Ferro Matteo, Chiujdea Sever, Vartolomei Mihai Dorin, Bove Pierluigi, Porreca Angelo, Busetto Gian Maria, Del Giudice Francesco, Antonelli Alessandro, Foschi Nazario, Racioppi Marco, Autorino Riccardo, Chiancone Francesco, Longo Nicola, Barone Biagio, Crocetto Felice, Musi Gennaro, Luzzago Stefano, Piccinelli Mattia Luca, Mistretta Francesco Alessandro, de Cobelli Ottavio, Tataru Octavian Sabin, Hurle Rodolfo, Liguori Giovanni, Borghesi Marco, Veccia Alessandro, Greco Francesco, Schips Luigi, Marchioni Michele, Lucarelli Giuseppe, Dutto Daniele, Colucci Fulvia, Russo Giorgio Ivan, Giudice Arturo Lo, Montanari Emanuele, Boeri Luca, Simone Giuseppe, Rosazza Matteo, Livoti Simone, Gontero Paolo, Soria Francesco
Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy.
Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Urology, Medical University of Vienna, Wien, Austria; The Institution Organizing University Doctoral Studies (I.O.S.U.D.), George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, Târgu Mureș, Romania.
Clin Genitourin Cancer. 2024 Apr;22(2):27-37. doi: 10.1016/j.clgc.2023.08.001. Epub 2023 Aug 11.
Upper tract urothelial carcinoma is rare but has a poor prognosis. Prognostic factors have been extensively studied in order to provide the best possible management for patients. We have aimed to investigate commonly available factors predictive of recurrence and survival in this patient population at high risk of death and recurrence, with an emphasis on the effects of age (using a cutoff of 70 years) on survival outcomes.
From 1387 patients with clinically nonmetastatic upper tract urothelial carcinoma treated with radical nephroureterectomy at 21 academic hospital centers between 2005 and 2021, 776 patients were eligible and included in the study. Univariable and multivariable Cox regression models were built to evaluate the independent prognosticators for intravesical and extravesical recurrence, overall survival, and cancer-specific survival according to age groups. A P value of <.05 was considered statistically significant.
We did not find an association between groups aged <70 and >70 years old and preoperatively clinical or histopathological characteristics. Kaplan-Meier analysis was found no statistical significance between the 2 age groups in terms of intravesical or extravesical recurrence (P = .09 and P = .57). Overall survival (P = .0001) and cancer-specific survival (P = .0001) have been found to be statistically significantly associated with age as independent predictors (confounding factors: gender, tumor size, tumor side, clinical T stage, localization, preoperative hydronephrosis, tumor localization, type of surgery, multifocality of the tumor, pathological grade, lymphovascular invasion, concomitant CIS, lymph node status, necrosis, or history of previous bladder cancer).
This research confirms that patients aged 70 and above who undergo radical nephroureterectomy may have worse outcomes compared to younger patients, older patients needing an improved care and management of UTUC to improve their outcomes in the setting of an increase in this aged population group.
上尿路尿路上皮癌较为罕见，但预后较差。为了给患者提供最佳治疗方案，人们对预后因素进行了广泛研究。我们旨在调查在这一高死亡和复发风险患者群体中，常见的可预测复发和生存的因素，重点关注年龄（以70岁为界）对生存结果的影响。
在2005年至2021年间，21个学术医院中心对1387例接受根治性肾输尿管切除术治疗的临床非转移性上尿路尿路上皮癌患者进行研究，其中776例符合条件并纳入研究。构建单变量和多变量Cox回归模型，根据年龄组评估膀胱内和膀胱外复发、总生存以及癌症特异性生存的独立预后因素。P值<.05被认为具有统计学意义。
我们未发现年龄<70岁和>70岁的组与术前临床或组织病理学特征之间存在关联。Kaplan-Meier分析发现，在膀胱内或膀胱外复发方面，两个年龄组之间无统计学意义（P =.09和P =.57）。总生存（P =.0001）和癌症特异性生存（P =.0001）被发现与年龄作为独立预测因素具有统计学显著关联（混杂因素：性别、肿瘤大小、肿瘤侧别、临床T分期、部位、术前肾积水、肿瘤定位、手术类型、肿瘤多灶性、病理分级、淋巴管侵犯、伴发原位癌、淋巴结状态、坏死或既往膀胱癌病史）。
本研究证实，与年轻患者相比，接受根治性肾输尿管切除术的70岁及以上患者可能预后更差，在这一年龄组人群增加的情况下，老年患者需要改善上尿路尿路上皮癌的护理和管理以改善其预后。
