Zhai Hongyun, Wang Yanghai, Chen Zhenghao, Wang Zhiwen, Xing Jiyu, Zhu Xi, Hao Gangyue
Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
Int Urol Nephrol. 2024 Mar;56(3):941-955. doi: 10.1007/s11255-023-03838-0. Epub 2023 Oct 17.
To investigate clinicopathological characteristics, surgical treatments, and oncological outcomes of patients with localized primary unifocal urothelial carcinoma involving the ureterovesical junction (UC-UVJ).
Localized primary unifocal UC-UVJ cases in patients admitted to our hospital from March 2013 to August 2021 were reviewed. Clinicopathological parameters, perioperative data, and oncological outcomes were compared between patients grouped by tumor location and surgical treatment.
A total of 130 patients with localized primary unifocal UC-UVJ were enrolled in this study. These included 72 cases of bladder cancer (BC) involving the ureteral orifice, and 58 cases of upper urinary tract urothelial carcinoma (UTUC) involving the intramural ureter. The proportion of male patients, hydronephrosis, flank pain/abdominal pain, and tumor size differed significantly between the BC and UTUC groups (all P < 0.05). During the median follow-up period of 32.9 months, 49 cases (37.7%) recurred and 29 (22.3%) died from urothelial carcinoma (UC), though no statistical difference in recurrence (P = 0.436) or cancer-specific mortality (P = 0.653) was observed between the BC and UTUC groups. Cox proportional hazards regression analysis identified age, tumor grade, and lymphovascular invasion (LVI) as independent predictors of cancer-specific survival (CSS), and sex, T stage, tumor grade, and LVI as independent predictors of recurrence-free survival (RFS).
Owing to positional properties, patients with localized primary unifocal UC-UVJ exhibited significant heterogeneity, leading to varied treatment strategies. No statistically significant differences in CSS or RFS were observed between the BC and UTUC groups. Furthermore, age, sex, T stage, tumor grade, and LVI should be carefully considered in clinical practice because of their associations with CSS and RFS.
探讨局限性原发性单灶性输尿管膀胱连接部尿路上皮癌（UC-UVJ）患者的临床病理特征、手术治疗方法及肿瘤学转归。
回顾性分析2013年3月至2021年8月我院收治的局限性原发性单灶性UC-UVJ患者病例。比较根据肿瘤位置和手术治疗分组的患者的临床病理参数、围手术期数据及肿瘤学转归。
本研究共纳入130例局限性原发性单灶性UC-UVJ患者。其中包括72例累及输尿管口的膀胱癌（BC）和58例累及壁内段输尿管的上尿路尿路上皮癌（UTUC）。BC组和UTUC组男性患者比例、肾积水、胁腹痛/腹痛及肿瘤大小差异有统计学意义（均P<0.05）。中位随访期32.9个月时，49例（37.7%）复发，29例（22.3%）死于尿路上皮癌（UC），但BC组和UTUC组之间复发（P=0.436）或癌症特异性死亡率（P=0.653）无统计学差异。Cox比例风险回归分析确定年龄、肿瘤分级及淋巴管侵犯（LVI）为癌症特异性生存（CSS）的独立预测因素，性别、T分期、肿瘤分级及LVI为无复发生存（RFS）的独立预测因素。
由于位置特性，局限性原发性单灶性UC-UVJ患者表现出显著的异质性，导致治疗策略各异。BC组和UTUC组之间CSS或RFS无统计学显著差异。此外，在临床实践中应仔细考虑年龄、性别、T分期、肿瘤分级及LVI，因为它们与CSS和RFS相关。
