Shiga Masanobu, Nagumo Yoshiyuki, Kojo Kosuke, Kandori Shuya, Takahashi Reo, Isoda Bunpei, Suzuki Shuhei, Hamada Kazuki, Tanuma Kozaburo, Nitta Satoshi, Hoshi Akio, Negoro Hiromitsu, Mathis Bryan J, Okuyama Ayako, Nishiyama Hiroyuki
Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Int J Urol. 2025 Apr;32(4):394-400. doi: 10.1111/iju.15665. Epub 2025 Jan 3.
Our study assessed the correlation between discrepancies in clinical and pathological T stages and overall survival (OS) in patients with upper urinary tract urothelial carcinoma (UTUC), including renal pelvis (UCP) and ureter (UCU) carcinoma, treated with radical surgery.
We utilized data from the Japanese Hospital-Based Cancer Registry (HBCR) to identify UTUC cases (n = 2376), consisting of UCP cases (n = 1196) and UCU cases (n = 1180), diagnosed with cTa-3N0M0 between 2012 and 2013. All cases were histologically confirmed and treated solely with radical surgery, excluding any chemotherapy or radiotherapy. We investigated the correlation between stage classification discrepancies and OS.
Among UCP and UCU patients, cT2N0M0 had the highest discrepancy rates between clinical and pathological stages (68% and 51%), while cT3N0M0 had the lowest (21% and 20%). Among UCP and UCU patients with cTa/is/1N0M0, those with up-staging showed significantly worse OS compared to same-staging (HR 1.7 and 2.5, p = 0.001 and <0.001, respectively). In UCU patients with cT2N0M0, the 5-year OS rates were 41.9% for up-staging, 63.7% for same-staging, and 76.4% for down-staging, with significantly worse survival in the up-staged group. Among UCP and UCU patients with cT3N0M0, the 5-year OS rates were 29.3% and 7.7% for those with up-staging, 53.7% and 30.6% for those with same staging, and 79.6% and 65.4% for those with down-staging.
Using a large real-world cohort, we found stage discrepancies to be a significant independent prognostic factor in non-metastatic UTUC patients. Treatment should be carefully selected, considering T-staging discrepancies and prognosis.
我们的研究评估了接受根治性手术治疗的上尿路尿路上皮癌（UTUC）患者，包括肾盂癌（UCP）和输尿管癌（UCU），其临床和病理T分期差异与总生存期（OS）之间的相关性。
我们利用日本医院癌症登记处（HBCR）的数据，确定2012年至2013年间诊断为cTa-3N0M0的UTUC病例（n = 2376），其中包括UCP病例（n = 1196）和UCU病例（n = 1180）。所有病例均经组织学确诊，仅接受根治性手术治疗，排除任何化疗或放疗。我们研究了分期分类差异与OS之间的相关性。
在UCP和UCU患者中，cT2N0M0的临床和病理分期差异率最高（分别为68%和51%），而cT3N0M0的差异率最低（分别为21%和20%）。在cTa/is/1N0M0的UCP和UCU患者中，分期上调的患者与分期相同的患者相比，OS明显更差（HR分别为1.7和2.5，p分别为0.001和<0.001）。在cT2N0M0的UCU患者中，分期上调组的5年OS率为41.9%，分期相同组为63.7%，分期下调组为76.4%，分期上调组的生存率明显更差。在cT3N0M0的UCP和UCU患者中，分期上调患者的5年OS率分别为29.3%和7.7%，分期相同患者分别为53.7%和30.6%，分期下调患者分别为79.6%和65.4%。
通过一个大型的真实世界队列，我们发现分期差异是无转移UTUC患者的一个重要独立预后因素。应考虑T分期差异和预后，谨慎选择治疗方案。
