Hughes Ryan T, Lucas John T, Krane Louis Spencer, Divers Jude L, Hemal Ashok K, Frizzell Bart A
Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston Salem, NC 27157, United States.
Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, United States.
Cancer Treat Commun. 2016;5:39-45. doi: 10.1016/j.ctrc.2015.12.004. Epub 2015 Dec 21.
Recurrence rates following nephroureterectomy (NU) for upper tract urothelial carcinoma (UTUC) remain high. As such, adjuvant therapy directed at high risk sites may improve long term outcomes. We describe patterns and predictors of UTUC recurrence according to patient, disease and treatment-related factors.
We reviewed the records of 113 patients treated with NU for UTUC at our institution between 2006 and 2013. Time to locoregional (LR), intravesical (IV), distant recurrence and death were described using the Kaplan-Meier method and compared using the log rank statistic. Cox Proportional Hazards analyses were performed to evaluate the adjusted hazard for LR/IV and LR recurrence.
Advanced T stage (T3/4) was present in 41 (36%) patients, 10 (9%) were node-positive and 21 (19%) showed evidence of lymphovascular space invasion (LVSI). Median overall survival and time to any recurrence was 54.6 and 20.7 months, respectively. Disease recurrence was observed in 48 (42%) patients. The location of failure was intravesical in 27 (24%), locoregional in 22 (19%) and distant in 20 (18%). Three-year LR/IV and distant failure rates were 38.7% and 22.2%, respectively. Three-year LR failure was 4.6% in pTa-2 vs. 25.8% in
In this study we demonstrate LR/IV recurrence as the predominant pattern of failure in UTUC patients treated with nephroureterectomy. This systematic description of recurrence patterns and associated factors will guide further investigation of adjuvant therapy to minimize the treatment failures defined herein.
上尿路尿路上皮癌（UTUC）行肾输尿管切除术（NU）后的复发率仍然很高。因此，针对高危部位的辅助治疗可能会改善长期预后。我们根据患者、疾病和治疗相关因素描述UTUC复发的模式和预测因素。
我们回顾了2006年至2013年间在我院接受NU治疗UTUC的113例患者的记录。使用Kaplan-Meier方法描述局部区域（LR）、膀胱内（IV）、远处复发和死亡的时间，并使用对数秩统计进行比较。进行Cox比例风险分析以评估LR/IV和LR复发的调整后风险。
41例（36%）患者为晚期T分期（T3/4），10例（9%）为淋巴结阳性，21例（19%）有淋巴管侵犯（LVSI）证据。中位总生存期和至任何复发时间分别为54.6个月和20.7个月。48例（42%）患者出现疾病复发。失败部位膀胱内为27例（24%），局部区域为22例（19%），远处为20例（18%）。三年LR/IV和远处失败率分别为38.7%和22.2%。pTa-2期患者三年LR失败率为4.6%，而……为25.8%
在本研究中，我们证明LR/IV复发是接受肾输尿管切除术的UTUC患者的主要失败模式。对复发模式和相关因素的这种系统描述将指导辅助治疗的进一步研究，以尽量减少本文定义的治疗失败。 （原文此处pTa-2 vs. 25.8% in后面内容不完整）
