行肾输尿管切除术的pT3期UTUC患者。通过查阅病历获取组织学和临床数据。单因素和多因素Cox比例风险分析显示了不同变量对无复发生存期（RFS）、癌症特异性生存期（CSS）和总生存期（OS）的影响。
患者的中位年龄为72岁。pT3期UTUC患者分为两组：仅侵犯肾实质的患者（pT3a，n = 95）和侵犯肾盂或输尿管周围脂肪的患者（pT3b，n = 228）。pT3b期UTUC与肾积水、术前估计肾小球滤过率（eGFR）低、组织学淋巴结转移、核分级3级、淋巴管侵犯（LVI）、原位癌和手术切缘阳性显著相关。基于单因素分析，pT3b期UTUC患者的5年RFS（42.4%对70.1%，p < 0.0001）、5年CSS（54.3%对80.0%，p = 0.0002）和5年OS（47.8%对76.8%，p < 0.0001）显著低于pT3a期UTUC患者。根据多因素分析，淋巴结转移、LVI、辅助化疗、术前eGFR、核分级（仅RFS）、手术切缘（仅RFS）和Charlson合并症指数（仅OS）与生存相关，但pT3b分期与生存无关。
与pT3a期UTUC相比，pT3b期UTUC与更差的组织学特征显著相关，因此导致生存结局不理想。
