Sou Sung Jun, Ku Ja Yoon, Kim Kyung Hwan, Seo Won Ik, Ha Hong Koo, Gu Hui Mo, Hwang Eu Chang, Park Young Joo, Lee Chan Ho
Department of Urology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Department of Urology, Dongnam Institute of Radiological & Medical Sciences Cancer Center, Busan, Korea.
Investig Clin Urol. 2025 Mar;66(2):114-123. doi: 10.4111/icu.20240323.
Adjuvant chemotherapy (AC) is recommended for muscle-invasive or lymph node-positive upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). However, disease recurrences are frequently observed in pT1 disease, and AC may increase the risk of overtreatment in pT2 UTUC patients. This study aimed to validate a risk-adapted scoring model for selecting UTUC patients with ≤pT2 disease who would benefit from AC.
We retrospectively analyzed 443 ≤pT2 UTUC patients who underwent RNU. A risk-adapted scoring model was applied, categorizing patients into low- or high-risk groups. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were analyzed according to risk group.
Overall, 355 patients (80.1%) and 88 patients (19.9%) were categorized into the low- and high-risk groups, respectively, with the latter having higher pathological stages, concurrent carcinoma , and synchronous bladder tumors. Disease recurrence occurred in 45 patients (10.2%), among whom 19 (5.4%) and 26 (29.5%) belonged to the low- and high-risk groups, respectively (p<0.001). High-risk patients had significantly shorter RFS (64.3% vs. 93.6% at 60 months; hazard ratio [HR] 13.66; p<0.001) and worse CSS (80.7% vs. 91.5% at 60 months; HR 4.25; p=0.002). Multivariate analysis confirmed that pT2 stage and the high-risk group were independent predictors of recurrence and cancer-specific death (p<0.001). Decision curve analysis for RFS showed larger net benefits with our model than with the T stage model.
The risk-adapted scoring model effectively predicts recurrence and identifies optimal candidates for AC post RNU in non-metastatic UTUC.
对于根治性肾输尿管切除术（RNU）后肌肉浸润性或淋巴结阳性的上尿路尿路上皮癌（UTUC），推荐进行辅助化疗（AC）。然而，pT1期疾病中经常观察到疾病复发，并且AC可能会增加pT2期UTUC患者过度治疗的风险。本研究旨在验证一种风险适应性评分模型，以选择≤pT2期且能从AC中获益的UTUC患者。
我们回顾性分析了443例接受RNU的≤pT2期UTUC患者。应用风险适应性评分模型，将患者分为低风险或高风险组。根据风险组分析无复发生存期（RFS）和癌症特异性生存期（CSS）。
总体而言，分别有355例患者（80.1%）和88例患者（19.9%）被归类为低风险组和高风险组，后者具有更高的病理分期、并发癌和同步膀胱肿瘤。45例患者（10.2%）出现疾病复发，其中19例（5.4%）和26例（29.5%）分别属于低风险组和高风险组（p<0.001）。高风险患者的RFS明显更短（60个月时为64.3%对93.6%；风险比[HR]13.66；p<0.001），CSS更差（60个月时为80.7%对91.5%；HR 4.25；p=0.002）。多变量分析证实，pT2期和高风险组是复发和癌症特异性死亡的独立预测因素（p<0.001）。RFS的决策曲线分析显示，我们的模型比T分期模型具有更大的净效益。
风险适应性评分模型可有效预测复发，并确定非转移性UTUC患者RNU后AC的最佳候选者。
