Yamaguchi Ryotaro, Kagawa Hirokazu, Yoshihara Kentaro, Yamamoto Shutaro, Hara Shuhei, Miyajima Keiichiro, Enei Yuki, Fukuokaya Wataru, Iwatani Kosuke, Imai Yu, Atsuta Mahito, Mori Keiichiro, Igarashi Taro, Aikawa Koichi, Yanagisawa Takafumi, Kimura Shoji, Tashiro Kojiro, Tsuzuki Shunsuke, Ishii Gen, Higuchi Takahiro, Sato Shun, Yamada Yuta, Furuta Akira, Shimomura Tatsuya, Kimura Takahiro, Miki Jun, Urabe Fumihiko
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
Department of Urology, Jikei Katsushika Medical Center, Tokyo, Japan.
Transl Androl Urol. 2024 Nov 30;13(11):2384-2395. doi: 10.21037/tau-24-357. Epub 2024 Nov 27.
Despite the availability of advanced imaging technologies, it remains difficult to achieve sufficient staging accuracy to ensure a tailored treatment strategy for patients with upper tract urothelial carcinoma (UTUC). The aim of the study was to identify preoperative risk factors for tumor upstaging in patients with UTUC initially staged as clinical T2 or lower and to analyze these factors separately for renal pelvic cancer and ureteral cancer.
This retrospective study included data from patients with UTUC who underwent nephroureterectomy. Among them, patients who underwent a staging evaluation using computed tomography urography within 90 days before surgery were selected. Various preoperative factors were evaluated, and multivariate logistic regression analyses were conducted to identify predictors of pathological tumor upstaging.
The study included 496 patients, of whom 392 were diagnosed with clinical T2 stage or lower. Among these, 125 patients (31.9%) were upstaged to pathological T3 or T4 disease. Multivariate analysis identified positive voided urine cytology [hazard ratio (HR) =2.94, P<0.001] and tumor size ≥30 mm (HR =1.90, P=0.008) as independent predictors of upstaging. Subgroup analysis showed that positive voided urine cytology (HR =2.71, P=0.004) and tumor size ≥30 mm (HR =3.39, P=0.001) were significant risk factors for renal pelvic cancer. In contrast, significant predictors for ureteral cancer included positive voided urine cytology (HR =3.11, P=0.003) and hydronephrosis (HR =2.69, P=0.03).
Positive voided urine cytology and larger tumor size were significant predictors of pathological upstaging in patients with UTUC. Differences in the risk factors between renal pelvic and ureteral cancers highlight the need for tailored preoperative evaluations and management strategies. Further studies are required to refine these predictive models and improve clinical decision-making.
尽管有先进的成像技术，但对于上尿路尿路上皮癌（UTUC）患者，仍难以实现足够的分期准确性以确保制定个性化的治疗策略。本研究的目的是确定最初分期为临床T2期或更低的UTUC患者肿瘤分期上调的术前危险因素，并分别对肾盂癌和输尿管癌的这些因素进行分析。
这项回顾性研究纳入了接受肾输尿管切除术的UTUC患者的数据。其中，选择了术前90天内使用计算机断层扫描尿路造影进行分期评估的患者。评估了各种术前因素，并进行多因素逻辑回归分析以确定病理肿瘤分期上调的预测因素。
该研究纳入了496例患者，其中392例被诊断为临床T2期或更低。其中，125例患者（31.9%）分期上调为病理T3或T4期疾病。多因素分析确定尿脱落细胞学阳性[风险比（HR）=2.94，P<0.001]和肿瘤大小≥30 mm（HR =1.90，P=0.008）是分期上调的独立预测因素。亚组分析显示，尿脱落细胞学阳性（HR =2.71，P=0.004）和肿瘤大小≥30 mm（HR =3.39，P=0.001）是肾盂癌的显著危险因素。相比之下，输尿管癌的显著预测因素包括尿脱落细胞学阳性（HR =3.11，P=0.003）和肾积水（HR =2.69，P=0.03）。
尿脱落细胞学阳性和肿瘤较大是UTUC患者病理分期上调的显著预测因素。肾盂癌和输尿管癌危险因素的差异凸显了进行个性化术前评估和管理策略的必要性。需要进一步研究以完善这些预测模型并改善临床决策。
