根治性肾输尿管切除术治疗上尿路尿路上皮癌早期复发预测模型的开发与验证
Development and validation of a prediction model for early recurrence in upper tract urothelial carcinoma treated with radical nephroureterectomy.
作者信息
Chou Yi-Ju, Luo Hao-Lun, Wang Hung-Jen, Huang Steven K, Hsieh Yu-Che, Wu Wen-Jeng, Li Ching-Chia, Weng Han-Yu, Tai Ta-Yao, Chang Chao-Hsiang, Wu Hsi-Chin, Lin Po-Hung, Pang Jacob See-Tong, Chen Chung-Hsin, Hong Jian-Hua, Tseng Jen-Shu, Chen Marcelo, Chen I-Hsuan Alan, Yu Chia-Cheng, Chen Pi-Che, Cheong Ian-Seng, Tsai Chung-You, Cheng Pai-Yu, Jiang Yuan-Hong, Lee Yu-Khun, Wang Shian-Shiang, Chen Chuan-Shu, Hsueh Thomas Y, Chen Wei-Chieh, Wu Chia-Chang, Chen Yung-Tai, Lin Wei-Yu, Wu Richard Chen-Yu, Lo Chi-Wen, Moschini Marco, Soria Francesco, Laukhtina Ekaterina, Fazekas Tamás, Chlosta Marcin, Teoh Jeremy Yuen-Chun, Shariat Shahrokh F, Tsai Yao-Chou
机构信息
Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei, 23142, Taiwan.
School of Medicine, Buddhist Tzu Chi University, Hualien, 97004, Taiwan.
出版信息
BMC Cancer. 2025 Apr 30;25(1):808. doi: 10.1186/s12885-025-14180-2.
BACKGROUND
Most cases of upper tract urothelial carcinoma (UTUC) exhibit recurrence within the first year following surgery. The time from surgery to recurrence significantly impacts cancer-specific survival. In this study, we analyzed patients with localized UTUC (pTis-3N0/xcM0) who experienced postoperative recurrence to identify an appropriate early recurrence time point and the associated risk factors.
METHODS
From July 1988 to October 2022, we retrospectively analyzed 3435 localized UTUC patients after undergoing radical nephroureterectomy using Taiwan's UTUC Collaboration Group Database. Early recurrence time point was defined according to oncologic outcome. Variables including clinical and pathological characteristics were assessed in relation to early recurrence. A prediction model was constructed by factors associated with early recurrence and externally validated.
RESULTS
Early recurrence time point in localized UTUC was determined at 9 months post-surgery, with patients experiencing early recurrence exhibiting worse overall and cancer specific survival. Diabetes mellitus, multifocality, lympho-vascular invasion, tumor necrosis and pathologic T stage were independent factors associated with early recurrence. The predictive model for early recurrence achieved an area under the curve (AUC) of 0.84 (95%CI: 0.82-0.86). External validation demonstrated that the model exhibited good discrimination (AUC: 0.76, 95%CI: 0.73-0.79), calibration (Brier score: 0.08) and clinical utility in a distinct cohort.
CONCLUSIONS
This study identified the optimal time point for early recurrence and its associated risk factors. A prediction model for early recurrence was developed based on these factors and validated externally, demonstrating good generalizability. This clinical tool can facilitate early identification of high-risk patients, enabling targeted surveillance and timely intervention. Future studies should explore effective treatment strategies for preventing early recurrence.
背景
大多数上尿路尿路上皮癌（UTUC）病例在手术后第一年内出现复发。从手术到复发的时间对癌症特异性生存有显著影响。在本研究中，我们分析了局部UTUC（pTis - 3N0/xcM0）术后复发的患者，以确定合适的早期复发时间点及相关危险因素。
方法
1988年7月至2022年10月，我们使用台湾UTUC协作组数据库对3435例接受根治性肾输尿管切除术后的局部UTUC患者进行了回顾性分析。根据肿瘤学结果定义早期复发时间点。评估包括临床和病理特征在内的变量与早期复发的关系。通过与早期复发相关的因素构建预测模型并进行外部验证。
结果
局部UTUC的早期复发时间点确定为术后9个月，早期复发的患者总体生存和癌症特异性生存较差。糖尿病、多灶性、淋巴管侵犯、肿瘤坏死和病理T分期是与早期复发相关的独立因素。早期复发的预测模型曲线下面积（AUC）为0.84（95%CI：0.82 - 0.86）。外部验证表明，该模型在不同队列中表现出良好的区分度（AUC：0.76，95%CI：0.73 - 0.79）、校准度（Brier评分：0.08）和临床实用性。
结论
本研究确定了早期复发的最佳时间点及其相关危险因素。基于这些因素开发了早期复发预测模型并进行了外部验证，显示出良好的通用性。这种临床工具可有助于早期识别高危患者，实现有针对性的监测和及时干预。未来研究应探索预防早期复发的有效治疗策略。
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