Morra Simone, Incesu Reha-Baris, Scheipner Lukas, Baudo Andrea, Jannello Letizia Maria Ippolita, Siech Carolin, de Angelis Mario, Tian Zhe, Creta Massimiliano, Califano Gianluigi, Collà Ruvolo Claudia, Saad Fred, Shariat Shahrokh F, Chun Felix K H, de Cobelli Ottavio, Musi Gennaro, Briganti Alberto, Tilki Derya, Ahyai Sascha, Carmignani Luca, Longo Nicola, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131, Naples, Italy.
World J Urol. 2024 May 22;42(1):343. doi: 10.1007/s00345-024-05057-3.
It is unknown whether the stage of the primary may influence the survival (OS) of metastatic upper tract urothelial carcinoma (mUTUC) patients treated with nephroureterectomy (NU) and systemic therapy (ST). We tested this hypothesis within a large-scale North American cohort.
Within Surveillance Epidemiology and End Results database 2000-2020, all mUTUC patients treated with ST+NU or with ST alone were identified. Kaplan-Maier plots depicted OS. Multivariable Cox regression (MCR) models tested for differences between ST+NU and ST alone predicting overall mortality (OM). All analyses were performed in localized (T1-T2) and then repeated in locally advanced (T3-T4) patients.
Of all 728 mUTUC patients, 187 (26%) harbored T1-T2 vs 541 (74%) harbored T3-T4. In T1-T2 patients, the median OS was 20 months in ST+NU vs 10 months in ST alone. Moreover, in MCR analyses that also relied on 3 months' landmark analyses, the combination of ST+NU independently predicted lower OM (HR 0.37, p < 0.001). Conversely, in T3-T4 patients, the median OS was 12 in ST+NU vs 10 months in ST alone. Moreover, in MCR analyses that also relied on 3 months' landmark analyses, the combination of ST+NU was not independently associated with lower OM (HR 0.85, p = 0.1).
In mUTUC patients, treated with ST, NU drastically improved survival in T1-T2 patients, even after strict methodological adjustments (multivariable and landmark analyses). However, this survival benefit did not apply to patients with locally more advanced disease (T3-T4).
对于接受肾输尿管切除术（NU）和全身治疗（ST）的转移性上尿路尿路上皮癌（mUTUC）患者，原发肿瘤的分期是否会影响其总生存期（OS）尚不清楚。我们在一个大规模的北美队列中验证了这一假设。
在监测、流行病学和最终结果数据库2000 - 2020中，识别出所有接受ST + NU或仅接受ST治疗的mUTUC患者。采用Kaplan - Maier曲线描绘总生存期。多变量Cox回归（MCR）模型测试ST + NU与单纯ST在预测总死亡率（OM）方面的差异。所有分析先在局限性（T1 - T2）患者中进行，然后在局部晚期（T3 - T4）患者中重复进行。
在所有728例mUTUC患者中，187例（26%）为T1 - T2期，541例（74%）为T3 - T4期。在T1 - T2期患者中，ST + NU组的中位总生存期为20个月，单纯ST组为10个月。此外，在同样依赖3个月标志性分析的MCR分析中，ST + NU联合治疗独立预测较低的总死亡率（风险比0.37，p < 0.001）。相反，在T3 - T4期患者中，ST + NU组的中位总生存期为12个月，单纯ST组为10个月。此外，在同样依赖3个月标志性分析的MCR分析中，ST + NU联合治疗与较低的总死亡率无独立相关性（风险比0.85，p = 0.1）。
在接受ST治疗的mUTUC患者中，即使经过严格的方法学调整（多变量和标志性分析），NU仍能显著提高T1 - T2期患者的生存率。然而，这种生存获益不适用于局部病变更晚期（T3 - T4）的患者。
